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Fredrick JW, Jacobson LA, Peterson RK, Becker SP. Cognitive disengagement syndrome (sluggish cognitive tempo) and medical conditions: a systematic review and call for future research. Child Neuropsychol 2024; 30:783-817. [PMID: 37712631 PMCID: PMC10940202 DOI: 10.1080/09297049.2023.2256052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Cognitive disengagement syndrome (CDS, previously referred to as sluggish cognitive tempo) is a unique set of symptoms distinct from ADHD inattentive symptoms that appear to be independently associated with neuropsychological and psychosocial outcomes in community and ADHD-specific samples of youth. However, our understanding of CDS in individuals with chronic or complex medical conditions is limited. The current systematic review is the first to summarize the literature on CDS prevalence rates and associations with neurocognitive and functional outcomes in youth with medical conditions, and to discuss areas of future research to guide clinical intervention. We conducted literature searches across four major databases and included studies assessing prevalence estimates, associations with neuropsychological and/or psychosocial functioning, or predictors of CDS in individuals with chronic or complex medical conditions. Twenty-five studies were identified and retained. Fifteen of sixteen studies reported elevations in CDS symptoms, though findings were mixed in studies comparing mean differences to typically developing youth. Seven studies provided inconsistent evidence for CDS being associated with neuropsychological or academic functioning, with six studies demonstrating consistent effects on psychosocial functioning. Finally, nine studies identified biological and sociodemographic factors associated with CDS, though almost all await replication. CDS symptoms are significantly elevated in youth with medical conditions and appear to be particularly linked with psychosocial functioning. Future research is needed to identify prevalence of CDS across a range of medical conditions, examine associations with neuropsychological and psychosocial functioning, and examine whether CDS impacts self-management.
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Affiliation(s)
- Joseph W. Fredrick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Lisa A. Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute; Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore MD, USA
| | - Rachel K. Peterson
- Department of Neuropsychology, Kennedy Krieger Institute; Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore MD, USA
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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2
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Gionet S, Lord M, Plourde V. The diagnosis of ADHD in children and adolescents with epilepsy: a scoping review. Child Neuropsychol 2024:1-33. [PMID: 38588042 DOI: 10.1080/09297049.2024.2337954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/27/2024] [Indexed: 04/10/2024]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is often diagnosed in children and adolescents with epilepsy, but clear clinical guidelines on how to make this diagnosis are still lacking. Without these guidelines, there is no consensus between specialists on how to proceed when assessing children with epilepsy for ADHD, which can negatively impact the quality of care being offered to this population. As a first step toward gaining more specific clinical guidelines, this scoping review was aimed at documenting the tools and procedures used to diagnose ADHD in children and adolescents with epilepsy over time and at determining whether the diagnoses were made in accordance with clinical guidelines and recommendations. The literature search was conducted using PsycINFO, PubMed, and CINAHL. Studies were included if conducted with children and adolescents aged between 4 and 18 years with epilepsy being evaluated for ADHD. Studies were clustered according to their publication date and the reported diagnostic procedures were identified. Forty-nine out of 3854 records were included. Results highlight discrepancies between how ADHD was diagnosed in reviewed studies and clinical guidelines or recommendations. Indeed, most studies did not use a multi-method and multi-informant approach when diagnosing ADHD in children with epilepsy, with no improvement over time. Future studies aimed at diagnosing ADHD in children and adolescents should ensure that they are following clinical guidelines and recommendations, in addition to adapting their diagnostic procedures to the presence of any neurological comorbidities, such as epilepsy.
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Affiliation(s)
| | - Maryse Lord
- École de Psychologie, Université de Moncton, Moncton, Canada
| | - Vickie Plourde
- École de Psychologie, Université de Moncton, Moncton, Canada
- Centre de formation médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, Canada
- Faculté Saint-Jean, University of Alberta, Edmonton, Canada
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3
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Nimgampalle M, Chakravarthy H, Sharma S, Shree S, Bhat AR, Pradeepkiran JA, Devanathan V. Neurotransmitter systems in the etiology of major neurological disorders: Emerging insights and therapeutic implications. Ageing Res Rev 2023; 89:101994. [PMID: 37385351 DOI: 10.1016/j.arr.2023.101994] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/01/2023]
Abstract
Neurotransmitters serve as chemical messengers playing a crucial role in information processing throughout the nervous system, and are essential for healthy physiological and behavioural functions in the body. Neurotransmitter systems are classified as cholinergic, glutamatergic, GABAergic, dopaminergic, serotonergic, histaminergic, or aminergic systems, depending on the type of neurotransmitter secreted by the neuron, allowing effector organs to carry out specific functions by sending nerve impulses. Dysregulation of a neurotransmitter system is typically linked to a specific neurological disorder. However, more recent research points to a distinct pathogenic role for each neurotransmitter system in more than one neurological disorder of the central nervous system. In this context, the review provides recently updated information on each neurotransmitter system, including the pathways involved in their biochemical synthesis and regulation, their physiological functions, pathogenic roles in diseases, current diagnostics, new therapeutic targets, and the currently used drugs for associated neurological disorders. Finally, a brief overview of the recent developments in neurotransmitter-based therapeutics for selected neurological disorders is offered, followed by future perspectives in that area of research.
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Affiliation(s)
- Mallikarjuna Nimgampalle
- Department of Biology, Indian Institute of Science Education and Research Tirupati (IISER T), Transit campus, Karakambadi Road, Mangalam, Tirupati 517507, Andhra Pradesh, India
| | - Harshini Chakravarthy
- Department of Biology, Indian Institute of Science Education and Research Tirupati (IISER T), Transit campus, Karakambadi Road, Mangalam, Tirupati 517507, Andhra Pradesh, India.
| | - Sapana Sharma
- Department of Biology, Indian Institute of Science Education and Research Tirupati (IISER T), Transit campus, Karakambadi Road, Mangalam, Tirupati 517507, Andhra Pradesh, India
| | - Shruti Shree
- Department of Biology, Indian Institute of Science Education and Research Tirupati (IISER T), Transit campus, Karakambadi Road, Mangalam, Tirupati 517507, Andhra Pradesh, India
| | - Anoop Ramachandra Bhat
- Department of Biology, Indian Institute of Science Education and Research Tirupati (IISER T), Transit campus, Karakambadi Road, Mangalam, Tirupati 517507, Andhra Pradesh, India
| | | | - Vasudharani Devanathan
- Department of Biology, Indian Institute of Science Education and Research Tirupati (IISER T), Transit campus, Karakambadi Road, Mangalam, Tirupati 517507, Andhra Pradesh, India.
