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He Z, Yang X, Li Y, Zhao X, Li J, Li B. Attention-deficit/hyperactivity disorder in children with epilepsy: A systematic review and meta-analysis of prevalence and risk factors. Epilepsia Open 2024; 9:1148-1165. [PMID: 38798030 PMCID: PMC11296131 DOI: 10.1002/epi4.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/24/2024] [Accepted: 03/26/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE To evaluate the prevalence of and risk factors for attention-deficit/hyperactivity disorder (ADHD) in children with epilepsy (CWE). METHODS We conducted a systematic search in PubMed and Embase for the meta-analysis. The pooled prevalence of ADHD was calculated using a random-effects model; subgroup analyses were performed to explore heterogeneity. We collected raw data from articles reporting potential risk factors, which were included in the subsequent risk factor analysis. RESULTS Forty-six articles met the inclusion criteria for the meta-analysis, which showed a pooled ADHD prevalence of 30.7% in CWE, with a predominance of the inattentive subtype of ADHD; the heterogeneity of prevalence was related to population source/study setting (clinic based, community based, or database based) and method of ADHD diagnosis (with or without clinical review). Risk factors for ADHD in epilepsy included younger age, intellectual/developmental disabilities, a family history of epilepsy, earlier epilepsy onset, absence epilepsy, more frequent seizures, and polytherapy; In contrast, risk factors such as sex, generalized epilepsy or seizures, epilepsy etiology, and electroencephalogram abnormalities were not significantly associated with the occurrence of ADHD. SIGNIFICANCE The prevalence of ADHD in CWE is high and several potential risk factors are associated with it. This study contributes to a better understanding of ADHD in epilepsy for screening and treatment. PLAIN LANGUAGE SUMMARY This systematic review summarizes the prevalence of attention-deficit/hyperactivity disorder (ADHD) occurring in children with epilepsy and analyses the risk factors for comorbid ADHD in epilepsy. By reviewing 46 articles, we concluded that the overall prevalence of ADHD in children with epilepsy was 30.7% and that intellectual/developmental disabilities were the most significant risk factor for combined ADHD in children with epilepsy. This study provides a wealth of information on comorbid ADHD in epilepsy, which will help clinicians identify and treat potential ADHD in children with epilepsy in a timely manner.
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Affiliation(s)
- Zimeng He
- Shandong UniversityJinanShandongChina
| | - Xiaofan Yang
- Department of PediatricsQilu Hospital of Shandong UniversityJinanShandongChina
| | - Yumei Li
- Shandong UniversityJinanShandongChina
| | | | - Jun Li
- Department of PediatricsQilu Hospital of Shandong UniversityJinanShandongChina
| | - Baomin Li
- Shandong UniversityJinanShandongChina
- Department of PediatricsQilu Hospital of Shandong UniversityJinanShandongChina
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El-Saied MM, Afify O, Abdelraouf ER, Oraby A, Hashish AF, Zeidan HM. BDNF, proBDNF and proBDNF/BDNF ratio with electroencephalographic abnormalities in children with attention deficit hyperactivity disorder: Possible relations to cognition and severity. Int J Dev Neurosci 2024; 84:368-380. [PMID: 38712701 DOI: 10.1002/jdn.10332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/07/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) with and without subclinical epileptogenic discharges (SED) have been suggested to negatively affect cognitive abilities of children with ADHD. The role of brain-derived neurotrophic factor (BDNF) and its precursor proBDNF in ADHD is in need of being investigated. The aims were to evaluate the levels of serum BDNF, proBDNF and the proBDNF/BDNF ratio in addition to the potential impacts of SED on the children's cognitive abilities and the severity of ADHD. The included participants with ADHD were 30 children with normal electroencephalogram (EEG) (G1) and 30 children with SED (G2), together with 30 healthy children (G3). The cognitive abilities and severity of the disorder were evaluated. The biochemical measures were determined by ELISA. The presence of coexisting SED and nocturnal enuresis has led to a deleterious effect on cognitive processes but not on the severity. The focal epileptogenic discharge was the most common among children in G2. The levels of BDNF in Groups 1 and 2 were less than those in G3. The higher proBDNF/BDNF ratio could be related to the low BDNF levels rather than high proBDNF levels. The findings of this study highlight the importance of investigating the presence of SED and nocturnal enuresis in children with ADHD. Targeting strengthening of cognitive abilities in children with coexisting ADHD and SED is advised. The role of proBDNF in the pathophysiology of ADHD needs further investigation.
