Practical Considerations for the Assessment and Treatment of ADHD in Children with Epilepsy

Rachel Burmeister Tangen; Elizabeth Ann Diekroger

doi:10.1055/s-0038-1676584

Journal of Pediatric Epilepsy, Table of Contents

Journal of Pediatric Epilepsy 2018; 07(03): 089-096
DOI: 10.1055/s-0038-1676584

Review Article

Georg Thieme Verlag KG Stuttgart · New York

Practical Considerations for the Assessment and Treatment of ADHD in Children with Epilepsy

Authors

Rachel Burmeister Tangen

¹Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
Elizabeth Ann Diekroger

¹Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

Abstract

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent psychiatric comorbidities in children with epilepsy, but it is under diagnosed and under treated which can impact the quality of life. Knowledge regarding ADHD characteristics, epilepsy-related risk factors, and associations with specific types of epilepsy provide a base for assessment. Epilepsy-related variables have not consistently predicted ADHD status, so screening and assessment for ADHD in children with epilepsy should be systematic and broad. Different assessment tools and techniques can be helpful including rating scales, diagnostic interviews, and neuropsychological testing. Treatment of ADHD with methylphenidate has been found to be safe and effective including in populations with uncontrolled seizures and coexisting intellectual disability. There are limited data on other medication and behavioral treatments. To improve assessment, diagnosis and treatment, medical provider knowledge, and practices, as well as family barriers to behavioral health should be targeted.

Keywords

attention deficit hyperactivity disorder - pediatric epilepsy - behavioral aspects of childhood epilepsy