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Fan HC, Chiang KL, Chang KH, Chen CM, Tsai JD. Epilepsy and Attention Deficit Hyperactivity Disorder: Connection, Chance, and Challenges. Int J Mol Sci 2023; 24:ijms24065270. [PMID: 36982345 PMCID: PMC10049646 DOI: 10.3390/ijms24065270] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
Comorbidities are common in children with epilepsy, with nearly half of the patients having at least one comorbidity. Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder characterized by hyperactivity and inattentiveness level disproportional to the child’s developmental stage. The burden of ADHD in children with epilepsy is high and can adversely affect the patients’ clinical outcomes, psychosocial aspects, and quality of life. Several hypotheses were proposed to explain the high burden of ADHD in childhood epilepsy; the well-established bidirectional connection and shared genetic/non-genetic factors between epilepsy and comorbid ADHD largely rule out the possibility of a chance in this association. Stimulants are effective in children with comorbid ADHD, and the current body of evidence supports their safety within the approved dose. Nonetheless, safety data should be further studied in randomized, double-blinded, placebo-controlled trials. Comorbid ADHD is still under-recognized in clinical practice. Early identification and management of comorbid ADHD are crucial to optimize the prognosis and reduce the risk of adverse long-term neurodevelopmental outcomes. The identification of the shared genetic background of epilepsy and ADHD can open the gate for tailoring treatment options for these patients through precision medicine.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
| | - Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, Taichung 433, Taiwan
- Department of Nutrition, Hungkuang University, Taichung 433, Taiwan
| | - Kuang-Hsi Chang
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
| | - Chuan-Mu Chen
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
- The iEGG and Animal Biotechnology Center, and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
| | - Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
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Salpekar JA. Ripples of Hyperexcitability in Epilepsy, Autism, and Inattention. Epilepsy Curr 2023; 23:97-98. [PMID: 37122401 PMCID: PMC10131567 DOI: 10.1177/15357597221147351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The Association Between Early Childhood Onset Epilepsy and Attention-Deficit Hyperactivity Disorder (ADHD) in 3237 Children and Adolescents With Autism Spectrum Disorder (ASD): A Historical Longitudinal Cohort Data Linkage Study Carson L, Parlatini V, Safa T, Baig B, Shetty H, Phillips-Owen J, Prasad V, Downs J. Eur Child Adolesc Psychiatry. 2022. doi:10.1007/s00787-022-02041-3 Children and young people with Autism Spectrum Disorder (ASD) have an increased risk of comorbidities, such as epilepsy and Attention-Deficit/Hyperactivity Disorder (ADHD). However, little is known about the relationship between early childhood epilepsy (below age 7) and later ADHD diagnosis (at age 7 or above) in ASD. In this historical cohort study, we examined this relationship using an innovative data source, which included linked data from routinely collected acute hospital paediatric records and childhood community and inpatient psychiatric records. In a large sample of children and young people with ASD (N = 3237), we conducted a longitudinal analysis to examine early childhood epilepsy as a risk factor for ADHD diagnosis while adjusting for potential confounders, including socio-demographic characteristics, intellectual disability, family history of epilepsy and associated physical conditions. We found that ASD children and young people diagnosed with early childhood epilepsy had nearly a twofold increase in risk of developing ADHD later in life, an association which persisted after adjusting for potential confounders (adjusted OR = 1.72, CI95% = 1.13-2.62). This study suggests that sensitive monitoring of ADHD symptoms in children with ASD who have a history of childhood epilepsy may be important to promote early detection and treatment. It also highlights how linked electronic health records can be used to examine potential risk factors over time for multimorbidity in neurodevelopmental conditions.
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Maximizing Quality of Life in Children with Epilepsy. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010065. [PMID: 36670616 PMCID: PMC9863253 DOI: 10.3390/children10010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/16/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022]
Abstract
Arguably significant progress and improvement in the medical and surgical treatments of seizures and epilepsy in children have occurred; however, there have been relatively fewer efforts in optimizing the care of lifestyle complications related to the disease state. Many patients have significant behavioral and mental health comorbidities, including ADHD (attention deficit hyperactivity disorder), which should be treated. After epilepsy surgery, only seizure freedom results in improved quality of life (QOL). Improved compliance leads to better seizure control and ensuring that caregivers have a rescue treatment helps empower patients. Education and improving seizure illness perception is beneficial. Cannabidiol may have benefits other than seizure control. The majority of children are mainly concerned about the stigma attached to having epilepsy. Driving affecting older children is discussed. Restrictions on these children should be minimized and enabling regular activities maximized.
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Pham C, Roy C, Tang C, Maheshwari A. Low recognition of attention deficit hyperactivity disorder in adult patients admitted to the Epilepsy Monitoring Unit. Brain Behav 2022; 12:e32731. [PMID: 35899366 PMCID: PMC9392548 DOI: 10.1002/brb3.2731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/08/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Adult patients with epilepsy (PWE) have an 18% prevalence of comorbid attention deficit hyperactivity disorder (ADHD) compared to a prevalence of 2%-5% in the general population. Recognition of this dual diagnosis is important since stimulant therapy is both safe and effective in this population. METHODS Here, we aim to determine if PWE have adequate documentation for comorbid ADHD when being admitted to the Epilepsy Monitoring Unit (EMU). A retrospective review was conducted at the Baylor St. Luke's Medical Center EMU for patients presenting between July 2017 and November 2020. Patients were divided into two groups: Group I-patients without a documented ADHD diagnosis or ADHD medications and Group II-patients with a documented ADHD diagnosis and/or taking medications indicated specifically for ADHD. RESULTS Of 524 individual patients who presented to the EMU, only 25 patients (4.8%) had documentation of a diagnosis of ADHD and/or ADHD medications (Group II). The proportion of patients in Group II did not significantly differ based on the EMU diagnosis. However, there was a significantly greater number of other psychiatric diagnoses (p = .005) and a greater number of psychiatric medications prescribed (p < .001) in patients in Group II. CONCLUSION Our study suggests that ADHD is underrecognized and underdiagnosed in patients presenting to the EMU, and screening tools may be useful to help clinicians address seizure comorbidities such as ADHD.
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Affiliation(s)
- Caitlynn Pham
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Cayla Roy
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Christine Tang
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Atul Maheshwari
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
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Ahmed GK, Darwish AM, Khalifa H, Haridy NA. Relationship between Attention Deficit Hyperactivity Disorder and epilepsy: a literature review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00482-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurological disorder. ADHD has been linked to epilepsy.
Main body
ADHD was found to be present in 30–40% of epileptic children. Researchers have developed numerous theories to explain how and why ADHD and epilepsy coexist. Whether ADHD and epilepsy symptoms are caused by co-occurring psychiatric disorders or by the temporary effects of epileptic discharges or by antiepileptic medicines is critical to consider. Diagnosis and treatment of individuals with ADHD and epilepsy are complicated and challenging from the clinical base.
Conclusions
Comorbidity between ADHD and epilepsy is still challenging to understand. The two diseases have a bidirectional link, so the association may not be coincidental. A disputable point is whether co-occurring ADHD and epilepsy symptoms represent a comorbid psychiatric disorder or are the epileptic discharges’ temporary effects, and are they related to antiepileptic drugs (AEDs). It is recommended to follow up with children with epilepsy or ADHD as they may develop comorbidity after a while.