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Affiliation(s)
- Mostafa M El-Saied
- Department of Research on Children with Special Needs, Institute of Medical Research and Clinical Studies, National Research Centre, Cairo, Egypt
- Learning Disability and Neurorehabilitation Research Field, Medical Research Centre of Excellence, National Research Centre, Cairo, Egypt
| | - Omneya Afify
- Department of Pediatrics, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ehab R Abdelraouf
- Department of Research on Children with Special Needs, Institute of Medical Research and Clinical Studies, National Research Centre, Cairo, Egypt
- Learning Disability and Neurorehabilitation Research Field, Medical Research Centre of Excellence, National Research Centre, Cairo, Egypt
| | - Azza Oraby
- Department of Pediatrics, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Adel F Hashish
- Department of Research on Children with Special Needs, Institute of Medical Research and Clinical Studies, National Research Centre, Cairo, Egypt
| | - Hala M Zeidan
- Department of Research on Children with Special Needs, Institute of Medical Research and Clinical Studies, National Research Centre, Cairo, Egypt
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Tsai ML, Wang CC, Wang AYD, Lee FC, Chang H, Liu YL, Wong TT, Peng SJ. Antiseizure Medications Normalize Electroencephalographic Functional Connectivity and Power in Children With Benign Epilepsy With Centrotemporal Spikes. Pediatr Neurol 2024; 156:41-50. [PMID: 38729071 DOI: 10.1016/j.pediatrneurol.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 02/12/2024] [Accepted: 03/17/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The decision to treat children with benign epilepsy with centrotemporal spikes (BECTS) using antiseizure medications (ASM) is controversial. Our goal is to compare the effect of ASM treatment on the alteration of electroencephalographic (EEG) functional connectivity and power across four frequency bands in children with BECTS. METHODS Children with BECTS with two-year follow-up were retrospectively divided into ASM versus non-ASM groups. The network properties of the EEGs as based on network-based statistic and graph theory were evaluated by the following indices: global efficiency, clustering coefficient, betweenness centrality, and nodal strength in four frequency bands (delta, theta, alpha, and beta). EEG power including absolute power (AP) and relative power (RP) was analyzed in four frequency bands. RESULTS In children with BECTS with ASM treatment, there was no significant change in EEG connectivity across all bands before and after two years of ASM. In children with BECTS without ASM treatment, there was a significant increase of global efficiency, clustering coefficient, and nodal strength but not the betweenness centrality in the delta band after two years of follow-up. A decrease in AP in the delta and theta bands and a decrease in RP in the theta band were found in the ASM group after two years of treatment. CONCLUSIONS Our results suggest that ASM may play a role in modulating the development of increasing overall brain connectivity and in downregulating overt synaptic activity, but not intrinsic focal connectivity, in the early years of BECTS. The changes in the EEG power indicate that ASM significantly normalized slow-wave band power.
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Affiliation(s)
- Min-Lan Tsai
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chuang-Chin Wang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Andy Yu-Der Wang
- Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Feng-Chin Lee
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsi Chang
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Lin Liu
- Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tai-Tong Wong
- Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
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Pan G, Han Y, Wang TC, Chen ZY, Wang XQ, Sun HB, Liu YH, Wang Q, Lin WH, Li JM, Zhou SZ, Zhang YH. Attention deficit hyperactivity disorder in children with epilepsy: a multicenter cross-sectional analysis in China. World J Pediatr 2024:10.1007/s12519-024-00813-2. [PMID: 38806855 DOI: 10.1007/s12519-024-00813-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/07/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) comorbid with epilepsy have been insufficiently addressed in China. We conducted a study in China to investigate the current status, diagnosis, and treatment of ADHD in children to further our understanding of ADHD comorbid with epilepsy, strengthen its management, and improve patients' quality of life. METHODS We carried out a multicenter cross-sectional survey of children with epilepsy across China between March 2022 and August 2022. We screened all patients for ADHD and compared various demographic and clinical factors between children with and without ADHD, including gender, age, age at epilepsy onset, duration of epilepsy, seizure types, seizure frequency, presence of epileptiform discharges, and treatment status. Our objective was to explore any possible associations between these characteristics and the prevalence of ADHD. RESULTS Overall, 395 epilepsy patients aged 6-18 years were enrolled. The age at seizure onset and duration of epilepsy ranged from 0.1-18 to 0.5-15 years, respectively. Focal onset seizures were observed in 212 (53.6%) patients, while 293 (76.3%) patients had epileptiform interictal electroencephalogram (EEG) abnormalities. Among the 370 patients treated with anti-seizure medications, 200 (54.1%) had monotherapy. Although 189 (47.8%) patients had ADHD, only 31 received treatment for it, with the inattentive subtype being the most common. ADHD was more common in children undergoing polytherapy compared to those on monotherapy. Additionally, poor seizure control and the presence of epileptiform interictal EEG abnormalities may be associated with a higher prevalence of ADHD. CONCLUSIONS While the prevalence of ADHD was higher in children with epilepsy than in normal children, the treatment rate was notably low. This highlights the need to give more importance to the diagnosis and treatment of ADHD in children with epilepsy.
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Affiliation(s)
- Gang Pan
- Department of Neurology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Minhang District, Shanghai, China
| | - Ying Han
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Tian-Cheng Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zi-Yi Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiang-Qing Wang
- Department of Neurology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hong-Bin Sun
- Department of Neurology, Sichuan Provincial People Hospital, Chengdu, China
| | - Yong-Hong Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Captial Medical University, Beijing, China
| | - Wei-Hong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jin-Mei Li
- Department of Neurology, Sichuan University West China Hospital, Chengdu, China
| | - Shui-Zhen Zhou
- Department of Neurology, Children's Hospital of Fudan University, 399 Wan Yuan Road, Minhang District, Shanghai, China.
| | - Yue-Hua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
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Xu F, Li Y, Wang Y, Wang S, Sun F, Wang X. Interictal magnetic signals in new-onset Rolandic epilepsy may help with timing of treatment selection. Epilepsia Open 2024; 9:368-379. [PMID: 38145506 PMCID: PMC10839299 DOI: 10.1002/epi4.12884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/03/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE With research progress on Rolandic epilepsy (RE), its "benign" nature has been phased out. Clinicians are exhibiting an increasing tendency toward a more assertive treatment approach for RE. Nonetheless, in clinical practice, delayed treatment remains common because of the "self-limiting" nature of RE. Therefore, this study aimed to identify an imaging marker to aid treatment decisions and select a more appropriate time for initiating therapy for RE. METHODS We followed up with children newly diagnosed with RE, classified them into medicated and non-medicated groups according to the follow-up results, and compared them with matched healthy controls. Before beginning follow-up visits, interictal magnetic data were collected using magnetoencephalography in treatment-naïve recently diagnosed patients. The spectral power of the whole brain during initial diagnosis was determined using minimum normative estimation combined with the Welch technique. RESULTS A difference was observed in the magnetic source intensity within the left caudal anterior cingulate and precentral and postcentral gyri in the delta band between the medicated and non-medicated groups. The results revealed good discriminatory ability within the receiver operator characteristic curve. In the medicated group, there was a specific change in the frontotemporal magnetic source intensity, which shifted from high to low frequencies, compared with the healthy control group. SIGNIFICANCE The intensity of the precentral gyrus magnetic source within the delta band showed good specificity. Considering the rigor of initial treatment, the intensity of the precentral gyrus magnetic source can provide some help as an imaging marker for initial RE treatment, particularly for the timing of treatment initiation.