Full Text

References

References
1 Dunn DW, Kronenberger WG. Childhood epilepsy, attention problems, and ADHD: review and practical considerations. Semin Pediatr Neurol 2005; 12 (04) 222-228
2 Kaufmann R, Goldberg-Stern H, Shuper A. Attention-deficit disorders and epilepsy in childhood: incidence, causative relations and treatment possibilities. J Child Neurol 2009; 24 (06) 727-733
3 Parisi P, Moavero R, Verrotti A, Curatolo P. Attention deficit hyperactivity disorder in children with epilepsy. Brain Dev 2010; 32 (01) 10-16
4 Reilly CJ. Attention deficit hyperactivity disorder (ADHD) in childhood epilepsy. Res Dev Disabil 2011; 32 (03) 883-893
5 Salpekar JA, Mishra G. Key issues in addressing the comorbidity of attention deficit hyperactivity disorder and pediatric epilepsy. Epilepsy Behav 2014; 37: 310-315
6 Williams AE, Giust JM, Kronenberger WG, Dunn DW. Epilepsy and attention-deficit hyperactivity disorder: links, risks, and challenges. Neuropsychiatr Dis Treat 2016; 12: 287-296
7 Besag F, Aldenkamp A, Caplan R, Dunn DW, Gobbi G, Sillanpää M. Psychiatric and behavioural disorders in children with epilepsy: an ILAE task force report. Epileptic Disord 2016; 18 (Suppl. 01) 1-86
8 Ott D, Siddarth P, Gurbani S. , et al. Behavioral disorders in pediatric epilepsy: unmet psychiatric need. Epilepsia 2003; 44 (04) 591-597
9 Reilly C, Atkinson P, Das KB. , et al. Neurobehavioral comorbidities in children with active epilepsy: a population-based study. Pediatrics 2014; 133 (06) e1586-e1593
10 Baca CB, Vickrey BG, Caplan R, Vassar SD, Berg AT. Psychiatric and medical comorbidity and quality of life outcomes in childhood-onset epilepsy. Pediatrics 2011; 128 (06) e1532-e1543
11 Ekinci O, Okuyaz Ç, Erdoğan S. , et al. Attention-deficit hyperactivity disorder (ADHD) in epilepsy and primary ADHD: Differences in symptom dimensions and quality of life. J Child Neurol 2017; 32 (14) 1083-1091
12 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013
13 Froehlich TE, Lanphear BP, Epstein JN, Barbaresi WJ, Katusic SK, Kahn RS. Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med 2007; 161 (09) 857-864
14 Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol 2014; 43 (02) 434-442
15 Davies S, Heyman I, Goodman R. A population survey of mental health problems in children with epilepsy. Dev Med Child Neurol 2003; 45 (05) 292-295
16 Hesdorffer DC, Ludvigsson P, Olafsson E, Gudmundsson G, Kjartansson O, Hauser WA. ADHD as a risk factor for incident unprovoked seizures and epilepsy in children. Arch Gen Psychiatry 2004; 61 (07) 731-736
17 Sherman EM, Slick DJ, Connolly MB, Eyrl KL. ADHD, neurological correlates and health-related quality of life in severe pediatric epilepsy. Epilepsia 2007; 48 (06) 1083-1091
18 Cohen R, Senecky Y, Shuper A. , et al. Prevalence of epilepsy and attention-deficit hyperactivity (ADHD) disorder: a population-based study. J Child Neurol 2013; 28 (01) 120-123
19 Dunn DW, Austin JK, Harezlak J, Ambrosius WT. ADHD and epilepsy in childhood. Dev Med Child Neurol 2003; 45 (01) 50-54
20 Thome-Souza S, Kuczynski E, Assumpção Jr F. , et al. Which factors may play a pivotal role on determining the type of psychiatric disorder in children and adolescents with epilepsy?. Epilepsy Behav 2004; 5 (06) 988-994
21 Hermann B, Jones J, Dabbs K. , et al. The frequency, complications and aetiology of ADHD in new onset paediatric epilepsy. Brain 2007; 130 (Pt 12): 3135-3148
22 Liu ST, Tsai FJ, Lee WT. , et al. Attentional processes and ADHD-related symptoms in pediatric patients with epilepsy. Epilepsy Res 2011; 93 (01) 53-65
23 Kwong KL, Lam D, Tsui S, Ngan M, Tsang B, Lam SM. Attention deficit hyperactivity disorder in adolescents with epilepsy. Pediatr Neurol 2016; 57: 56-63
24 Choudhary A, Gulati S, Sagar R, Sankhyan N, Sripada K. Childhood epilepsy and ADHD comorbidity in an Indian tertiary medical center outpatient population. Sci Rep 2018; 8 (01) 2670
25 Gonzalez-Heydrich J, Dodds A, Whitney J. , et al. Psychiatric disorders and behavioral characteristics of pediatric patients with both epilepsy and attention-deficit hyperactivity disorder. Epilepsy Behav 2007; 10 (03) 384-388
26 Loutfi KS, Carvalho AM, Lamounier JA, Nascimento JA. ADHD and epilepsy: contributions from the use of behavioral rating scales to investigate psychiatric comorbidities. Epilepsy Behav 2011; 20 (03) 484-489
27 Barkley RA. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 4th ed. Guilford, NY: The Guilford Press; 2014
28 Bechtel N, Weber P. Attention problems in children with epilepsy. How is the long-term outcome?. Eur J Paediatr Neurol 2015; 19 (03) 383-385
29 Høie B, Mykletun A, Waaler PE, Skeidsvoll H, Sommerfelt K. Executive functions and seizure-related factors in children with epilepsy in Western Norway. Dev Med Child Neurol 2006; 48 (06) 519-525
30 MacAllister WS, Bender HA, Whitman L. , et al. Assessment of executive functioning in childhood epilepsy: the Tower of London and BRIEF. Child Neuropsychol 2012; 18 (04) 404-415
