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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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Wu Z, Li X, Huang Y, Huang K, Xiao B, Chi Y, Feng L, Yang H. Effects of a Nurse-Led Cognitive Behavioral Intervention for Parents of Children With Epilepsy. Pediatr Neurol 2024; 154:70-78. [PMID: 38552337 DOI: 10.1016/j.pediatrneurol.2024.03.003] [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: 12/20/2022] [Revised: 02/18/2024] [Accepted: 03/03/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND This study aimed to evaluate the effects of a nurse-led cognitive behavioral intervention for parents of children with epilepsy (CWE). METHODS The study recruited 238 CWE from the neurology ward of Xiangya Hospital from March 2019 to August 2022. According to the interventions after discharge, the children and their parents were randomly divided into 117 parent-child dyads in the intervention group and 121 parent-child dyads in the control group. The seizure severity and treatment compliance in CWE as well as the parents' psychological states and satisfaction with the care provided by nurses were compared before and after intervention. RESULTS The follow-up six months after discharge showed that the seizure frequency among CWE in the intervention group was significantly less than the controls (P = 0.048). Compared with the controls, the intervention group also reported fewer symptoms of anxiety and depression, better sleep quality, and more positive attitudes toward epilepsy, as well as higher nursing satisfaction (P < 0.001). The correlation analysis indicated the correlation of CWE's seizure severity was correlated with the compliance, parents' psychological states, and parents' satisfaction with the care provided by nurses. CONCLUSIONS The adoption of the nurse-led cognitive behavioral intervention on parents of CWE can improve the parents' mental health status and their satisfaction with the nurses, which can have a positive association with the seizure severity of CWE. In light of this information, this nursing intervention may be a new method for the long-term disease management of CWE.
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Affiliation(s)
- Zhongling Wu
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Clinical Nursing Teaching and Research Section, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaolei Li
- Department of Cardiology, Laizhou People's Hospital, Yantai, Shandong, China
| | - Yuanxin Huang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Clinical Nursing Teaching and Research Section, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kailing Huang
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Neurology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Neurology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yunfang Chi
- Department of Cardiology, Laizhou People's Hospital, Yantai, Shandong, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Neurology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Neurology, Xiangya Hospital, Central South University (Jiangxi Branch), Nanchang, Jiangxi, China.
| | - Haojun Yang
- Department of Anesthesiology, Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Miller DJ, Komanapalli H, Dunn DW. Comorbidity of attention deficit hyperactivity disorder in a patient with epilepsy: Staring down the challenge of inattention versus nonconvulsive seizures. Epilepsy Behav Rep 2024; 25:100651. [PMID: 38357032 PMCID: PMC10865219 DOI: 10.1016/j.ebr.2024.100651] [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: 10/23/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
Epilepsy is a heterogeneous disorder of recurrent seizures which often is comorbid with anxiety, depression, attention deficit hyperactivity disorder (ADHD), intellectual disability (ID), and other psychiatric manifestations. Treating both epilepsy and behavioral symptoms from psychiatric disorders can result in polypharmacy with interactions of medications leading to both worsened efficacy of antiseizure medications due to psychotropic effects and worsening of psychiatric symptoms due to antiseizure medication side effects. We aim to suggest pragmatic strategies for the neurologist in the diagnosis and management of comorbid ADHD in patients with epilepsy based on the International League Against Epilepsy (ILAE) Pediatric Commission guidelines and additional literature review. The screening tool of choice for the symptoms of ADHD is validated in the country of practice and written in the language of the family, though various screening tools and advantages and disadvantages of each will be discussed. Once ADHD is diagnosed, recent safety data suggest that Methylphenidate, Amphetamine, and Atomoxetine are generally safe for patients with epilepsy. We present a case of a child with epilepsy and ADHD and discuss the clinical signs, symptoms, and strategies for treatment as well as when to refer to child psychiatry.