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Affiliation(s)
- Fengyuan Xu
- Country Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Yihan Li
- Country Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Yingfan Wang
- Country Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Siyi Wang
- Country Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Fangling Sun
- Country Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Xiaoshan Wang
- Country Department of NeurologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
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Halász P, Szũcs A. Self-limited childhood epilepsies are disorders of the perisylvian communication system, carrying the risk of progress to epileptic encephalopathies-Critical review. Front Neurol 2023; 14:1092244. [PMID: 37388546 PMCID: PMC10301767 DOI: 10.3389/fneur.2023.1092244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/04/2023] [Indexed: 07/01/2023] Open
Abstract
"Sleep plasticity is a double-edged sword: a powerful machinery of neural build-up, with a risk to epileptic derailment." We aimed to review the types of self-limited focal epilepsies..."i.e. keep as two separate paragraphs" We aimed to review the types of self-limited focal epilepsies: (1) self-limited focal childhood epilepsy with centrotemporal spikes, (2) atypical Rolandic epilepsy, and (3) electrical status epilepticus in sleep with mental consequences, including Landau-Kleffner-type acquired aphasia, showing their spectral relationship and discussing the debated topics. Our endeavor is to support the system epilepsy concept in this group of epilepsies, using them as models for epileptogenesis in general. The spectral continuity of the involved conditions is evidenced by several features: language impairment, the overarching presence of centrotemporal spikes and ripples (with changing electromorphology across the spectrum), the essential timely and spatial independence of interictal epileptic discharges from seizures, NREM sleep relatedness, and the existence of the intermediate-severity "atypical" forms. These epilepsies might be the consequences of a genetically determined transitory developmental failure, reflected by widespread neuropsychological symptoms originating from the perisylvian network that have distinct time and space relations from secondary epilepsy itself. The involved epilepsies carry the risk of progression to severe, potentially irreversible encephalopathic forms.
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Affiliation(s)
- Péter Halász
- Department of Neurology, University Medical School, Pécs, Hungary
| | - Anna Szũcs
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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Uliel-Sibony S, Chernuha V, Tokatly Latzer I, Leitner Y. Epilepsy and attention-deficit/hyperactivity disorder in children and adolescents: An overview of etiology, prevalence, and treatment. Front Hum Neurosci 2023; 17:1021605. [PMID: 37113319 PMCID: PMC10126237 DOI: 10.3389/fnhum.2023.1021605] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Epilepsy and attention-deficit/hyperactivity disorder (ADHD) are closely connected and commonly seen in both children and adults. Each of the disorders has major psychosocial and quality of life (QOL) effects, and their co-occurrence makes coping even more challenging for both the patients and their families. Moreover, an adverse effect of some anti-seizure medications can potentially induce or exacerbate symptoms of ADHD on the one hand, while some ADHD medications may increase seizure risk on the other. The combination of proper diagnosis and appropriate treatment may improve or even prevent many of the complications associated with these conditions. The objectives of this review are to present the complex relationship between epilepsy and ADHD, looking into the pathophysiological, anatomical, and functional perspectives along with the psychosocial and QOL influences and the recommended treatment approaches in accordance with the latest literature.
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Affiliation(s)
| | - Veronika Chernuha
- Pediatric Neurology Institute, Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - Itay Tokatly Latzer
- Pediatric Neurology Institute, Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - Yael Leitner
- The Pediatric ADHD Clinic, Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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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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Vetri L, Pepi A, Alesi M, Maltese A, Scifo L, Roccella M, Quatrosi G, Elia M. Poor School Academic Performance and Benign Epilepsy with Centro-Temporal Spikes. Behav Sci (Basel) 2023; 13:bs13020106. [PMID: 36829335 PMCID: PMC9952252 DOI: 10.3390/bs13020106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Poor academic performance of students with epilepsy seems to be a multifactorial problem related to difficulties in reading, writing, math, and logic skills. Poor school and academic performances refer to learning problems in a specific academic area due to learning disorders and learning difficulties not excluding the ability to learn in a different manner during school and academic life. Sometimes, school, academic difficulties, and Rolandic epilepsy can coexist together, and there may be comorbidities. Consequently, the risk of impaired academic performance in people with epilepsy is high. METHODS This review analyzed the relationship between Benign Epilepsy with Centro-Temporal Spikes (BECTS) and poor school and academic performance (PSAP) in children and adolescents (aged 6 to 19), and in adults (aged 20 to no age limit). The PRISMA guideline was used to guide our review strategy. RESULTS This research shows that Benign Epilepsy with Centro-Temporal Spikes (BECTS) and poor school and academic performances are strongly correlated. An early onset age, as well as a long persistence of seizures, correlate more closely with PSAP. On the other hand, it appears that good pharmacological control of seizures and remission from the acute phase of the pathology support better school performance. CONCLUSIONS This review highlights how neuropsychological aspects are also involved in patients with BECTS and PSAP, both in the greater predisposition to the establishment of other neuropsychiatric conditions and in the possibility that stigma conditions and poor academic results may have repercussions on the adaptation and functioning of these subjects. Global management of the subject with BECTS and PSAP is essential, which also pays attention to the aspects of social and scholastic inclusion, both to achieve age-appropriate educational and behavioral objectives, to give the necessary tools for the growth of the individual, and to allow a serene transition to adulthood, favoring autonomous learning and better outcomes.
