1
|
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. [PMID: 38798030 DOI: 10.1002/epi4.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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.
Collapse
Affiliation(s)
- Zimeng He
- Shandong University, Jinan, Shandong, China
| | - Xiaofan Yang
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yumei Li
- Shandong University, Jinan, Shandong, China
| | | | - Jun Li
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Baomin Li
- Shandong University, Jinan, Shandong, China
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Rogač Ž, Stevanović D, Bečanović S, Dimitrijević A, Andrić I, Božić L, Nikolić DM. Onset of Inattention and Hyperactivity in Children and Adolescents With Epilepsy 6 months After the Diagnosis. J Atten Disord 2023; 27:1662-1669. [PMID: 37465953 DOI: 10.1177/10870547231187150] [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] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Complete or major symptoms of ADHD are often present in epilepsy. This study evaluated inattention and hyperactivity symptoms over the first 6 months in newly diagnosed pediatric epilepsy without comorbid ADHD. METHOD Children and adolescents with newly diagnosed epilepsy were followed for 6 months after starting antiseizure medications. The Nisonger Child Behavior Rating Form (NCBRF), Adverse Event Profile (AEP), and the Revised Wechsler Intelligence Scale for Children were used. RESULTS There was a marked increase in attention difficulties while a moderate increase in hyperactivity levels. AEP scores, changes in non-verbal aspects of intelligence, levels of hyperactivity at the follow-up, and attention at baseline were significant predictors for inattention. In contrast, only levels of hyperactivity at the baseline and inattention at the follow-up were significant predictors for hyperactivity. CONCLUSION Significant inattention and hyperactivity levels originated 6 months after the diagnosis of epilepsy and starting antiseizure medication.
Collapse
Affiliation(s)
- Željka Rogač
- Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Dejan Stevanović
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | | | | | | | | | - Dimitrije M Nikolić
- University Children's Hospital, Belgrade, Serbia
- University of Belgrade, Serbia
| |
Collapse
|
4
|
Luo X, Li C, Yu X, Kuang G, Wang X, Liang J, Jiang J. The effect of hippocampal NR2B-containing NMDA receptors on chronic cognitive dysfunction in rats with temporal lobe epilepsy. ACTA EPILEPTOLOGICA 2023. [DOI: 10.1186/s42494-022-00111-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
We have previously reported that hippocampal long-term potentiation (LTP) was suppressed in temporal lobe epilepsy (TLE) rats. The N-methyl-D-aspartic acid receptors containing 2B subunit (NR2B-NMDARs) are indispensable to induce the LTP of hippocampus. However, it is still unknown whether the NR2B-NMDARs are implied with the cognitive dysfunction in TLE rats.
Methods
The TLE model was lithium chloride-pilocarpine (li-pilo) model. Morris water maze test was used to evaluate the cognitive function of epileptic rats. Expression of hippocampal NR2B-NMDAs was evaluated by western blotting. Stereotactic injection of NMDA, an agonist of NR2B-NMDARs, into the hippocampus of TLE rats was used to investigate the role of NR2B-NMDARs on cognitive dysfunction.
Results
Cognitive function TLE rats was significantly reduced compared with controls in the Morris water maze test (P < 0.05). Western blotting data showed the down-expression of hippocampal NR2B-NMDARs and p-NR2B in TLE rats compared with the control (P < 0.05). In addition, hippocampal stereolocalization of NMDA injection improved partially the learning and memory in TLE rats (P < 0.05).
Conclusions
Down-expression and low activity of hippocampal NR2B-NMDARs may be implied with chronic cognitive dysfunction in TLE rats.