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Sleep disorders and ADHD symptoms in children and adolescents with typical absence seizures: An observational study. Epilepsy Behav 2022; 128:108513. [PMID: 35085916 DOI: 10.1016/j.yebeh.2021.108513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the occurrence of sleep disorders (SD) and attention deficit hyperactivity disorder (ADHD) symptoms in children with typical absence seizures (TAS) compared to control children and to evaluate the impact of epilepsy-related factors on sleep and attention in children with TAS. METHODS The Sleep Disturbance Scale for Children (SDSC) and the ADHD rating scale were filled in by parents of a cohort composed by 82 children aged from 5 to 15.6 years, 49% of boys (41 with TAS with a syndromic diagnosis of childhood absence epilepsy and 41 controls). For children with TAS, the Pediatric Epilepsy Side Effects Questionnaire was completed. Statistical analyses were conducted in order to compare sleep and attention scores between groups. In children with TAS, a correlation was computed between these scores. Logistics regression models were conducted to identify predictors of excessive diurnal sleepiness and inattention in children with TAS. RESULTS Compared to controls, children with TAS had higher total scores for subjective sleep (mean 42.9 vs 38.3, p = 0.05) and attention disorders (mean 16.8 vs 11.6, p = 0.01), especially for excessive diurnal sleepiness (mean 3.9 vs 3.2, p = 0.02) and inattention (mean 9.3 vs 5.6, p = 0.003) components. In children with TAS, sleep problems were significantly under-reported by parents. Sleep disorders symptoms as breathing-related sleep disturbance, excessive diurnal sleepiness or naps at or after 7 years of age were reported. Subjective sleep and attention disorders were significantly correlated (r = 0.43, p = 0.01). Subjective excessive diurnal sleepiness may be the result of a polytherapy (p = 0.05) or a side effect of anti-seizure medication (ASM) (p = 0.03) but children without medication side effects also reported subjective SD. In children with TAS, the risk of inattention symptoms was increased in boys (p = 0.02), with a high BMI (p = 0.05), or with ASM side effects (p = 0.03). CONCLUSIONS This study demonstrates that children with TAS are at risk of sleep and attention disorder symptoms. If attention disorders in a context of epilepsy are now widely assessed and identified, sleep disorders are still under-estimated. An accurate identification and management of sleep disorders could improve academic performances, quality of life, and seizure management in children with TAS.
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Wagner JL, Mueller M, Hellier TS, Smith G, Modi A. ADHD and epilepsy-related QoL in youth with epilepsy. Epilepsy Behav 2021; 123:108250. [PMID: 34399393 DOI: 10.1016/j.yebeh.2021.108250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pediatric epilepsy and attention-deficit/hyperactivity disorder (ADHD) present a cumulative vulnerability to youth, particularly in the domains of executive function (EF) and quality of life (QoL). The aim of this study was to explore the relationships between EF and epilepsy-specific QoL in youth with epilepsy (YWE) who also have ADHD. METHODS Youth with epilepsy aged 5-18 years and caregivers participated in a large multi-site national validation of the PedsQL™ Epilepsy Modules. YWE and their caregivers were asked to complete measures of epilepsy-specific QoL, ADHD symptoms, and EF. Previous ADHD diagnosis was reported by caregivers as well as abstracted from the medical record. RESULTS Caregiver and YWE reports of current ADHD symptoms significantly predicted all epilepsy-specific QoL domains. Suboptimal QoL was reported for those YWE whose ADHD symptoms were above the clinical threshold compared to YWE whose ADHD symptoms were within the average range. Results were similar for YWE with a documented ADHD vs no ADHD diagnosis. In addition, poorer metacognition and behavioral regulation EF was associated with lower epilepsy-specific QoL for both YWE with ADHD and without ADHD diagnosis. However, in YWE with ADHD, effect sizes were consistently larger for behavioral regulation compared to metacognition across epilepsy-specific QoL domains, with behavioral regulation accounting for 50% of the variance in each of the EF and mood QoL domains. SIGNIFICANCE Addressing ADHD symptoms, epilepsy-specific, QoL, and EF as part of routine epilepsy care may promote optimal outcomes for YWE with ADHD as well as relieve burden on the healthcare system.
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Affiliation(s)
- Janelle L Wagner
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Tanja S Hellier
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Gigi Smith
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Avani Modi
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Bearden DJ, Shakil S, O'Banion D, Ono KE, Drane DL, Loring DW, Tarquinio DC. Methylphenidate treatment for cognitive symptoms associated with ADHD in a pediatric epilepsy patient following resection of a left frontal cortical dysplasia. Epilepsy Behav Rep 2021; 16:100435. [PMID: 33981985 PMCID: PMC8085698 DOI: 10.1016/j.ebr.2021.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/02/2021] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
ADHD symptoms can emerge or worsen after epilepsy surgery. Methylphenidate use improved cognitive symptoms of ADHD in our patient. Seizure aggravation did not occur following use of a neurostimulant in our patient. Our patient benefitted from a multidisciplinary intervention approach.
We present data on a 10-year-old patient with drug-resistant epilepsy who was treated with methylphenidate for symptoms of attention deficit hyperactivity disorder (ADHD) that developed after she underwent surgical resection of a left frontal cortical dysplasia. . The patient’s parents reported methylphenidate was helpful in improving their child’s reading performance. Based on parents’ report, we examined benefits of methylphenidate on our patient’s cognitive problems in a controlled setting. The patient underwent a neuropsychological evaluation completed in three sessions over a five-day period. Methylphenidate was administered prior to the second testing session only and was associated with improvements in the patient’s attention, executive function, processing speed, and short-term memory performances. In comparison, word-reading performance, a task less susceptible to neurological impairment, was stable over the three sessions. The patient remained seizure-free after surgery and use of methylphenidate did not reduce seizure threshold. These findings support the use of methylphenidate in treating targeted cognitive problems associated with ADHD emerging after epilepsy surgery in children.
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Affiliation(s)
- Donald J. Bearden
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Corresponding author at: Center for Advanced Pediatrics, Children’s Healthcare of Atlanta, 1400 Tullie Rd. NE, Ste. 430, Atlanta, GA 30329, USA.
| | - Sidra Shakil
- Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - David O'Banion
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Developmental Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Kim E. Ono
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L. Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology University of Washington School of Medicine, Seattle, WA, USA
| | - David W. Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Zhang Y, Wang R, Liu Z, Jiang S, Du L, Qiu K, Li F, Wang Q, Jin J, Chen X, Li Z, Wu J, Zhang N. Distinct genetic patterns of shared and unique genes across four neurodevelopmental disorders. Am J Med Genet B Neuropsychiatr Genet 2021; 186:3-15. [PMID: 32929885 DOI: 10.1002/ajmg.b.32821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 06/04/2020] [Accepted: 08/15/2020] [Indexed: 01/09/2023]
Abstract
Neurodevelopmental disorders, including autism spectrum disorder (ASD), intellectual disability (ID), developmental disorders (DD) and epileptic encephalopathy (EE), have a strong clinical comorbidity, which indicates a common genetic etiology across various disorders. However, the underlying genetic mechanisms of comorbidity and specificity remain unknown across neurodevelopmental disorders. Based on de novo mutations, we compared systematically the functional characteristics between shared and unique genes under these disorders, as well as the spatiotemporal trajectory of development in brain and common molecular pathways of all shared genes. We observed that shared genes present more constrained against functional rare genetic variation, and harbor more pathogenic rare variants than do unique genes in each disorder. Furthermore, 71 shared genes formed two clusters related to synaptic transmission, transcription regulation and chromatin regulator. Particularly, we also found that two core genes STXBP1 and SCN2A, that were shared by the four neurodevelopmental disorders showed prominent pleiotropy. Our findings shed light on the shared and specific patterns across neurodevelopmental disorders and will enable us to further comprehend the etiology and provide valuable information for the diagnosis of neurodevelopmental disorders.