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Affiliation(s)
- Luigi Vetri
- Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy
- Correspondence: (L.V.); (L.S.)
| | - Annamaria Pepi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy
| | - Marianna Alesi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy
| | - Agata Maltese
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy
| | - Lidia Scifo
- Department of Human Studies-Communication, Education and Psychology, LUMSA University, 00193 Roma, Italy
- Correspondence: (L.V.); (L.S.)
| | - Michele Roccella
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy
| | - Giuseppe Quatrosi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy
| | - Maurizio Elia
- Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy
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Li Y, Wang Y, Jiang P, Sun J, Chen Q, Wang X. Alterations in the default mode network in rolandic epilepsy with mild spike-wave index in non-rapid eye movement sleep. Front Neurosci 2022; 16:944391. [PMID: 36017188 PMCID: PMC9395966 DOI: 10.3389/fnins.2022.944391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Rolandic epilepsy (RE) is one of the most common epilepsy syndromes during childhood. The aim of this study was to investigate the alterations in the default mode network (DMN) of RE patients whose spike-wave index (SWI) was within the 50–85% range during non-rapid eye movement (NREM) during sleep, as well as to detect early neuroimaging markers. Methods Resting-state data was recorded for each subject using magnetoencephalography (MEG). DMN-related brain regions were chosen as regions of interest. The spectral power and functional connectivity (FC) of the DMN were estimated through the use of minimum norm estimation (MNE) combined with Welch technique and corrected amplitude envelope correlation (AEC-c). Results The patient group included 20 patients with NREM phase 50% ≤ SWI < 85% (mild SWI group), and 18 typical RE patients (SWI < 50% group). At the regional level, the mild SWI group exhibited enhanced spectral power in the delta band of the bilateral posterial cingulate cortex and attenuated the spectral power in the alpha band of the bilateral posterial cingulate cortex. Enhanced spectral power in the bilateral precuneus (PCu) in the delta band and attenuated spectral power in the right lateral temporal cortex (LTC) in the alpha band were common across all RE patients. At the FC level, patients in the mild SWI group indicated increased AEC-c values between the bilateral posterial cingulate cortex in the delta band and between the left medial frontal cortex (MFC) and bilateral posterial cingulate cortex in the alpha band. Increased AEC-c values between the right PCu and left MFC in the delta band, and between the left PCu and right MFC in the theta band, were common across all RE patients. Moreover, the spectral power in the bilateral posterial cingulate cortex in the alpha band and the AEC-c value between the bilateral posterial cingulate cortex in the delta band demonstrated good discrimination ability. Conclusion The spectral power of the bilateral posterior cingulate cortex (PCC) in the alpha band and the AEC-c value between the bilateral PCC in the delta band may be promising indicators of early differentiation between mild SWI and typical RE.
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Affiliation(s)
- Yihan Li
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yingfan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ping Jiang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jintao Sun
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, China
| | - Xiaoshan Wang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Xiaoshan Wang,
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Miano S, Castelnovo A, Bruni O, Manconi M. Sleep microstructure in attention deficit hyperactivity disorder according to the underlying sleep phenotypes. J Sleep Res 2022; 31:e13426. [PMID: 34169594 DOI: 10.1111/jsr.13426] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/16/2023]
Abstract
The analysis of sleep microstructure in attention deficit hyperactivity disorder (ADHD) revealed an under-representation of the EEG slow component during NREM sleep. Previous studies either excluded or did not characterize objectively sleep disorders, which notoriously affect sleep architecture. The present study aimed to investigate the cyclic alternating pattern in a real clinical sample of children with ADHD, in whom sleep disorders could be considered. Twenty-seven consecutively enrolled drug-naïve children (mean age, 10.53 years; nine females) and 23 controls (mean age, 10.22 years; 11 females) underwent a full sleep investigation, including attended video-polysomnography. Visual cyclic alternating pattern analysis was performed in a blinded way. Children with ADHD had one or more sleep disorders (a narcolepsy-like phenotype was found in two cases, sleep onset insomnia in three cases, arousal disorder in one case, movement disorder phenotype in six cases and obstructive sleep apnea in 11 cases, and six children had sleep-related epileptiform discharges). Children with ADHD and normal controls showed a similar microstructure with a cyclic alternating pattern rate of about 50%. Children with obstructive sleep apnea had a significantly higher cyclic alternating pattern rate during stage N3. Despite not reaching statistical differences, a lower cyclic alternating pattern rate and A1 index were found in children without epileptic abnormalities/obstructive sleep apnea. Our analysis might allow differentiation of the "primary form" of ADHD associated with a decrease of NREM instability from those forms associated with sleep apnea and epileptic activity.