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Affiliation(s)
- Derryl J. Miller
- Clinical Neurology, Indiana University School of Medicine and Riley Hospital for Children, 705 Riley Hospital Dr, Indianapolis, IN 46202, USA
| | - Hannah Komanapalli
- Undergraduate Medical Education, Indiana University School of Medicine, 635 Barnhill Dr, Indianapolis, IN 46202, USA
| | - David W. Dunn
- Psychiatry and Neurology, Indiana University School of Medicine and Riley Hospital for Children, 705 Riley Hospital Dr, Indianapolis, IN 46202, USA
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Wang S, Yao B, Zhang H, Xia L, Yu S, Peng X, Xiang D, Liu Z. Comorbidity of epilepsy and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Neurol 2023; 270:4201-4213. [PMID: 37326829 DOI: 10.1007/s00415-023-11794-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
Epilepsy and attention-deficit/hyperactivity disorder (ADHD) are common neurological and neuropsychiatric disorders, respectively, that can exist as comorbidities. However, the degree of comorbidity between both disorders has never been quantified based on a systematic review with meta-analysis. We performed a systematic search of the literature in Embase, PubMed, PsychINFO and the Cochrane Library on June 20, 2022. In a meta-analysis of 63 studies with a total sample size of 1,073,188 individuals (172,206 with epilepsy and 900,982 with ADHD) from 17 countries, the pooled prevalence of ADHD in epilepsy was 22.3% (95% CI 20.3-24.4%). The highest pooled prevalence was 12.7% (95% CI 9-17.1%) for ADHD-I subtype, whereas the pooled prevalence of epilepsy in ADHD was 3.4% (95% CI 2.53-4.21%). However, substantial heterogeneity in comorbidity rates was observed and partially attributed to the following factors: sample size, sample specification, geographical variations and diagnostic methods. Our study highlights the need for increased awareness of this diagnostic co-occurrence, and research is warranted to elucidate the underlying pathophysiological mechanisms.
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Affiliation(s)
- Shun Wang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Baozhen Yao
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Haiju Zhang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Liping Xia
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Shiqian Yu
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xia Peng
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Dan Xiang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Elhady M, Elattar RS, Elaidy AMA, Abdallah NA, Elmalt HA. Role of inflammation in childhood epilepsy and ADHD comorbidity. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:291-296. [PMID: 32841085 DOI: 10.1080/21622965.2020.1807982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Epilepsy is a heterogeneous disorder that is not limited to experiencing seizures but also includes multiple neuropsychiatric squeal (i.e. attention-deficit/hyperactivity disorder (ADHD), depression and anxiety) that adversely impact a child quality of life. However, the underlying mechanism linking both disorders is not yet thoroughly explored. Our objective was to assess pro-inflammatory cytokines levels in children with seizure controlled epilepsy and explore the association between pro-inflammatory cytokines and the co-occurrence of ADHD in such children. A cross-sectional study included 50 children with controlled epilepsy for at least one year, in addition to 30 neurotypical children as controls. All children were assessed by the Conner parent scale for ADHD. Serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) levels were measured and correlated to clinical data. In the present study, 23 out of 50 children with epilepsy also had ADHD (46%). Children with ADHD have been found to have a significantly lower age of onset, longer duration of epilepsy, and a higher serum level of IL-6 and TNF-α than those without ADHD. The Conner's parent rating scale overall total score yielded significant negative correlations with the age of onset of epilepsy and a significant positive correlation with the duration of epilepsy and pro-inflammatory cytokine levels. In addition to active seizures, the presence of elevated circulating inflammation markers may be associated with increased frequency of ADHD in children with epilepsy aged 6-14 years.
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Affiliation(s)
- Marwa Elhady
- Pediatric Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Rasha Sobhy Elattar
- Neurology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | | | | | - Heba A Elmalt
- Medical Biochemistry, National Research Center, Cairo, Egypt
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