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Affiliation(s)
- Yijia Zhang
- Reproductive Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ruochen Wang
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Zhenwei Liu
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Shan Jiang
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Lifeng Du
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Kairui Qiu
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Fengxia Li
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Qiongdan Wang
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Jing Jin
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xiaomin Chen
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Zhongshan Li
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Jinyu Wu
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Na Zhang
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China.,Medicine & Technology School of Zunyi Medical University, Zunyi, China
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13
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Horvath AA, Csernus EA, Lality S, Kaminski RM, Kamondi A. Inhibiting Epileptiform Activity in Cognitive Disorders: Possibilities for a Novel Therapeutic Approach. Front Neurosci 2020; 14:557416. [PMID: 33177974 PMCID: PMC7593384 DOI: 10.3389/fnins.2020.557416] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
Abstract
Cognitive impairment is a common and seriously debilitating symptom of various mental and neurological disorders including autism, attention deficit hyperactivity disorder, multiple sclerosis, epilepsy, and neurodegenerative diseases, like Alzheimer's disease. In these conditions, high prevalence of epileptiform activity emerges as a common pathophysiological hallmark. Growing body of evidence suggests that this discrete but abnormal activity might have a long-term negative impact on cognitive performance due to neuronal circuitries' remodeling, altered sleep structure, pathological hippocampo-cortical coupling, and even progressive neuronal loss. In animal models, epileptiform activity was shown to enhance the formation of pathological amyloid and tau proteins that in turn trigger network hyperexcitability. Abolishing epileptiform discharges might slow down the cognitive deterioration. These findings might provide basis for therapeutic use of antiepileptic drugs in neurodegenerative cognitive disorders. The aim of our review is to describe the data on the prevalence of epileptiform activity in various cognitive disorders, to summarize the current knowledge of the mechanisms of epileptic activity in relation to cognitive impairment, and to explore the utility of antiepileptic drugs in the therapy of cognitive disorders. We also propose future directions for drug development and novel therapeutic interventions targeting epileptiform discharges in these disorders.
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Affiliation(s)
- Andras Attila Horvath
- Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
- Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Sara Lality
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Rafal M. Kaminski
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Anita Kamondi
- Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
- Department of Neurology, Semmelweis University, Budapest, Hungary
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Park KJ, Ahn H, Yum MS, Ko TS, Kim HW. Treatment of Children and Adolescents with Epilepsy with Atomoxetine. Psychiatry Investig 2020; 17:412-416. [PMID: 32295327 PMCID: PMC7265023 DOI: 10.30773/pi.2019.0287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/11/2020] [Accepted: 02/22/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the effectiveness and safety of atomoxetine in Korean children and adolescents with epilepsy. METHODS We retrospectively reviewed the electronic medical records of 105 children and adolescents with epilepsy treated with atomoxetine. Effectiveness was measured with the Clinical Global Impressions-Severity (CGI-S) and/or Clinical Global Impressions-Improvement (CGI-I) scales at baseline, and after 4 and 12 weeks. We defined response to atomoxetine as a CGI-I score less than three at week 12. Safety was evaluated at each visit, based on clinical assessment by a child and adolescent psychiatrist and reports from participants or their caregivers. RESULTS In total participants (n=105), 33 (31.4%) showed a response to treatment: a significant decrease in CGI-S scale score was observed over 12 weeks of atomoxetine treatment. The most common adverse event (AE) was decreased appetite (n=16, 15.2%), and life-threatening AEs were not observed. Seizure aggravation due to atomoxetine was observed in 7.6% (n=8) of total participants, and one of them discontinued atomoxetine. CONCLUSION Our results provide preliminary evidence of the effectiveness and safety of atomoxetine in children and adolescents with epilepsy.
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Affiliation(s)
- Kee Jeong Park
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyunji Ahn
- Department of Pediatric Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Sun Yum
- Department of Pediatric Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae-Sung Ko
- Department of Pediatric Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyo-Won Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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15
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BLAST paradigm: A new test to assess brief attentional fluctuations in children with epilepsy, ADHD, and normally developing children. Epilepsy Behav 2019; 99:106470. [PMID: 31430660 DOI: 10.1016/j.yebeh.2019.106470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pure attentional deficits are still underdiagnosed in children with epilepsy. While attention-deficit hyperactivity disorder (ADHD) is historically the most studied cause of attentional disorders, an important number of children with epilepsy and attentional complaints do not fully meet the DSM-V (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) criteria for ADHD and may be excluded from specific care. Clinical tools currently available are insufficient to detect more subtle but clinically relevant attentional fluctuations. OBJECTIVE/METHODS The recently developed Bron-Lyon Attention Stability Test (BLAST) was used to evaluate brief attentional fluctuations with a high temporal precision. Drawing on two new attentional indices, we evaluated spontaneous fluctuations of response accuracy and timing, underlying attentional stability. The main objective was to assess attentional stability in children with i) epilepsy with comorbid ADHD, ii) epilepsy without comorbid ADHD, iii) ADHD not medicated and without epilepsy, and iv) normal development. Further objectives were to assess the main determinants of attentional stability in those groups, including the effect of factors related to the epileptic condition. RESULTS In 122 children with epilepsy (67 with comorbid ADHD), 52 children with ADHD, and 53 healthy controls, we demonstrated lower attentional stability in both the groups with epilepsy and ADHD compared with healthy children. In children with epilepsy, BLAST scores were negatively associated with earlier seizure onset and AED (antiepileptic drug) polytherapy, while the seizure frequency, epilepsy duration, or type did not influence BLAST scores. CONCLUSIONS This study demonstrates that attentional stability is impaired in children with epilepsy and/or ADHD. Bron-Lyon Attention Stability Test seems to be a sensitive test to detect attentional stability deficit in children with epilepsy and with attentional complaints who did not meet all criteria of ADHD. We propose that BLAST could be a useful clinical neuropsychological tool to assess attentional disorders in children.
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16
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Krinzinger H, Hall CL, Groom MJ, Ansari MT, Banaschewski T, Buitelaar JK, Carucci S, Coghill D, Danckaerts M, Dittmann RW, Falissard B, Garas P, Inglis SK, Kovshoff H, Kochhar P, McCarthy S, Nagy P, Neubert A, Roberts S, Sayal K, Sonuga-Barke E, Wong ICK, Xia J, Zuddas A, Hollis C, Konrad K, Liddle EB. Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence. Neurosci Biobehav Rev 2019; 107:945-968. [PMID: 31545988 DOI: 10.1016/j.neubiorev.2019.09.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 10/26/2022]
Abstract
Methylphenidate (MPH), the most common medication for children with Attention Deficit/Hyperactivity Disorder (ADHD) in many countries, is often prescribed for long periods of time. Any long-term psychotropic treatment in childhood raises concerns about possible adverse neurological and psychiatric outcomes. We aimed to map current evidence regarding neurological and psychiatric outcomes, adverse or beneficial, of long-term MPH (> 1 year) treatment in ADHD. We coded studies using a "traffic light" system: Green: safe/favours MPH; Amber: warrants caution; Red: not safe/not well-tolerated. Un-categorisable study findings were coded as "Unclear". Although some evidence suggests an elevated risk of psychosis and tics, case reports describe remission on discontinuation. Several studies suggest that long-term MPH may reduce depression and suicide in ADHD. Evidence suggests caution in specific groups including pre-school children, those with tics, and adolescents at risk for substance misuse. We identified a need for more studies that make use of large longitudinal databases, focus on specific neuropsychiatric outcomes, and compare outcomes from long-term MPH treatment with outcomes following shorter or no pharmacological intervention.