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Affiliation(s)
- Silvia Miano
- Sleep Medicine Unit, Civic Hospital of Lugano (EOC), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Anna Castelnovo
- Sleep Medicine Unit, Civic Hospital of Lugano (EOC), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Department of Developmental and Social Psychology, Sapienza University, Rome, Italy.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Mauro Manconi
- Sleep Medicine Unit, Civic Hospital of Lugano (EOC), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Department of Neurology, Inselspital, University Hospital, Bern, Switzerland.,Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
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12
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An O, Nagae LM, Aringazina A, Winesett SP. Comparative assessment of health-related quality of life with and without anticonvulsant therapy in patients with childhood epilepsy with centrotemporal spikes. J Int Med Res 2021; 49:3000605211039805. [PMID: 34459274 PMCID: PMC8408894 DOI: 10.1177/03000605211039805] [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] [Indexed: 11/17/2022] Open
Abstract
Objective To estimate anti-seizure medication (ASM) treatment burden and its effects on health-related quality of life (HRQOL) in new-onset childhood epilepsy with centrotemporal spikes (CECTS) using different treatment approaches in Kazakhstan. Methods Forty-three patients were followed prospectively during 2015 to 2020 for at least 2 years. Patients were divided into three groups: (1) history of ≤3 seizures (n = 32); (2) ≥4 seizures (n = 6); (3) cerebral palsy coexisting with CECTS (n = 5). The first group was subdivided into treated (n = 8) and observed (n = 24) subgroups. The shortened Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) was completed by parents after 6 months of follow-up. Results At the end of the study, all children had a sustained remission from seizures for at least 2 years. Differences were identified in emotional, social, and physical subscales between patients in the low seizure frequency group. Signs of low self-esteem, anxiety, depression, limited social interaction owing to pharmacotherapy, painful medical procedures, and stigma were reasons for decreased HRQOL in the treated subgroup. Overall HRQOL in treated (89.2 ± 5.2) patients was significantly decreased compared with observed children with low seizure frequency (98.0 ± 3.0). Conclusion ASM therapy does not necessarily improve and may decrease HRQOL in children with low seizure frequency CECTS.
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Affiliation(s)
- Olga An
- Department of Children's Diseases, Kazakhstan's Medical University, School of Public Health (KSPH), Almaty, Kazakhstan
| | - Lidia Mayumi Nagae
- Department of Medical Imaging, Neuroradiology, Banner University Medical Center, Tucson, AZ, USA
| | - Altyn Aringazina
- Department of Population Health and Social Sciences, Kazakhstan's Medical University, School of Public Health (KSPH), Almaty, Kazakhstan
| | - Steven Parrish Winesett
- Department of Pediatrics, Division of Pediatric Neurology, University of Florida, Gainesville, FL, USA
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Ahmed GK, Darwish AM, Khalifa H, Khashbah MA. Comparison of cognitive function, socioeconomic level, and the health-related quality of life between epileptic patients with attention deficit hyperactivity disorder and without. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-020-00054-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Abstract
Background
Epilepsy is one of the most common neurological conditions. Attention deficit hyperactivity disorder (ADHD) in children with epilepsy proves to be very common. Both epilepsy and ADHD impair quality of life. We aimed to evaluate cognitive function, socioeconomic level, and quality of life (QOL) among children with ADHD and epilepsy. A total of 100 children were divided into 5 groups (20 children/group) as (I) epilepsy, (II) ADHD with epilepsy, (III) ADHD with EEG changes, (IV) ADHD without EEG changes, and (V) control. Children aged between 6 and 11 years were recruited for this study. Early Childhood Epilepsy Severity Scale (E-Chess), Conners’ Parent Rating Scale (CPRS), Wechsler Intelligence Scale for Children-3rd edition (WISC-III), socioeconomic scale for assessment of social burden and socioeconomic classes, and PedsQL (quality of life measure) assessed.
Results
Children with ADHD and epilepsy had the lowest PedsQL total scores and lower scores than other groups especially in performance IQ score. The highest percentage of low socioeconomic class (25%) was observed in the group of ADHD with epilepsy and the group of epilepsy.
Conclusion
ADHD with epilepsy is associated with low performance IQ, poor socioeconomic level, and quality of life. Pediatric Quality of Life Inventory scores show significant correlation with total IQ score in the group of ADHD with epilepsy.
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ADHD and ADHD-related neural networks in benign epilepsy with centrotemporal spikes: A systematic review. Epilepsy Behav 2020; 112:107448. [PMID: 32916583 DOI: 10.1016/j.yebeh.2020.107448] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) and benign epilepsy with centrotemporal spikes (BECTS or rolandic epilepsy) present with a very high level of comorbidity. We aimed to review the existing literature focusing on two aspects: the possible role of epileptic activity in the damage of ADHD-related neural networks and the clinical approach to patients presenting with both conditions. MATERIAL AND METHODS A systematic review was performed using Sapienza Library System and PubMed. The following search terms have been considered: attention networks, ADHD, attention systems, rolandic epilepsy, benign epilepsy with centrotemporal spikes, centrotemporal spikes epilepsy, and focal epilepsy in children. The target population consisted of patients under 18 years of age diagnosed with either BECTS and ADHD or healthy controls. RESULTS Nine case-control and cohort studies have been selected. The reported prevalence of ADHD in patients with BECTS was around 60%. No clinical correlation was found between the medical records and the presence of ADHD in patients with BECTS, if not due to febrile convulsion (FC). One study showed higher levels of bilateral discharges in patients with severe ADHD. The negative influence of the age at onset of seizures was demonstrated on attention but not on intelligence quotient (IQ). Moreover, the frequency of seizures and the occurrence of discharges during nonrapid eye movement (NREM) sleep were correlated to attention impairment. From a neurobiological point of view, functional connectivity in patients with BECTS and ADHD appears to be disrupted. Two studies reported a specific impairment in selective visual attention, while one study underlined a decreased activation of the dorsal attention network (DAN). Two different studies found that patients with BECTS and comorbid ADHD presented with altered thickness in their magnetic resonance imaging (MRI) scans in the cortical and subcortical regions (including the frontal lobes, lingual-fusiform cortex, cuneus and precuneus, limbic area and pericalcarine cortex among others). This might explain the cognitive and behavioral symptoms such as poor selective visual attention, speech disturbance, and impulsivity. CONCLUSIONS Despite BECTS being considered to have a relative benign course, many studies have documented cognitive and/or behavioral problems in patients diagnosed with this type of epilepsy. In particular, children affected by rolandic epilepsy should receive a complete neuropsychological evaluation at seizure onset considering the high rate of comorbidity with ADHD. A further investigation of the common pathogenic substrate is desirable to better orientate the clinical and therapeutic interventions applied.
