title: Attention-deficit/hyperactivity disorder in childhood epilepsy: a neuropsychological and functional imaging study.
abstract: OBJECTIVE
  Children with epilepsy have a significant risk for attention-deficit/hyperactivity disorder (ADHD), which is often accompanied by deficits in working memory performance. However, it is not yet clear whether there are specific differences in the underlying mechanisms of working memory capability between children with epilepsy-related ADHD and those with developmental ADHD. There is evidence that methylphenidate can improve the behavioral difficulties in children with developmental ADHD. Whether this medication has the same effect on ADHD symptoms in patients with epilepsy is not yet well understood. The aim of the present study is, therefore, to evaluate whether boys with epilepsy-related ADHD and developmental ADHD share a common behavioral, pharmacoresponsive, and neurofunctional pathophysiology.
  
  
  METHODS
  Seventeen boys with diagnosed combined epilepsy/ADHD, 15 boys with developmental ADHD, and 15 healthy controls (aged 8-14 years) performed on working memory tasks (N-back) while brain activation was recorded using functional magnetic resonance imaging. Each patient was tested twice: once after the intake of methylphenidate and once without in a counterbalanced order.
  
  
  RESULTS
  On a behavioral level, we show that boys with epilepsy-related ADHD as well as those with developmental ADHD performed similarly poorly on tasks with high cognitive load when compared to healthy controls, and that intake of methylphenidate improved performance almost to normal levels in both ADHD groups. On the functional level, both patient groups showed similar reductions of activation in all relevant parts of the functional network of working memory when compared to controls. Of interest, intake of methylphenidate did not significantly alter this activity pattern.
  
  
  CONCLUSIONS
  Our data show strong similarities between epilepsy-related and developmental ADHD on the behavioral, pharmacoresponsive, and neural level, favoring the view that ADHD with and without epilepsy shares a common underlying neurobehavioral pathophysiology.
authors.affiliation: Division of Neuropediatrics and Developmental Medicine, University Children's Hospital Basel, Basel, Switzerland. nina.bechtel@unibas.ch
authors.forename: Nina
authors.initials: N
authors.lastname: Bechtel
authors.forename: Maja
authors.initials: M
authors.lastname: Kobel
authors.forename: Iris-Katharina
authors.initials: IK
authors.lastname: Penner
authors.forename: Karsten
authors.initials: K
authors.lastname: Specht
authors.forename: Markus
authors.initials: M
authors.lastname: Klarhöfer
authors.forename: Klaus
authors.initials: K
authors.lastname: Scheffler
authors.forename: Klaus
authors.initials: K
authors.lastname: Opwis
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmitt-Mechelke
authors.forename: Andrea
authors.initials: A
authors.lastname: Capone
authors.forename: Peter
authors.initials: P
authors.lastname: Weber
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D001921:Brain / Q000187:drug effects / Q000503:physiopathology*; D001931:Brain Mapping; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D004827:Epilepsy / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D009483:Neuropsychological Tests
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate