ADHD, neurological correlates and health-related quality of life in severe pediatric epilepsy.
OBJECTIVE
ADHD is reported as a frequent comorbidity in pediatric epilepsy. We aimed to clarify the prevalence of ADHD, its neurological correlates and the role of ADHD in health-related quality of life (HRQOL) in children with severe epilepsy.


METHODS
Data from the ADHD Rating Scale-IV (ADHD-RS-IV) from 203 children (mean age = 11.8, SD=3.8) from a tertiary center serving children with severe epilepsy were reviewed.


RESULTS
Inattention was frequently elevated in the sample (40% vs. 18% for hyperactivity-impulsivity). Age of onset, epilepsy duration, and seizure frequency were not related to severity of inattention or hyperactivity-impulsivity. Over 60% of children met screening criteria for ADHD-Inattentive subtype (ADHD-I) or ADHD-Combined Inattentive/Hyperactive-Impulsive subtype (ADHD-C). Compared to ADHD-I, ADHD-C was associated with earlier onset of seizures, generalized epilepsy, lower adaptive level, and in normally developing children, a higher degree of intractability compared to ADHD-I. ADHD-I was more prevalent in localization-related epilepsy, and there was a trend for a higher use of AEDs with cognitive side effects in this group. ADHD was associated with poor HRQOL: children with ADHD-I and ADHD-C had a two- and four-fold likelihood of low HRQOL, respectively, compared to non-ADHD children.


CONCLUSIONS
Children seen at tertiary care centers for severe epilepsy are at high risk for attention problems and ADHD, and ADHD is a significant predictor of poor HRQOL in epilepsy, particularly in the case of ADHD-C. ADHD occurring in the context of severe epilepsy appears to be associated with specific neurological characteristics, which has implications for comorbidity models of ADHD and epilepsy.
Sherman
Elisabeth M S
EM
Alberta Children's Hospital, Calgary, Alberta, Canada. elisabeth.sherman@calgaryhealthregion.ca
Slick
Daniel J
DJ
Connolly
Mary B
MB
Eyrl
Kim L
KL
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000927:Anticonvulsants / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D001955:British Columbia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index
D000927:Anticonvulsants