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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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Drechsler R, Brem S, Brandeis D, Grünblatt E, Berger G, Walitza S. ADHD: Current Concepts and Treatments in Children and Adolescents. Neuropediatrics 2020; 51:315-335. [PMID: 32559806 PMCID: PMC7508636 DOI: 10.1055/s-0040-1701658] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/28/2019] [Indexed: 12/17/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is among the most frequent disorders within child and adolescent psychiatry, with a prevalence of over 5%. Nosological systems, such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and the International Classification of Diseases, editions 10 and 11 (ICD-10/11) continue to define ADHD according to behavioral criteria, based on observation and on informant reports. Despite an overwhelming body of research on ADHD over the last 10 to 20 years, valid neurobiological markers or other objective criteria that may lead to unequivocal diagnostic classification are still lacking. On the contrary, the concept of ADHD seems to have become broader and more heterogeneous. Thus, the diagnosis and treatment of ADHD are still challenging for clinicians, necessitating increased reliance on their expertise and experience. The first part of this review presents an overview of the current definitions of the disorder (DSM-5, ICD-10/11). Furthermore, it discusses more controversial aspects of the construct of ADHD, including the dimensional versus categorical approach, alternative ADHD constructs, and aspects pertaining to epidemiology and prevalence. The second part focuses on comorbidities, on the difficulty of distinguishing between "primary" and "secondary" ADHD for purposes of differential diagnosis, and on clinical diagnostic procedures. In the third and most prominent part, an overview of current neurobiological concepts of ADHD is given, including neuropsychological and neurophysiological researches and summaries of current neuroimaging and genetic studies. Finally, treatment options are reviewed, including a discussion of multimodal, pharmacological, and nonpharmacological interventions and their evidence base.
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Affiliation(s)
- Renate Drechsler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Silvia Brem
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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Abstract
We aimed to explore the link between NREM sleep and epilepsy. Based on human and experimental data we propose that a sleep-related epileptic transformation of normal neurological networks underlies epileptogenesis. Major childhood epilepsies as medial temporal lobe epilepsy (MTLE), absence epilepsy (AE) and human perisylvian network (PN) epilepsies - made us good models to study. These conditions come from an epileptic transformation of the affected functional systems. This approach allows a system-based taxonomy instead of the outworn generalized-focal classification. MTLE links to the memory-system, where epileptic transformation results in a switch of normal sharp wave-ripples to epileptic spikes and pathological high frequency oscillations, compromising sleep-related memory consolidation. Absence epilepsy (AE) and juvenile myoclonic epilepsy (JME) belong to the corticothalamic system. The burst-firing mode of NREM sleep normally producing sleep-spindles turns to an epileptic working mode ejecting bilateral synchronous spike-waves. There seems to be a progressive transition from AE to JME. Shared absences and similar bilateral synchronous discharges show the belonging of the two conditions, while the continuous age windows - AE affecting schoolchildren, JME the adolescents - and the increased excitability in JME compared to AE supports the notion of progression. In perisylvian network epilepsies - idiopathic focal childhood epilepsies and electrical status epilepticus in sleep including Landau-Kleffner syndrome - centrotemporal spikes turn epileptic, with the potential to cause cognitive impairment. Postinjury epilepsies modeled by the isolated cortex model highlight the shared way of epileptogenesis suggesting the derailment of NREM sleep-related homeostatic plasticity as a common step. NREM sleep provides templates for plasticity derailing to epileptic variants under proper conditions. This sleep-origin explains epileptiform discharges' link and similarity with NREM sleep slow oscillations, spindles and ripples. Normal synaptic plasticity erroneously overgrowing homeostatic processes may derail toward an epileptic working-mode manifesting the involved system's features. The impact of NREM sleep is unclear in epileptogenesis occurring in adolescence and adulthood, when plasticity is lower. The epileptic process interferes with homeostatic synaptic plasticity and may cause cognitive impairment. Its type and degree depends on the affected network's function. We hypothesize a vicious circle between sleep end epilepsy. The epileptic derailment of normal plasticity interferes with sleep cognitive functions. Sleep and epilepsy interconnect by the pathology of plasticity.
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Affiliation(s)
- Péter Halász
- Szentágothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Anna Szűcs
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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18
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Besag FMC, Vasey MJ. Social cognition and psychopathology in childhood and adolescence. Epilepsy Behav 2019; 100:106210. [PMID: 31196824 DOI: 10.1016/j.yebeh.2019.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/04/2019] [Accepted: 03/10/2019] [Indexed: 11/16/2022]
Abstract
There is a substantial body of research on social cognition in adults with epilepsy, and in broad categories such as focal and generalized epilepsies, but much less has been written about social cognition in children with epilepsy (CWE), and in childhood-onset epilepsy syndromes specifically. In several of these syndromes, autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD), two disorders with social cognitive impairments, are reported. There is strong evidence for social cognitive deficits in juvenile myoclonic epilepsy (JME). There is also a considerable amount of evidence for such deficits in a number of syndromes that may be associated with ASD or ADHD, including West syndrome (WS), Dravet syndrome (DS), and the Landau-Kleffner syndrome (LKS). However, the evidence is of variable quality and incomplete across the range of childhood epilepsy syndromes. In some syndromes, childhood epilepsy substantially increases the risk of severe social cognitive impairment, which may persist after the seizures remit. This paper presents an overview of current research on social cognition in childhood epilepsy, with a particular focus on syndromes with a high prevalence of autistic and behavioral comorbidities. Social cognitive impairments represent a considerable additional challenge for patients and caregivers. Early diagnosis and intervention might significantly improve long-term social cognitive outcomes, highlighting the need for greater awareness among clinicians of this important topic. This article is part of the Special Issue "Epilepsy and social cognition across the lifespan".
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Affiliation(s)
- Frank M C Besag
- East London Foundation NHS Trust, 5-7 Rush Court, Bedford MK40 3JT, UK; University College, London, UK; King's College, London, UK.
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The role of sleep-related cognitive functions in the spectrum of benign epilepsy with centro-temporal spikes. Eur J Pediatr 2019; 178:1129-1137. [PMID: 31227889 DOI: 10.1007/s00431-019-03413-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 01/02/2023]
Abstract
Heterogeneous cognitive deficits have been described in the spectrum of benign epilepsy with centro-temporal spikes, which strongly correlate with the intensity of interictal epileptiform discharges and its spreading, in particular during sleep, mostly within the perisylvian cognitive network. The aim of this review is to discuss current findings regarding the connection between sleep alterations and cognitive function in the spectrum of benign epilepsy with centro-temporal spikes. A longer sleep onset latency is the only evident sleep macrostructure alteration reported in the spectrum of benign epilepsy with centro-temporal spikes. On a microstructural level, a higher spike count of descending compared to ascending slopes of sleep cycles, an impairment of slow wave downscaling, and amplitude and slope of slow waves were found in the spectrum of benign epilepsy with centro-temporal spikes. Moreover, children with benign epilepsy with centro-temporal spikes had a reduced non-rapid eye movement sleep instability, in terms of cyclic alternating pattern, similar to that found in children with attention-deficit hyperactivity disorders and in children with obstructive sleep apnea and centro-temporal spike during sleep. Children with benign epilepsy with centro-temporal spikes have a known comorbidity with attention-deficit hyperactivity disorders and obstructive sleep apnea.Conclusion: Considering the common sleep microstructure alterations, the presence of attention deficit and hyperactivity and/or sleep apnea may be a considered warning sign in the case of benign epilepsy with centro-temporal spikes. What is Known: • Sleep related-cognitive deficits have been described in the spectrum of benign epilepsy with centro-temporal spikes. The degree of sleep alterations may predict the neurocognitive outcome, and help clinicians to choose the right treatment. What is New: • Considering the common sleep microstructure alterations, attention deficit and sleep apnea, may be a considered warning signs.
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Bektaş G, Tekin U, Yıldız EP, Aydınlı N, Çalışkan M, Özmen M. Autism spectrum disorder and attention-deficit/hyperactivity disorder-related symptoms in benign childhood epilepsy with centrotemporal spikes: A prospective case-control study. Epilepsy Behav 2019; 95:61-64. [PMID: 31026784 DOI: 10.1016/j.yebeh.2019.03.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Benign childhood epilepsy with centrotemporal spikes (BECTS), one of the most common idiopathic epilepsy syndromes in children, has been associated with neuropsychological problems. PURPOSE The objective of this study was to investigate the frequency of symptoms related to comorbid neurodevelopmental disorders, the autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children with typical BECTS, and to identify corresponding risk factors. METHODS Children and adolescents with typical BECTS aged 6-16 years were included in the study period from January 1, 2017, to December 31, 2017. Children with atypical presentations of BECTS, other neurological disorders, and preexisting neuropsychiatric disorders were excluded. The ASD and ADHD were assessed by the Social Communication Questionnaire (SCQ) and the Turgay Diagnostic and Statistical Manual of Mental Disorders - 4th Edition - Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), respectively. Patients' scores were compared with those of healthy subjects. Correlation analyses were performed to evaluate the association between the age at seizure onset, the total number of seizures and the SCQ and T-DSM-IV-S scores. RESULTS Fifty-eight children with BECTS and 60 healthy children participated in the study. The total SCQ score, the SCQ reciprocal social interaction score, and the SCQ communication score significantly differed between children with BECTS and the control group (p = 0.001, p < 0.001, p = 0.001, respectively). The total ADHD score was significantly different between patients and controls (p < 0.001). A significant difference was observed between patients and controls in terms of the T-DSM-IV-S hyperactivity-impulsivity score and the T-DSM-IV-S inattention score (p = 0.012, p < 0.001, respectively). The age at seizure onset was significantly correlated with the total SCQ score (p = 0.03). The Spearman's correlation coefficient was 0.352 for the total SCQ score, indicating a positive association between the age at seizure onset and the total SCQ score. CONCLUSION Children with typical BECTS may have an increased risk of suffering from symptoms of ASD and ADHD. Children with late onset of seizures may be more likely to develop neuropsychological disturbances regarding ASD and ADHD.
