Childhood Epilepsy and ADHD: The Comorbidity

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What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a behavioral disorder that affects 5% of the world’s population in which the majority of prevalence is in children and adolescents. ADHD is diagnosed using the Diagnostic Statistical Manual Five (APA, 2013) in which it is stated to have the subtype known as Predominately Inattentive Presentation, that at least six or more manifestations of inattention should be present for at least six months to a maladaptive degree. Some examples of this may include making careless mistakes and being easily distracted. On the other hand, if there are six or more manifestations of hyperactivity and impulsivity present for at least 6 months, then the individual would fall in the Predominately Hyperactivity-Impulsive presentation. Some examples may include fidgeting and (rudely) interrupting. Several of these characteristics need to be present before the age of 12, leading to impairment in social, academic or occupational functioning. If a combination of these characteristics is present in the individual, then there is Combined Presentation. That said, there are many proposed risk factors including a high genetic heritability, the DAT1 gene and dopaminergic areas such as the frontal lobe, that may be contributing to the development of this disorder.

What is Epilepsy?

Epilepsy is one of the most common neurological conditions in the world, with as many as 1 in 103 people living with this condition. The illness is largely characterised by seizures caused by excessive electrical activity within networks of neurons in the brain, in the frontal, parietal, temporal, occipital lobes and the cerebellum. This means that seizures can affect speech, facial recognition, motor control, taste, reading, vision and coordination. Commonly studied seizures include generalised onset such as tonic, tonic-clonic, atonic and myoclonic, focal onset such as auras, focal with no loss of awareness and focal impaired awareness. In addition, urgent seizures states that can include any of the other sub-types such as serial, prolonged, convulsive and non-convulsive status epilepticus.

Study:

One recent study aimed to assess the prevalence of ADHD and characteristics/risk factors in children with epilepsy in a medical Centre in New Delhi, India.

The study utilized 73 patients aged 6-12 years, with epilepsy who were also assessed for ADHD with DSM-IV criteria. Their IQ was evaluated using Malin’s Intelligence Scale for Indian Children (MISIC); and the Indian adaptation of the Wechsler Intelligence Scale for Children, along with some psychiatric assessments and EEG assessments.

Of the 73 participants, 17 had both epilepsy and ADHD, 10 had inattentive ADHD type, 6 had ADHD combination type and 1 had ADHD hyperactive-impulsive type. The prevalence rate is around 23.4% of children with comorbidity, with inattentive ADHD type being the most prevalent. Most epilepsy characteristics did not seem to differ significantly with or without ADHD. However, abnormal EEG records were associated with ADHD. Further, children with comorbidity had lower IQ scores and also showed a lower percentage of attendance at schools. 

The researchers say that research on medications such as anti-depressants, amphetamines, atomoxetine and agonists, that can be used to treat both conditions is fairly limited; making the need for future studies regarding effective treatments for children, pertinent. 

Source: Choudhary, A., Gulati, S., Sagar, R. et al. Childhood epilepsy and ADHD comorbidity in an Indian tertiary medical centre outpatient population. Sci Rep 8, 2670 (2018). https://doi.org/10.1038/s41598-018-20676-8

Image source: Alex Green, Pexels.

Edited by Malavika

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