The frequency, complications and aetiology of ADHD in new onset paediatric epilepsy
Bruce Hermann1, Jana Jones, Kevin Dabbs
1Matthews Neuropsychology Lab, Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA. hermann@neurology.wisc.edu
Insights
Attention Deficit Hyperactivity Disorder (ADHD) is common in childhood epilepsy, often preceding seizures. This condition is linked to academic, cognitive, and behavioral issues, and may involve brain structure differences.
Area of Science:
- Neuroscience
- Pediatrics
- Psychiatry
Background:
- Attention Deficit Hyperactivity Disorder (ADHD) is increasingly recognized as a common comorbidity in childhood epilepsy.
- However, the specific nature, frequency, timing, and etiology of ADHD in pediatric epilepsy remain poorly understood.
Purpose of the Study:
- To investigate the prevalence and subtypes of ADHD in children with new-onset idiopathic epilepsy.
- To examine the association of ADHD with academic, neuropsychological, behavioral, and psychiatric status.
- To explore the underlying etiology of ADHD in this population.
Main Methods:
- Seventy-five children with new-onset idiopathic epilepsy and 62 healthy controls (ages 8-18) were assessed.
- Methods included structured interviews (K-SADS) for ADHD diagnosis, neuropsychological testing, quantitative MRI, executive function assessment, academic review, and risk factor evaluation.
Main Results:
- ADHD prevalence was significantly higher in children with epilepsy (31%) compared to controls (6%), predominantly the inattentive subtype.
- ADHD onset often predated epilepsy diagnosis.
- ADHD was associated with increased need for academic support, executive function deficits, and dysexecutive behaviors.
- Quantitative MRI revealed increased frontal lobe gray matter and smaller brainstem volume in children with ADHD and epilepsy.
Conclusions:
- ADHD is a prevalent comorbidity in new-onset idiopathic epilepsy, presenting significant educational, cognitive, and behavioral challenges.
- These complications frequently antedate epilepsy onset and appear linked to neurodevelopmental brain structure abnormalities.
- ADHD in pediatric epilepsy is not associated with demographic factors or perinatal risks.
Abstract:
Recent studies suggest that Attention Deficit Hyperactivity Disorder (ADHD) is a common comorbid condition in childhood epilepsy, but little is known regarding the nature, frequency and timing of associated neurobehavioural/cognitive complications or the underlying aetiology of ADHD in epilepsy. This investigation examined: (i) the prevalence of ADHD and its subtypes; (ii) the association of ADHD with abnormalities in academic, neuropsychological, behavioural and psychiatric status and (iii) the aetiology of ADHD in paediatric epilepsy. Seventy-five children (age 8-18) with new/recent onset idiopathic epilepsy and 62 healthy controls underwent structured interview (K-SADS) to identify the presence and type of DSM-IV defined ADHD, neuropsychological assessment, quantitative MR volumetrics, characterization of parent observed executive function, review of academic/educational progress and assessment of risk factors during gestation and delivery. The results indicate that ADHD is significantly more prevalent in new onset epilepsy than healthy controls (31% versus 6%), characterized predominantly by the inattentive variant, with onset antedating the diagnosis of epilepsy in the majority of children. ADHD in childhood epilepsy is associated with significantly increased rates of school based remedial services for academic underachievement, neuropsychological consequences with prominent differences in executive function, and parent-reported dysexecutive behaviours. ADHD in paediatric epilepsy is neither associated with demographic or clinical epilepsy characteristics nor potential risk factors during gestation and birth. Quantitative MRI demonstrates that ADHD in epilepsy is associated with significantly increased gray matter in distributed regions of the frontal lobe and significantly smaller brainstem volume. Overall, ADHD is a prevalent comorbidity of new onset idiopathic epilepsy associated with a diversity of salient educational, cognitive, behavioural and social complications that antedate epilepsy onset in a significant proportion of cases, and appear related to neurodevelopmental abnormalities in brain structure.
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