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Affiliation(s)
- Gonca Bektaş
- Division of Pediatric Neurology, Department of Pediatrics, Bakırköy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey.
| | - Uğur Tekin
- Department of Child and Adolescent Psychiatry, Bakırköy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Edibe Pembegül Yıldız
- Division of Pediatric Neurology, Department of Pediatrics, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Nur Aydınlı
- Department of Pediatric Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mine Çalışkan
- Department of Pediatric Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Meral Özmen
- Department of Pediatric Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Levetiracetam versus carbamazepine in treatment of rolandic epilepsy. Epilepsy Behav 2019; 94:1-8. [PMID: 30884401 DOI: 10.1016/j.yebeh.2019.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/08/2019] [Accepted: 02/08/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of the current study was to systematically review the literature to compare the efficacy of levetiracetam (LEV) with that of carbamazepine (CBZ) to control seizures and reduce the burden of interictal epileptiform discharges in children with rolandic epilepsy (RE) and also to compare their tolerability. METHODS We searched the electronic database PubMed on January 9, 2019 for original articles that included the following English-language search terms in the title: "Rolandic epilepsy" OR "benign childhood epilepsy with centrotemporal spikes" since 2000. We concentrated our review on three main areas: 1. Neuropsychological impairments in children with RE; 2. Influence of epileptic activity on cognitive performance in RE; 3. Effects of antiepileptic drug (AED) therapies in RE. RESULTS The primary search yielded 308 papers. We reviewed the results and removed duplicate articles and all nonoriginal, non-English papers. Finally, after carefully reviewing the full texts, we included 44 original articles to achieve the aims of this review. CONCLUSION Physicians taking care of children with RE should be aware of the risks for cognitive dysfunctions in these patients and screen their patients for any subtle dysfunction that may affect their academic performance and achievement. If and when the physician decides to prescribe an AED for their patients with RE, LEV is probably a better option compared with CBZ to prescribe for these children.
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Halász P, Ujma PP, Fabó D, Bódizs R, Szűcs A. Epilepsy as a derailment of sleep plastic functions may cause chronic cognitive impairment - A theoretical review. Sleep Med Rev 2019; 45:31-41. [PMID: 30878843 DOI: 10.1016/j.smrv.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 12/31/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
We report on a peculiar way of chronic cognitive impairment associated with interictal epileptic activity during NREM sleep. We review three major groups of epilepsy: mesiotemporal epilepsy (MTLE) involving the epileptic derailment of the hippocampal declarative memory system; childhood developmental epileptic encephalopathies; and the spectrum disorders of the perisylvian communication network with the centrotemporal spike phenomenon, overarching child- and adulthood epilepsies, totaling up the majority of epilepsies in childhood. We outline high impact research-lines on the cognitive harm of epilepsy; causing specific or global cognitive decline through its interference with sleep plastic functions. We highlight the key role of interictal activity in the development of cognitive impairment and the fact that we are unarmed against this harm, antiepileptic pharmaco-therapy being ineffective against the interictal process marked by spikes and high frequency oscillations.
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Affiliation(s)
- Péter Halász
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary.
| | - Péter Przemyslaw Ujma
- Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary
| | - Róbert Bódizs
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary; Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Anna Szűcs
- National Institute of Clinical Neurosciences, Amerikai út 57, Budapest, H-1145, Hungary; Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
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Halász P, Kelemen A, Rosdy B, Rásonyi G, Clemens B, Szűcs A. Perisylvian epileptic network revisited. Seizure 2019; 65:31-41. [DOI: 10.1016/j.seizure.2018.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/27/2022] Open
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Halász P, Bódizs R, Ujma PP, Fabó D, Szűcs A. Strong relationship between NREM sleep, epilepsy and plastic functions - A conceptual review on the neurophysiology background. Epilepsy Res 2019; 150:95-105. [PMID: 30712997 DOI: 10.1016/j.eplepsyres.2018.11.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/08/2018] [Accepted: 11/15/2018] [Indexed: 12/15/2022]
Abstract
The aim of this review is to summarize and discuss the strong bond between NREM sleep and epilepsy underlain by the shared link and effect on brain plasticity. Beyond the seizure occurrence rate, sleep relatedness may manifest in the enhancement of interictal epileptic discharges (spikes and pathological ripples). The number of the discharges as well as their propagation increase during NREM sleep, unmasking the epileptic network that is hidden during wakefulness. The interictal epileptic discharges associate with different sleep constituents (sleep slow waves, spindling and high frequency oscillations); known to play essential role in memory and learning. We highlight three major groups of epilepsies, in which sleep-related plastic functions suffer an epileptic derailment. In absence epilepsy mainly involving the thalamo-cortical system, sleep spindles transform to generalized spike-wave activity. In mesio-temporal epilepsy affecting the hippocampal declarative memory system, the sharp wave ripples derail to dysfunctional epileptic oscillations (spikes and pathological ripples). Idiopathic childhood epilepsies affecting the perisylvian network may progress to catastrophic status electricus during NREM sleep. In these major epilepsies, NREM sleep has a pivotal role in the development and course of the disorder. Epilepsy is born in-, and exhibits its pathological properties during NREM sleep. Interictal discharges are important causative agents in this process.
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Affiliation(s)
- Péter Halász
- National Institute of Clinical Neuroscience, Amerikai út 57. Budapest, H-1145, Hungary.
| | - Róbert Bódizs
- Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Péter Przemyslaw Ujma
- Semmelweis University, Institute of Behavioral Sciences, Nagyvárad tér 4, Budapest, H-1089, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neuroscience, Amerikai út 57. Budapest, H-1145, Hungary
| | - Anna Szűcs
- National Institute of Clinical Neuroscience, Amerikai út 57. Budapest, H-1145, Hungary
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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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