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Affiliation(s)
- Helga Krinzinger
- Section Child Neuropsychology, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Germany
| | - Charlotte L Hall
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Madeleine J Groom
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada
| | - Tobias Banaschewski
- Department of Child & Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, & Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | - Sara Carucci
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari & "A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, University Psychiatric Center, Leuven, KU, Belgium; Department of Neurosciences, University Psychiatric Center, Leuven, KU, Belgium
| | - Ralf W Dittmann
- Paediatric Psychopharmacology, Department of Child & Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bruno Falissard
- University Paris-Sud, Univ. Paris-Descartes, AP-HP, INSERM U1178, Paris, France
| | - Peter Garas
- Semmelweis University, Károly Rácz School of PhD Studies, Mental Health Sciences Phd School, Budapest, Hungary
| | - Sarah K Inglis
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Hanna Kovshoff
- School of Psychology, University of Southampton, Southampton, UK
| | - Puja Kochhar
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | | | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Antje Neubert
- Department of Paediatrics and Adolescents Medicine, University Hospital Erlangen, Erlangen, Germany
| | | | - Kapil Sayal
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK; Department of Experimental Clinical & Health Psychology, Ghent University, Ghent, Belgium
| | - Ian C K Wong
- Centre for Paediatric Pharmacy Research, Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Jun Xia
- The Nottingham Ningbo GRADE Center, Nottingham China Health Institute, The University of Nottingham Ningbo, China
| | - Alessandro Zuddas
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari & "A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy
| | - Chris Hollis
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK; National Institute of Health Research (NIHR) MindTech MedTech Cooperative, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Kerstin Konrad
- Section Child Neuropsychology, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Germany; JARA-BRAIN Institute II, Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
| | - Elizabeth B Liddle
- Division of Psychiatry & Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, UK.
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Salpekar JA, Mula M. Common psychiatric comorbidities in epilepsy: How big of a problem is it? Epilepsy Behav 2019; 98:293-297. [PMID: 30149996 DOI: 10.1016/j.yebeh.2018.07.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
Psychiatric illness and epilepsy commonly co-occur in adults and in children and adolescents. Theories of comorbidity are complex, but recurring associations between the conditions suggest overlap that is more than simple co-occurrence. Common underlying pathophysiology may imply that epilepsy itself may constituently include psychiatric symptoms. Conditions such as depression or cognitive difficulties commonly occur and in some cases, are considered to be associated with specific epilepsy characteristics such as localization or seizure type. Regardless of etiologic attributions to psychiatric comorbidity, it is clear today that treatment for epilepsy needs to target psychiatric illness. In many cases, quality-of-life improvements depend more upon addressing psychiatric symptoms than seizures themselves. This article is part of the Special Issue "Obstacles of Treatment of Psychiatric Comorbidities in Epilepsy".
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Affiliation(s)
- Jay A Salpekar
- Kennedy Krieger Institute, Johns Hopkins University, USA.
| | - Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London, United Kingdom; Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
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18
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Paying Attention to Quality of Life: Epilepsy and Attention Deficit Hyperactivity Disorder. Epilepsy Curr 2018; 18:220-221. [PMID: 30254512 DOI: 10.5698/1535-7597.18.4.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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19
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Auvin S, Wirrell E, Donald KA, Berl M, Hartmann H, Valente KD, Van Bogaert P, Cross JH, Osawa M, Kanemura H, Aihara M, Guerreiro MM, Samia P, Vinayan KP, Smith ML, Carmant L, Kerr M, Hermann B, Dunn D, Wilmshurst JM. Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission. Epilepsia 2018; 59:1867-1880. [DOI: 10.1111/epi.14549] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/28/2018] [Accepted: 07/31/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Stéphane Auvin
- Department of Pediatric Neurology; Robert-Debré University Hospital; APHP; Paris France
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy; Mayo Clinic; Rochester Minnesota
| | - Kirsten A. Donald
- Division of Developmental Paediatrics; Department of Paediatrics and Child Health; Neurosciences Institute; Red Cross War Memorial Children’s Hospital; University of Cape Town; Cape Town South Africa
| | - Madison Berl
- Division of Pediatric Neuropsychology; Children’s National Medical Center; Washington District of Columbia
| | - Hans Hartmann
- Clinic for Pediatric Kidney, Liver and Metabolic Disorders; Hannover Medical School; Hannover Germany
| | - Kette D. Valente
- Division of Clinical Neurophysiology, Institute and Department of Psychiatry; Clinics Hospital (HCFMUSP); Faculty of Medicine; University of São Paulo; São Paulo Brazil
| | - Patrick Van Bogaert
- Department of Pediatric Neurology and Neurosurgery; University Hospital of Angers; Angers France
| | - J. Helen Cross
- Developmental Neurosciences Programme; UCl Great Ormond Street Institute of Child Health, London & Young Epilepsy; Lingfield UK
| | - Makiko Osawa
- Department of Pediatrics; Tokyo Women’s Medical University; Tokyo Japan
| | - Hideaki Kanemura
- Department of Pediatrics; Faculty of Medicine; University of Yamanashi; Yamanashi Japan
| | - Masao Aihara
- Graduate Faculty of Interdisciplinary Research; Graduate School; University of Amanashi; Yamanashi Japan
| | | | - Pauline Samia
- Department of Paediatrics and Child Health; Aga Khan University; Nairobi Kenya
| | | | - Mary Lou Smith
- Department of Psychology; The Hospital for Sick Children; University of Toronto Mississauga; Toronto Canada
| | - Lionel Carmant
- Department of Neurosciences and Pediatrics; CHU Sainte-Justine; University of Montreal; Montreal Canada
| | - Michael Kerr
- Division of Psychological Medicine and Clinical Neuroscience; Cardiff University; Cardiff Wales UK
| | - Bruce Hermann
- Department of Neurology; School of Medicine and Public Health; University of Wisconsin; Madison Wisconsin
| | - David Dunn
- Section of Child and Adolescent Psychiatry; Departments of Psychiatry and Neurology; Indiana University School of Medicine; Indianapolis Indiana
| | - Jo M. Wilmshurst
- Division of Paediatric Neurology; Neuroscience Institute; Department of Paediatrics and Child Health; Red Cross War Memorial Children’s Hospital; University of Cape Town; Cape Town South Africa
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Abstract
PURPOSE OF REVIEW The overlap of neuropsychiatric illness and developmental disability continues to be prominently recognized in clinical practice and in the academic literature. Theoretical and practical considerations may represent a frontier for understanding brain and behavior relationships. The purpose of this review is to explore this common relationship and report on recent literature that helps advance the larger fields of psychiatry and neurology. RECENT FINDINGS Overlap between developmental disability, epilepsy, and neuropsychiatric illness may be more common than originally thought. Excessive excitatory neurotransmitter activity may be present in epilepsy and in autism spectrum disorder. Specific seizure types may be associated with features of developmental disabilities and neuropsychiatric conditions. SUMMARY Neuropsychiatric illness is common in epilepsy and more frequent in developmental disabilities than generally recognized. Seizure foci in the temporal lobe may play a significant role. Brain connectivity and specific neurotransmitter systems are active areas of investigation. Antiepileptic drugs may improve neuropsychiatric symptoms in persons with developmental disability and epilepsy.
