Role of inflammation in childhood epilepsy and ADHD comorbidity
Marwa Elhady1, Rasha Sobhy Elattar2, Asmaa Mohamed Ali Elaidy3
1Pediatric Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
Insights
Children with controlled epilepsy and attention-deficit/hyperactivity disorder (ADHD) exhibit higher levels of pro-inflammatory cytokines like IL-6 and TNF-α. This suggests inflammation may link epilepsy and ADHD in pediatric patients.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Immunology
Background:
- Epilepsy is a complex neurological disorder with significant neuropsychiatric comorbidities, including ADHD, impacting children's quality of life.
- The underlying mechanisms connecting epilepsy and ADHD remain underexplored, necessitating further investigation into potential biological links.
- Inflammation is increasingly recognized as a factor in various neurological and psychiatric conditions.
Purpose of the Study:
- To investigate pro-inflammatory cytokine levels in children with seizure-controlled epilepsy.
- To explore the association between these cytokine levels and the co-occurrence of ADHD in children with epilepsy.
- To identify potential inflammatory markers associated with ADHD in this population.
Main Methods:
- A cross-sectional study involving 50 children with epilepsy (controlled for ≥1 year) and 30 neurotypical controls.
- Assessment of ADHD using the Conner parent rating scale.
- Measurement of serum Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α) levels, correlated with clinical data.
Main Results:
- 46% of children with epilepsy also presented with ADHD.
- Children with ADHD exhibited a younger age of epilepsy onset, longer epilepsy duration, and significantly higher IL-6 and TNF-α serum levels.
- Higher ADHD symptom scores correlated negatively with epilepsy onset age and positively with epilepsy duration and pro-inflammatory cytokine levels.
Conclusions:
- Elevated circulating inflammation markers, specifically IL-6 and TNF-α, are associated with a higher frequency of ADHD in children with controlled epilepsy.
- Inflammation may play a crucial role in the comorbidity of ADHD in pediatric epilepsy.
- These findings highlight the potential for targeting inflammation in managing neuropsychiatric aspects of epilepsy in children.
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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