ADHD symptom positivity and its association with medication adherence and psychiatric burden in adults with epilepsy

Attention-deficit/hyperactivity disorder (ADHD) symptoms are increasingly recognized in adults with epilepsy (AwE) and may contribute to psychiatric burden, seizure-related outcomes, and treatment adherence. We therefore investigated the frequency of ADHD symptom positivity and its associations with medication adherence, psychiatric symptoms, seizure burden, and neurophysiological findings.

This cross-sectional study included 100 AwE and 94 healthy controls. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale (ASRS-v1.1). Anxiety and depressive symptoms were evaluated using the Beck Anxiety Inventory and Beck Depression Inventory, respectively. Medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). Participants were classifiedas ASRS-positive or ASRS-negative according to the six-item ASRS Part A screener. Clinical, psychiatric, electroencephalographic, and magnetic resonance imaging findings were compared between groups. Multivariable logistic regression analyses were performed to identify factors independently associated with ADHD-symptom-positivity.

ADHD-symptom-positivity was significantly more frequent in AwE than in healthy controls (50.0% vs. 25.5%, p = 0.001). Within the epilepsy cohort, ASRS-positive participants demonstrated lower medication adherence (p = 0.010), higher rates of poor adherence (70.0% vs. 48.0%, p = 0.042), higher anxiety (p = 0.002), and depression scores (p < 0.001). Clinically significant anxiety and depression were also more common among ASRS-positive participants (p = 0.027 and p < 0.001, respectively). In multivariable analysis, depression score was independently associated with ADHD-symptom-positivity (OR = 1.147, 95% CI 1.039-1.267, p = 0.007).

ADHD-symptom-positivity is common in AwE and is associated with poorer medication adherence in the between-group analysis, but this association did not remain statistically significant after multivariable adjustment, while greater psychiatric symptom burden was observed. Routine screening for ADHD-related symptoms may facilitate identification of adults with epilepsy at increased riskfor adverse clinical outcomes and support more comprehensive epilepsy care.