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Childhood epilepsy and ADHD comorbidity in an Indian tertiary medical center outpatient population. Sci Rep 2018; 8:2670. [PMID: 29422636 PMCID: PMC5805699 DOI: 10.1038/s41598-018-20676-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/22/2018] [Indexed: 12/17/2022] Open
Abstract
This study aimed to assess the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) and its characteristics and risk factors in children with epilepsy at a tertiary medical center in New Delhi. Children with active epilepsy, aged 6 to 12 years, were assessed for ADHD using DSM-IV-TR criteria. Epilepsy and psychiatric characteristics, sociodemographic indicators, and use of antiepileptic drugs were analyzed for differences between the ADHD and non-ADHD groups. Among the 73 children with epilepsy, 23% (n = 17) had comorbid ADHD, of whom 59% (n = 10) had predominantly inattentive type, 35% (n = 6) combined type, and 6% (n = 1) predominantly hyperactive-impulsive type. Lower IQ scores, epileptiform EEG activity, not attending school, and male sex were significantly associated with comorbid ADHD in children with epilepsy. Groups were similar in terms of age, socioeconomic indicators, family history of psychiatric disorders, seizure frequency in the last six months, seizure etiology, and seizure type. Epilepsy is a common pediatric neurological condition with frequent psychiatric comorbidities, including ADHD. Specialists should collaborate to optimize treatment for children with epilepsy and ADHD, especially for families in developing countries where the burden of disease can be great.
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22
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Ekinci O, Okuyaz Ç, Erdoğan S, Gunes S, Ekinci N, Kalınlı M, Teke H, Direk MÇ. Attention-Deficit Hyperactivity Disorder (ADHD) in Epilepsy and Primary ADHD: Differences in Symptom Dimensions and Quality of Life. J Child Neurol 2017; 32:1083-1091. [PMID: 29129152 DOI: 10.1177/0883073817737445] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We aimed to (1) compare quality of life (QOL) among children with epilepsy, epilepsy and attention-deficit hyperactivity disorder (ADHD), and primary ADHD and (2) compare ADHD symptom dimensions and subtypes between children with epilepsy-ADHD and primary ADHD. METHODS A total of 140 children; 53 with epilepsy, 35 with epilepsy-ADHD, and 52 with primary ADHD were included. KINDL-R (quality of life measure), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), and Conners' Parent Rating Scale (CPRS) were completed. Neurology clinic charts were reviewed for epilepsy-related variables. RESULTS Children with epilepsy-ADHD had the lowest (poorest) KINDL-R total scores. Epilepsy-ADHD group had more inattentiveness symptoms, whereas primary ADHD group had more hyperactivity/impulsivity symptoms. The frequencies of ADHD combined and inattentiveness subtypes were 60% and 40% in children with epilepsy-ADHD and 80.7% and 19.3% in children with primary ADHD, respectively ( P = .034). CONCLUSION ADHD in epilepsy is associated with a significantly poor quality of life and predominantly inattentiveness symptoms.
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Affiliation(s)
- Ozalp Ekinci
- 1 Department of Child and Adolescent Psychiatry, University of Health Sciences Medical Faculty, Istanbul, Turkey
| | - Çetin Okuyaz
- 2 Department of Pediatric Neurology, Mersin University Medical Faculty, Mersin, Turkey
| | - Semra Erdoğan
- 3 Department of Biostatistics and Medical Informatics, Mersin University Medical Faculty, Mersin, Turkey
| | - Serkan Gunes
- 4 Department of Child and Adolescent Psychiatry, Hatay State Hospital, Hatay, Turkey
| | - Nuran Ekinci
- 5 Department of Child and Adolescent Psychiatry, Mersin University Medical Faculty, Mersin, Turkey
| | - Merve Kalınlı
- 5 Department of Child and Adolescent Psychiatry, Mersin University Medical Faculty, Mersin, Turkey
| | - Halenur Teke
- 5 Department of Child and Adolescent Psychiatry, Mersin University Medical Faculty, Mersin, Turkey
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Kim YS, Yoon BE. Altered GABAergic Signaling in Brain Disease at Various Stages of Life. Exp Neurobiol 2017; 26:122-131. [PMID: 28680297 PMCID: PMC5491580 DOI: 10.5607/en.2017.26.3.122] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/06/2017] [Accepted: 05/15/2017] [Indexed: 01/21/2023] Open
Abstract
In the healthy brain, gamma-aminobutyric acid (GABA) is regulated by neurons and glia. This begs the question: what happens in the malfunctioning brain? There are many reasons why diseases occur, including genetic mutations, systemic problems, and environmental influences. There are also many ways in which GABA can become dysregulated, such as through alterations in its synthesis or release, and changes in systems that respond to it. Notably, dysregulation of GABA can have a large impact on the brain. To date, few reviews have examined brain diseases in which dysregulation of GABA is implicated as an underlying factor. Accordingly, the time is ripe for investigating alterations in GABAergic signaling that may play a role in changes in neuronal activity observed in the major brain disorders that occur during various stages of life. This review is meant to provide a better understanding of the role of GABA in brain health and contributor to social problems from a scientific perspective.
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Affiliation(s)
- Yoo Sung Kim
- Department of Molecular Biology, Dankook University, Cheonan 31116, Korea
| | - Bo-Eun Yoon
- Department of Molecular Biology, Dankook University, Cheonan 31116, Korea
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Fluegge K. Does environmental exposure to the greenhouse gas, N 2O, contribute to etiological factors in neurodevelopmental disorders? A mini-review of the evidence. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2016; 47:6-18. [PMID: 27566494 DOI: 10.1016/j.etap.2016.08.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/11/2016] [Accepted: 08/13/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Neurodevelopmental disorders are increasing in prevalence worldwide. Previous work suggests that exposure to the environmental air pollutant and greenhouse gas - nitrous oxide (N2O) - may be an etiological factor in neurodevelopmental disorders through the targeting of several neural correlates. METHODOLOGY While a number of recent systematic reviews have addressed the role of general anesthesia in the surgical setting and neurodevelopmental outcomes, a narrative mini-review was conducted to first define and characterize the relevant variables (i.e., N2O, attention-deficit hyperactivity disorder [ADHD] and autism spectrum disorders [ASD]) and their potential interactions into a coherent, hypothesis-generating work. The narrative mini-review merges basic principles in environmental science, anesthesiology, and psychiatry to more fully develop the novel hypotheses that neurodevelopmental impairment found in conditions like ADHD and ASD may be due to exposure to the increasing air pollutant, N2O. RESULTS The results of the present mini-review indicate that exposure to N2O, even at non-toxic doses, may modulate central neurotransmission and target many neural substrates directly implicated in neurodevelopmental disorders, including the glutamatergic, opioidergic, cholinergic, and dopaminergic systems. Epidemiological studies also indicate that early and repeated exposure to general anesthesia, including N2O, may contribute to later adverse neurodevelopmental outcomes in children. CONCLUSIONS The current evidence and subsequent hypotheses suggest that a renewed interest be taken in the toxicological assessment of environmental N2O exposure using validated biomarkers and psychiatric endpoints. Given the relevance of N2O as a greenhouse gas, societies may also wish to engage in a more robust monitoring and reporting of N2O levels in the environment for climactic benefit as well.
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Affiliation(s)
- Keith Fluegge
- Institute of Health and Environmental Research, Cleveland, OH 44118, USA.