Collapse
|
5
|
Chen RH, Li BF, Wen JH, Zhong CL, Ji MM. Clinical and electroencephalogram characteristics and treatment outcomes in children with benign epilepsy and centrotemporal spikes. World J Clin Cases 2021; 9:10116-10125. [PMID: 34904081 PMCID: PMC8638062 DOI: 10.12998/wjcc.v9.i33.10116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/08/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Epilepsy is a syndrome characterized by transient, rigid, paroxysmal, and repetitive central nervous system dysfunction. Prevention, control, and improvement of cognitive and behavioral dysfunction are of great significance for improving the patients’ intellectual development and quality of life. Electroencephalograms (EEG) can predict an accelerated decline in cognitive function.
AIM To determine the clinical and EEG characteristics and treatment results of benign epilepsy in spiking children.
METHODS A total of 106 cases of benign epilepsy in children with myocardial spines treated at our hospital from January 2017 to January 2020 were selected. Differences in clinical data and EGG characteristics between treatment-effective/-ineffective patients were analyzed, and children’s intellectual development before and after treatment evaluated using the Gesell Development Diagnostic Scale.
RESULTS EEG showed that the discharge proportion in the awake and sleep periods was 66.04%, and the peak/peak discharge was mainly single-sided, accounting for 81.13%, while the discharge generalization accounted for 31.13%. There was no significant difference in any of these variables between sexes and ages (P > 0.05). The proportion of patients with early onset (< 5 years old) and seizure frequency > 3 times/half a year was 40.00% and 60.00%, respectively; the incidence rate and seizure frequency in the younger age group (< 5 years old) were significantly higher than those in the treatment-effective group (P < 0.05), while the discharge index was significantly lower than that in the treatment-effective group (P < 0.05). The discharge index was negatively correlated with fine motor skill and language development (r = -0.274 and -0.247, respectively; P < 0.05), but not with the rest (P > 0.05). Logistic regression analysis showed that low age onset (< 5 years old) and seizure frequency were the factors affecting ineffective-treatment of benign epilepsy in children (odds ratio = 11.304 and 5.784, respectively; P < 0.05). The discharge index of the responsive group after treatment was significantly lower than that of the unresponsive group (P < 0.05). However, there was no significant difference between groups after treatment in gross and fine motor skills, adaptability, language, and personal social development (P > 0.05).
CONCLUSION The EEG of children with benign epilepsy due to spinal wave in central time zone has characteristic changes, and the therapeutic effect is influenced by age of onset and attack frequency.
Collapse
Affiliation(s)
- Rui-Hua Chen
- Department of Children’s Neurology, Ganzhou Maternal and Child Health Hospital, Ganzhou 341000, Jiangxi Province, China
| | - Bing-Fei Li
- Department of Pediatrics, Ganzhou Maternal and Child Health Hospital, Ganzhou 341000, Jiangxi Province, China
| | - Jian-Hua Wen
- Department of Pediatrics, Ningdu County People's Hospital, Ganzhou 341000, Jiangxi Province, China
| | - Chun-Lan Zhong
- Department of Pediatrics, Ganzhou Maternal and Child Health Hospital, Ganzhou 341000, Jiangxi Province, China
| | - Ming-Ming Ji
- Department of Pediatrics, Ganzhou Maternal and Child Health Hospital, Ganzhou 341000, Jiangxi Province, China
| |
Collapse
|
6
|
Sager G, Vatansever Z, Batu U, Çağ Y, Akin Y. Neuropsychiatric comorbidities in genetic/idiopathic generalized epilepsies and their effects on psychosocial outcomes. Epilepsy Behav 2021; 124:108339. [PMID: 34600282 DOI: 10.1016/j.yebeh.2021.108339] [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: 06/30/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Idiopathic/genetic generalized epilepsy (GGE) accounts for 15-20% of all epilepsy cases. Neuropsychiatric comorbidities and disorders, such as attention-deficit hyperactivity disorder (ADHD), academic failure, and poor social competence, are present at a higher rate in patients with epilepsy compared with the general population. In this study, we aimed to determine the frequency of neuropsychiatric comorbidities in GGE subgroups, and to reveal the risk factors in the patient group with