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[Supplementary motor area epilepsy associated with ADHD in an abused history]
1Department of Pediatrics, National Chushin-Matsumoto Hospital, Matsumoto, Nagano.
Insights
Environmental adjustments alongside medication improved supplementary motor area (SMA) epilepsy and attention-deficit hyperactivity disorder (ADHD) symptoms in a child. This highlights the link between frontal lobe function and both conditions.
Area of Science:
- Neurology
- Child Psychiatry
Background:
- Attention-deficit hyperactivity disorder (ADHD) and epilepsy can co-occur, often indicating underlying neurological dysfunction.
- Childhood trauma, such as abuse, can have profound impacts on neurodevelopment and contribute to psychiatric and neurological disorders.
Observation:
- A 6-year-old girl with a history of infant abuse and ADHD developed supplementary motor area (SMA) epilepsy.
- Seizures were characterized by bilateral tonic activity, speech arrest, preserved consciousness, and brief duration, consistent with SMA epilepsy.
- Initial treatment with anti-epileptic drugs provided temporary relief, but seizures recurred, suggesting a link to the patient's mental state.
Findings:
- Diagnosis of SMA epilepsy was confirmed through clinical presentation, EEG, video-EEG, and SPECT.
- A combined treatment approach involving anti-epileptic drugs and environmental modification, in collaboration with a child guidance clinic, led to seizure and ADHD symptom improvement.
- The improvement suggests a potential relationship between frontal lobe dysfunction, epilepsy, and ADHD symptoms.
Implications:
- Environmental interventions can be effective in managing certain types of epilepsy, particularly those linked to frontal lobe dysfunction.
- Addressing psychological factors and improving the living environment may ameliorate both epileptic seizures and ADHD symptoms in children.
- This case underscores the interconnectedness of neurological and psychological health in pediatric patients and the benefits of integrated treatment approaches.
Abstract:
A 6-year-old girl with attention-deficit hyperactivity disorder (ADHD) who had been abused by her mother in infancy developed supplementary motor area (SMA) epilepsy. The seizure was characterized by bilateral tonic seizure of the upper and lower extremities, speech arrest, preserved consciousness and a lack of postictal confusion. The duration of the seizure was usually 10-60 seconds. The seizures sometimes clustered. She was diagnosed as having SMA epilepsy based on the characteristic clinical symptoms, interictal EEG, ictal video-EEG and ictal SPECT. Though her seizure was initially improved by anti-epileptic drugs, the symptoms appeared again after discharge. Since her clinical course indicated that her seizure was aggravated by her mental state, treatment included both medication with anti-epileptic drugs and the adjustment of her living environment in cooperation with a child guidance clinic. Thereafter both her epileptic seizure and ADHD symptoms improved. These changes may be related to each other, because both conditions are associated with frontal lobe dysfunction. It was interesting that the adjustment of the environment improved frontal lobe epilepsy, which in turn ameliorated ADHD symptoms.