Behavioral and Movement Disorders due to Long-Lasting Myoclonic Status Epilepticus Misdiagnosed as ADHD in a Patient With Juvenile Myoclonic Epilepsy: Electroclinical Findings and Related Hemodynamic Changes.
Epilepsy and attention-deficit/hyperactivity disorder (ADHD) likely share common underlying neural mechanisms, as often suggested by both the evidence of electroencephalography (EEG) abnormalities in ADHD patients without epilepsy and the coexistence of these 2 conditions. The differential diagnosis between epilepsy and ADHD may consequently be challenging. In this report, we describe a patient presenting with a clinical association of "tics" and behavioral disorders that appeared 6 months before our first observation and had previously been interpreted as ADHD. A video-EEG evaluation documented an electroclinical pattern of myoclonic status epilepticus. On the basis of the revised clinical data, the EEG findings, the good response to valproate, the long-lasting myoclonic status epilepticus, and the enduring epileptic abnormalities likely causing behavioral disturbances, the patient's symptoms were interpreted as being the expression of untreated juvenile myoclonic epilepsy. The EEG-functional magnetic resonance imaging study revealed, during clinical generalized spike-and-wave and polyspike-and-wave discharges, positive blood oxygen level-dependent (BOLD) signal changes bilaterally in the thalamus, the prefrontal cortex (Brodmann area 6, supplementary motor area) and the cerebellum, and negative BOLD signal changes in the regions of the default mode network. Such findings, which are typical of BOLD changes observed in idiopathic generalized epilepsy, may also shed light on the anatomofunctional network underlying ADHD.
Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Martina
M
Fanella
Department of Molecular Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Marco
M
Carnì
Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Alessandra
A
Morano
Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Mariarita
M
Albini
Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Leonardo
L
Lapenta
Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Sara
S
Casciato
Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Jinane
J
Fattouch
Department of Molecular Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Elisabetta
E
Di Castro
Department of Radiology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Claudio
C
Colonnese
Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy.
Anna Elisabetta
AE
Vaudano
Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
Anna Teresa
AT
Giallonardo
Department of Neurology and Psychiatry, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy c_dibonaventura@yahoo.it.
Carlo
C
Di Bonaventura
D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis*; D001931:Brain Mapping / Q000379:methods*; D002648:Child; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000379:methods*; D004831:Epilepsies, Myoclonic / Q000150:complications / Q000175:diagnosis*; D005188:False Negative Reactions; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000209:etiology; D009069:Movement Disorders / Q000175:diagnosis* / Q000209:etiology
attention-deficit/hyperactivity disorder; juvenile myoclonic epilepsy; long-lasting myoclonic status epilepticus