neuropsychiatric comorbidities. MATERIAL AND METHOD This hospital-based, cross-sectional study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Patients with seizure-controlled GGE were invited to a semi-structured interview at the hospital. Variables [photosensitivity, valproic acid (VPA) resistance, timing of the neuropsychiatric comorbidities Attention deficit and hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and low academic performance), seizure control, and timing of the antiepileptic treatment] were statistically analyzed and evaluated in terms of their association with GGE subgroups [Generalized tonic-clonic seizures alone (EGTGS), juvenile myoclonic epilepsy (JME), and juvenile absence epilepsy (JAE)], RESULTS: Total 101 patients with GGE were included in the study and the mean age was 13.94 ± 1.66 years. A total of 12.9% (n = 13) of the patients had EGTGS, 49.5% (n = 50) had JME, and 37.6% (n = 38) had JAE. VPA resistance, photosensitivity, and the presence of neuropsychiatric symptoms before the starting of epilepsy were found to be risk factors in the GGE group with neuropsychiatric comorbidities compared with the group without neuropsychiatric comorbidities (p < 0.001). The subgroups of GGE did not show any relationship with psychiatric disorders, including ADHD, ODD, and low academic performance (neuropsychiatric comorbidities) (p > 0.005). No correlation was found between seizure control and decline in neuropsychiatric symptoms (p > 0.05). CONCLUSION In this study, the onset of psychiatric symptoms prior to the onset of epilepsy, photosensitivity, and VPA resistance were the most important factors affecting neuropsychiatric comorbidities. The JME, JAE, and EGTCS subgroups, early initiation of antiepileptic treatment, and seizure control were found to have no effect on poor psychosocial outcome and neuropsychiatric comorbidities.
Collapse
Affiliation(s)
- Gunes Sager
- Department of Pediatric Neurology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
| | - Zeynep Vatansever
- Department of Child and Adolescent Psychiatry Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Utku Batu
- Department of Pediatrics, Van Education and Research Hospital, Van, Turkey
| | - Yakup Çağ
- Department of Pediatrics, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Yasemin Akin
- Department of Pediatrics, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| |
Collapse
|
7
|
Kuzman Z, Mlinarevic-Polic I, Aleric I, Katalinic D, Vcev A, Babic D. Clinical evaluation of psychiatric and behavioral disorders in adolescents with epilepsy: a cross-sectional study. Nord J Psychiatry 2020; 74:352-358. [PMID: 31961263 DOI: 10.1080/08039488.2020.1715475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Epilepsy is a neurological disease that is often associated with psychiatric comorbidities.Subjects and methods: The aim of the study was to examine the frequency of psychic symptoms and their association with different types of epilepsy in the adolescent population. The study involved 100 adolescents with epilepsy and 100 healthy adolescents of both sexes at the age of 13-19. The examinees completed a standardized Symptom Checklist-90-R (SCL-90-R) questionnaire, concerning self-assessment of psychological disorders in the previous week. The value system of nine dimensions and three global indexes of SCL-90-R scales were analyzed.Results: Our results suggest that adolescents with epilepsy have more than one psychic disorder compared to a healthy group of respondents. Somatic symptoms are more common in non-epileptic subjects, while obsessive-compulsive, depressive and phobic symptoms, as well as anxiety, aggressiveness, interpersonal vulnerability and paranoia, are more common in adolescents with epilepsy. Due to the type of epilepsy, obsessive compulsive symptoms are more common in adolescents with focal epilepsy, while the symptoms of phobia are more present in those with generalized epilepsy. The depth and intensity of psychological stress is higher in the group of adolescents with epilepsy compared to the healthy group of respondents.Conclusions: Psychiatric comorbidity is very common in epileptic patients and depending on the type of diagnosed epilepsy, various symptoms are expressed. Furthermore, psychological stress is more observable in adolescents with epilepsy. For patients with epilepsy, mental health care and seizure control is extremely important in the prevention of serious mental disabilities.
