Attention-deficit disorders and epilepsy in childhood: incidence, causative relations and treatment possibilities.
At least 20% of children with epilepsy have clinical attention-deficit hyperactivity disorder (ADHD) compared to 3% to 7% of the general pediatric population. Several mechanisms may account for the high prevalence, such as a common genetic propensity, noradrenergic system dysregulation, subclinical epileptiform discharges, or even seizures, antiepileptic drug effects, and psychosocial factors. At the same time, children with attention-deficit hyperactivity disorder have a higher than normal rate of electroencephalography abnormalities (5.6-30.1% vs. 3.5%). Methylphenidate treatment is equally efficient in children with isolated attention-deficit hyperactivity disorder and in children with attention-deficit hyperactivity disorder and epilepsy (70%-77%). Electroencephalography screening in patients with attention-deficit hyperactivity disorder in the absence of other clinical indications or before starting methylphenidate treatment is not currently indicated. Methylphenidate is considered safe for use in children who are seizure-free. However, the few reports of seizure aggravation in methylphenidate-treated children with uncontrolled epilepsy have raised concern.
Kaufmann
Rami
R
Department of Child Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Goldberg-Stern
Hadassa
H
Shuper
Avinoam
A
D000818:Animals; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D002491:Central Nervous System Agents / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D004569:Electroencephalography; D004827:Epilepsy / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008774:Methylphenidate / Q000627:therapeutic use; D015995:Prevalence
D002491:Central Nervous System Agents; D008774:Methylphenidate