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25
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Ekinci O, Isik U, Gunes S, Yildirim C, Killi Y, Guler G. Self-concept in children and adolescents with epilepsy: The role of family functioning, mothers' emotional symptoms and ADHD. Brain Dev 2016; 38:714-22. [PMID: 26992474 DOI: 10.1016/j.braindev.2016.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to identify the associated factors of poor self-concept in children and adolescents with epilepsy. METHODS Fifty-three patients with uncomplicated epilepsy (aged 7-18years) and 28 healthy controls were included. Study measures included the Piers-Harris 2 Self-Concept Scale, Family Assessment Device (FAD), Turgay DSM-IV based ADHD rating Scale (T-DSM-IV-S), Conners' Teacher Rating Scale (CTRS-R), Beck Depression Inventory and State-Trait Anxiety Inventory (STAI). Neurology clinic charts were reviewed for the epilepsy-related variables. RESULTS While the Piers-Harris 2 total score was not significantly different between the groups, patients with epilepsy had lower (poorer) scores on freedom from anxiety and popularity subscales. Linear regression analysis revealed that the problem solving, affective responsiveness, general functioning and communication scores of FAD; total and inattentiveness scores of T-DSM-IV-S and mothers' Beck scores were associated with the total score of Piers-Harris 2. Epilepsy-related factors were not found to be associated with self-concept scores. CONCLUSION Poor self-concept in children with epilepsy is associated with negative family functioning, mothers' emotional symptoms and ADHD, especially the symptoms of inattentiveness.
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Affiliation(s)
- Ozalp Ekinci
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey.
| | - Uğur Isik
- Department of Pediatrics, Division of Pediatric Neurology, Acıbadem University School of Medicine, Turkey
| | - Serkan Gunes
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey
| | - Canan Yildirim
- Pediatric Neurology Department, Istanbul Erdem Hospital, Turkey
| | - Yunus Killi
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey
| | - Gülen Guler
- Child and Adolescent Psychiatry Department, Mersin University School of Medicine, Turkey
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Fluegge K. Does the association between ADHD and pediatric epilepsy signal a tolerance continuum to human environmental exposures? A reply to Salpekar and Mishra (2014). Epilepsy Behav 2016; 58:143-4. [PMID: 26992665 DOI: 10.1016/j.yebeh.2016.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Keith Fluegge
- Institute of Health and Environmental Research, Cleveland, OH 44118, USA.
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27
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Lee EH, Choi YS, Yoon HS, Bahn GH. Clinical Impact of Epileptiform Discharge in Children With Attention-Deficit/Hyperactivity Disorder (ADHD). J Child Neurol 2016; 31:584-8. [PMID: 26341812 DOI: 10.1177/0883073815604223] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/06/2015] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the prevalence and clinical significance of epileptiform discharges in patients with attention-deficit/hyperactivity disorder (ADHD). The authors retrospectively reviewed 180 children who were diagnosed with ADHD and had an electroencephalography (EEG) recording. Epileptiform discharges were found in 29 (16.1%) of 180 patients with ADHD. Of these, 15 (8.3%) had generalized epileptiform discharges and 14 (7.7%) had focal epileptiform discharges. The focal epileptiform discharges were most prevalent from the frontal (5/14) and rolandic area (5/14). Among the 29 patients with epileptiform discharges and ADHD, 5 patients had previous history of epilepsy and 4 patients developed epilepsy later, whereas none of the normal EEG group developed epilepsy. The authors suggest that interictal epileptiform discharges appear to be associated with seizure occurrence in children with ADHD and might reflect maturational pathophysiology overlapping with epilepsy.
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Affiliation(s)
- Eun Hye Lee
- Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Sung Choi
- Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hoi Soo Yoon
- Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Geon Ho Bahn
- Department of Psychiatry, College of Medicine, Kyung Hee University, Seoul, Korea
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28
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Kwong KL, Lam D, Tsui S, Ngan M, Tsang B, Lam SM. Attention Deficit Hyperactivity Disorder in Adolescents With Epilepsy. Pediatr Neurol 2016; 57:56-63. [PMID: 26831952 DOI: 10.1016/j.pediatrneurol.2015.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 12/24/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND We examined attention-deficit hyperactivity disorder in adolescents with epilepsy and the association with seizure-related and sociodemographic variables. METHODS Strengths and Weakness of Attention-Deficit Hyperactivity Disorder Symptoms and Normal Behaviors rating scale was administered to 122 children with epilepsy and 50 children with asthma, aged 10 to 18 years attending mainstream schools. RESULTS Twenty-nine (23.7%) adolescents with epilepsy compared with five (10%) with asthma had attention deficit hyperactivity disorder (P = 0.037). Adolescents with epilepsy had a significantly higher score in the inattention subscale when compared with those with asthma (-0.25 ± 1.2 vs -0.64 ± 1.07, P = 0.049). Combined subtype was most frequent in the epilepsy group. Oppositional defiant disorders were more prevalent in those having attention deficit hyperactivity disorder. Psychiatric assistance had only been provided to one third of our patients with epilepsy and attention deficit hyperactivity disorder at the time of study. There was a negative correlation between attention deficit hyperactivity disorder scores and age of seizure onset. A positive correlation was observed between the number of antiepileptic drugs and the inattentive subscale score. The impact of various correlates on individual subtypes was not identical. Independent risk factors associated with attention deficit hyperactivity disorder were medical comorbidities (odds ratio = 12.82, 95% confidence interval 4.44, 37.03, P < 0.0001) and age at seizure onset (odds ratio = 0.73, 95% confidence interval 0.56, 0.94, P = 0.016). CONCLUSIONS Attention deficit hyperactivity disorder is overrepresented in adolescents with epilepsy; screening for its symptoms should be an integral part of management in adolescents with epilepsy.
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Affiliation(s)
- Karen L Kwong
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, China.
| | - David Lam
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Sarah Tsui
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Mary Ngan
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Brian Tsang
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Siu M Lam
- Department of Child Psychiatry, Castle Peak Hospital, Hong Kong, China
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29
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Zaimoğlu S, Türkdoğan D, Mazlum B, Bekiroğlu N, Tetik-Kabil A, Eyilikeder S. When Is EEG Indicated in Attention-Deficit/Hyperactivity Disorder? J Child Neurol 2015; 30:1785-93. [PMID: 25895916 DOI: 10.1177/0883073815580545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 02/10/2015] [Indexed: 11/15/2022]
Abstract
The authors investigated the parameters for predicting epileptiform abnormalities in a group of children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The sample consisted of 148 subjects aged between 6 and 13 (8.76 ± 1.26; 25.7% female) years. Subtypes of ADHD and comorbid psychiatric disorders were defined according to DSM-IV criteria. The Wechsler Intelligence Scale for Children-Revised was applied to all patients. Most of the subjects (89.2%) had wakefulness and sleep electroencephalography examinations lasting about one hour. The authors found out that the coexistence of speech sound disorder (odds ratio [OR] 3.90, 95% confidence interval [CI]: 1.61-9.48) and higher Digit Span test performance (OR 1.24, 95% CI: 1.06-1.44) predicted the presence of accompanying epileptiform abnormalities. The prevalence of epileptiform abnormalities was 26.4%, and they were frequently localized in the frontal (41%) and centrotemporal (28.2%) regions. Higher percentage of speech sound disorder co-occurrence (64%) in subjects with rolandic spikes suggests that epileptiform abnormalities associated with ADHD can be determined genetically at least in some cases. Pathophysiology of epileptiform abnormalities in ADHD might have complex genetic and maturational background.