Collapse
Affiliation(s)
- Zdravko Kuzman
- Department of Pediatrics, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ines Mlinarevic-Polic
- Department of Pediatrics, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ivan Aleric
- Department of Clinical Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Internal Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Pulmonology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Darko Katalinic
- Department of Clinical Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Internal Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Aleksandar Vcev
- Department of Clinical Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Internal Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Dragan Babic
- Department of Psychiatry, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| |
Collapse
|
8
|
Abstract
Psychiatric and cognitive disturbances are the most common comorbidities of epileptic disorders in children. The successful treatment of these comorbidities faces many challenges including their etiologically heterogonous nature. Translational neurobehavioral research in age-tailored and clinically relevant rodent seizure models offers a controlled setting to investigate emotional and cognitive behavioral disturbances, their causative factors, and potentially novel treatment interventions. In this review, we propose a conceptual framework that provides a nonsubjective approach to rodent emotional behavioral testing with a focus on the clinically relevant outcome of behavioral response adaptability. We also describe the battery of neurobehavioral tests that we tailored to seizure models with prominent amygdalo-hippocampal involvement, including testing panels for anxiety-like, exploratory, and hyperactive behaviors (the open-field and light-dark box tests), depressive-like behaviors (the forced swim test), and visuospatial navigation (Morris water maze). The review also discusses the modifications we introduced to active avoidance testing in order to simultaneously test auditory and hippocampal-dependent emotionally relevant learning and memory. When interpreting the significance and clinical relevance of the behavioral responses obtained from a given testing panel, it is important to avoid a holistic disease-based approach as a specific panel may not necessarily mirror a disease entity. The analysis of measurable behavioral responses has to be performed in the context of outcomes obtained from multiple related and complementary neurobehavioral testing panels. Behavioral testing is also complemented by mechanistic electrophysiological and molecular investigations.
Collapse
|
9
|
Oyegbile TO. The role of task-based neural activation research in understanding cognitive deficits in pediatric epilepsy. Epilepsy Behav 2019; 99:106332. [PMID: 31399340 DOI: 10.1016/j.yebeh.2019.05.028] [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: 03/20/2019] [Revised: 05/15/2019] [Accepted: 05/19/2019] [Indexed: 11/29/2022]
Abstract
Children with epilepsy can experience significant cognitive dysfunction that can lead to academic underachievement. Traditionally believed to be primarily due to the effects of factors such as the chronicity of epilepsy, medication effects, or the location of the primary epileptogenic lesion;, recent evidence has indicated that disruption of cognition-specific distributed neural networks may play a significant role as well. Specifically, over the last decade, researchers have begun to characterize the mechanisms underlying disrupted cognitive substrates by evaluating neural network abnormalities observed during specific cognitive tasks, using task-based functional magnetic resonance imaging (fMRI). This targeted review assesses the current literature investigating the relationship between neural network abnormalities and cognitive deficits in pediatric epilepsy. The findings indicate that there are indeed neural network abnormalities associated with deficits in executive function, language, processing speed, and memory. Overall, cognitive dysfunction in pediatric epilepsy is associated with a decrease in neural network activation/deactivation as well as increased recruitment of brain regions not typically related to the specific cognitive task under investigation. The research to date has focused primarily on children with focal epilepsy syndromes with small sample sizes and differing research protocols. More extensive research in children with a wider representation of epilepsy syndromes (including generalized epilepsy syndromes) is necessary to fully understand these relationships and begin to identify underlying cognitive phenotypes that may account for the variability observed across children with epilepsy. Furthermore, more uniformity in fMRI protocols and neuropsychological tasks would be ideal to advance this literature.
Collapse
Affiliation(s)
- Temitayo O Oyegbile
- Georgetown University Medical Center, Washington, D.C., United States of America.
| |
Collapse
|