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Affiliation(s)
- Sennur Zaimoğlu
- Child and Adolescent Psychiatry Istanbul, Institute of Neurological Sciences, Marmara University, Istanbul, Turkey
| | - Dilşad Türkdoğan
- Department of Child Neurology, Medical School, Marmara University, Istanbul, Turkey
| | - Betül Mazlum
- Department of Neuroscience, Institute of Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - Nural Bekiroğlu
- Department of Biostatistics and Bioinformatics, Medical School, Marmara University, Istanbul, Turkey
| | - Aylin Tetik-Kabil
- Foundation Development Year Psychological Counseling Center, School of Languages, Sabancı University, Istanbul, Turkey
| | - Seda Eyilikeder
- Department of Speech and Language Therapy, Anadolu University, Eskisehir, Turkey
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30
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Gao Y, Heldt SA. Lack of neuronal nitric oxide synthase results in attention deficit hyperactivity disorder-like behaviors in mice. Behav Neurosci 2015; 129:50-61. [PMID: 25621792 DOI: 10.1037/bne0000031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nitric oxide (NO) is an important molecule for the proper development and function of the central nervous system. In this study, we investigated the behavioral alterations in the neuronal NO synthase knockout mice (NOS1 KO) with a deficient NO production mechanism in the brain, characterizing it as a potential rodent model for attention deficit hyperactivity disorder (ADHD). NOS1 KO exhibited higher locomotor activity than their wildtype counterparts in a novel environment, as measured by open field (OF) test. In a 2-way active avoidance paradigm (TWAA), we found sex-dependent effects, where male KO displayed deficits in avoidance and escape behavior, sustained higher incidences of shuttle crossings, and higher incidences of intertrial interval crossings, suggesting learning, and/or performance impairments. On the other hand, female KO demonstrated few deficits in TWAA. Molsidomine (MSD), a NO donor, rescued TWAA deficits in male KO when acutely administered before training. In a passive avoidance paradigm, KO of both sexes displayed significantly shorter step-through latencies after training. Further, abnormal spontaneous motor activity rhythms were found in the KO during the dark phase of the day, indicating dysregulation of rhythmic activities. These data indicate that NOS1 KO mimics certain ADHD-like behaviors and could potentially serve as a novel rodent model for ADHD.
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31
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Lee BH, Smith T, Paciorkowski AR. Autism spectrum disorder and epilepsy: Disorders with a shared biology. Epilepsy Behav 2015; 47:191-201. [PMID: 25900226 PMCID: PMC4475437 DOI: 10.1016/j.yebeh.2015.03.017] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/06/2015] [Accepted: 03/13/2015] [Indexed: 12/17/2022]
Abstract
There is an increasing recognition of clinical overlap in patients presenting with epilepsy and autism spectrum disorder (ASD), and a great deal of new information regarding the genetic causes of both disorders is available. Several biological pathways appear to be involved in both disease processes, including gene transcription regulation, cellular growth, synaptic channel function, and maintenance of synaptic structure. We review several genetic disorders where ASD and epilepsy frequently co-occur, and we discuss the screening tools available for practicing neurologists and epileptologists to help determine which patients should be referred for formal ASD diagnostic evaluation. Finally, we make recommendations regarding the workflow of genetic diagnostic testing available for children with both ASD and epilepsy. This article is part of a Special Issue entitled "Autism and Epilepsy".
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Affiliation(s)
- Bo Hoon Lee
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Tristram Smith
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Alex R Paciorkowski
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA; Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA; Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY, USA; Center for Neural Development and Disease, University of Rochester Medical Center, Rochester, NY, USA.
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32
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Bechtel N, Weber P. Attention problems in children with epilepsy. How is the long-term outcome? Eur J Paediatr Neurol 2015; 19:383-5. [PMID: 25604809 DOI: 10.1016/j.ejpn.2014.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/17/2014] [Accepted: 12/31/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Attention deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders and frequently seen in other conditions like epilepsy as well. The prevalence of ADHD in the general paediatric population is estimated at 3-6% persisting into adulthood in up to one third of persons affected. The prevalence of ADHD in epilepsy is understood to be significantly higher. Approximately one third of children with epilepsy do also have a diagnosis of ADHD. How these attention problems develop over the years is however not clear. We therefore evaluated the severity of attention problems in children with epilepsy at late childhood and assessed it again in adolescence. Data was being compared with attention problems of children with developmental ADHD. METHOD 16 boys with diagnosed combined idiopathic epilepsy/ADHD and 14 boys with developmental ADHD were investigated twice; at a mean age of 10.94 (SD = 1.63) and then again at a mean age of 15.82 (SD = 2.0). At the baseline examination all patients completed Raven's Progressive Matrices to assess intelligence. To measure symptom severity of ADHD, parents were asked to complete the short version of the Conner's Rating Scale for Parents at both times. Parents of children with combined epilepsy/ADHD furthermore gave information about seizure frequency and intake of anticonvulsants. RESULTS Patient groups did not significantly differ in age and IQ. Results of the baseline examination revealed elevated scores in both patient groups for the Conner's Rating Scales; ADHD group: M = 16.86 (SD = 5.35); Epilepsy/ADHD group: M = 14.77 (SD = 4.76) but no differences between the groups (p = .29; z = .39). Qualitatively, patients with developmental ADHD showed more abnormalities in the area of hyperactivity/impulsivity while patients with epilepsy/ADHD had more problems with inattention. Results of the follow-up examination showed a significant reduction of symptoms in the ADHD group of minus 4.23 points; M = 12.63 (SD = 3.89) (p = .02); The reduction in the epilepsy/ADHD group was even bigger with minus 6.77 points; M = 8.00 (SD = 6.46) (p = .03). However, difference between the two groups reached no significance (p = .079; z = 1.19). None of the patients with epilepsy has had seizures in the meantime. CONCLUSION We found a significant reduction of ADHD symptoms in our patients from the time of late childhood to adolescence. That symptoms of ADHD, especially hyperactivity, lessen with age is known from the literature (Biedermann et al., 2010). We found the same data for patients with idiopathic epilepsy and ADHD. Over the same period of time problems of attention improved substantially. We conclude that development and brain maturation may have a similar positive effect on attention problems in children with epilepsy than in developmental ADHD.
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Affiliation(s)
- Nina Bechtel
- Department of Neuropediatrics and Developmental Medicine, University Children's Hospital Basel (UKBB), PB CH-4031 Basel, Switzerland.
| | - Peter Weber
- Department of Neuropediatrics and Developmental Medicine, University Children's Hospital Basel (UKBB), PB CH-4031 Basel, Switzerland
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33
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Wagner J. A 15-year snapshot of the behavioral and psychosocial aspects of epilepsy. Epilepsy Behav 2014; 40:108-9. [PMID: 25281299 DOI: 10.1016/j.yebeh.2014.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 09/08/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Janelle Wagner
- College of Nursing, Department of Pediatrics, Comprehensive Epilepsy Center, Medical University of South Carolina, USA.
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34
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Mitchell RH, Goldstein BI. High Psychiatric and Medical Comorbidity in Youth with Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder. Psychiatr Ann 2014. [DOI: 10.3928/00485713-20141003-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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35
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Dunn DW. Focusing on ADHD and attention in children with epilepsy. Epilepsy Behav 2014; 37:308-9. [PMID: 24998312 DOI: 10.1016/j.yebeh.2014.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 06/10/2014] [Indexed: 11/20/2022]
Affiliation(s)
- David W Dunn
- Indiana University School of Medicine, 705 Riley Hospital Drive, ROC 4300, Indianapolis, IN 46202, USA.
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