31 Prévost J, Lortie A, Nguyen D, Lassonde M, Carmant L. Nonlesional frontal lobe epilepsy (FLE) of childhood: clinical presentation, response to treatment and comorbidity. Epilepsia 2006; 47 (12) 2198-2201
32 Zhang DQ, Li FH, Zhu XB, Sun RP. Clinical observations on attention-deficit hyperactivity disorder (ADHD) in children with frontal lobe epilepsy. J Child Neurol 2014; 29 (01) 54-57
33 Braakman HM, Vaessen MJ, Hofman PA. , et al. Cognitive and behavioral complications of frontal lobe epilepsy in children: a review of the literature. Epilepsia 2011; 52 (05) 849-856
34 Tovia E, Goldberg-Stern H, Ben Zeev B. , et al. The prevalence of atypical presentations and comorbidities of benign childhood epilepsy with centrotemporal spikes. Epilepsia 2011; 52 (08) 1483-1488
35 Kim EH, Yum MS, Kim HW, Ko TS. Attention-deficit/hyperactivity disorder and attention impairment in children with benign childhood epilepsy with centrotemporal spikes. Epilepsy Behav 2014; 37: 54-58
36 Danhofer P, Pejčochová J, Dušek L, Rektor I, Ošlejšková H. The influence of EEG-detected nocturnal centrotemporal discharges on the expression of core symptoms of ADHD in children with benign childhood epilepsy with centrotemporal spikes (BCECTS): A prospective study in a tertiary referral center. Epilepsy Behav 2018; 79: 75-81
37 Neri ML, Guimarães CA, Oliveira EP. , et al. Neuropsychological assessment of children with rolandic epilepsy: executive functions. Epilepsy Behav 2012; 24 (04) 403-407
38 Deltour L, Quaglino V, Barathon M, De Broca A, Berquin P. Clinical evaluation of attentional processes in children with benign childhood epilepsy with centrotemporal spikes (BCECTS). Epileptic Disord 2007; 9 (04) 424-431
39 Kavros PM, Clarke T, Strug LJ, Halperin JM, Dorta NJ, Pal DK. Attention impairment in rolandic epilepsy: systematic review. Epilepsia 2008; 49 (09) 1570-1580
40 Filippini M, Boni A, Giannotta M, Gobbi G. Neuropsychological development in children belonging to BECTS spectrum: long-term effect of epileptiform activity. Epilepsy Behav 2013; 28 (03) 504-511
41 Caplan R, Siddarth P, Stahl L. , et al. Childhood absence epilepsy: behavioral, cognitive, and linguistic comorbidities. Epilepsia 2008; 49 (11) 1838-1846
42 Vega C, Vestal M, DeSalvo M. , et al. Differentiation of attention-related problems in childhood absence epilepsy. Epilepsy Behav 2010; 19 (01) 82-85
43 Verrotti A, Matricardi S, Rinaldi VE, Prezioso G, Coppola G. Neuropsychological impairment in childhood absence epilepsy: review of the literature. J Neurol Sci 2015; 359 (1–2): 59-66
44 Lee HJ, Kim EH, Yum MS, Ko TS, Kim HW. Attention profiles in childhood absence epilepsy compared with attention-deficit/hyperactivity disorder. Brain Dev 2018; 40 (02) 94-99
45 Masur D, Shinnar S, Cnaan A. , et al; Childhood Absence Epilepsy Study Group. Pretreatment cognitive deficits and treatment effects on attention in childhood absence epilepsy. Neurology 2013; 81 (18) 1572-1580
46 Antshel KM, Phillips MH, Gordon M, Barkley R, Faraone SV. Is ADHD a valid disorder in children with intellectual delays?. Clin Psychol Rev 2006; 26 (05) 555-572
47 Buelow JM, Austin JK, Perkins SM, Shen J, Dunn DW, Fastenau PS. Behavior and mental health problems in children with epilepsy and low IQ. Dev Med Child Neurol 2003; 45 (10) 683-692
48 Steffenburg S, Gillberg C, Steffenburg U. Psychiatric disorders in children and adolescents with mental retardation and active epilepsy. Arch Neurol 1996; 53 (09) 904-912
49 Reilly C, Atkinson P, Das KB. , et al. Parent- and teacher-reported symptoms of ADHD in school-aged children with active epilepsy: a population-based study. J Atten Disord 2017; 21 (11) 887-897
50 Mula M, Cavalheiro E, Guekht A. , et al. Educational needs of epileptologists regarding psychiatric comorbidities of the epilepsies: a descriptive quantitative survey. Epileptic Disord 2017; 19 (02) 178-185
51 Smith K, Siddarth P, Zima B. , et al. Unmet mental health needs in pediatric epilepsy: insights from providers. Epilepsy Behav 2007; 11 (03) 401-408
52 Wolraich M, Brown L, Brown RT. , et al; Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011; 128 (05) 1007-1022
53 Achenbach TM. Manual for the Child Behavior Checklist/4–18. Burlington VT: University of Vermont Department of Psychiatry; 2008
54 Reynolds CR, Kamphaus RW. Behavior Assessment System for Children 3rd ed. Circle Pine, NM: American Guidance Service; 2004
55 Rodenburg R, Stams GJ, Meijer AM, Aldenkamp AP, Deković M. Psychopathology in children with epilepsy: a meta-analysis. J Pediatr Psychol 2005; 30 (06) 453-468
56 Bender HA, Auciello D, Morrison CE, MacAllister WS, Zaroff CM. Comparing the convergent validity and clinical utility of the behavior assessment system for children-parent rating scales and child behavior checklist in children with epilepsy. Epilepsy Behav 2008; 13 (01) 237-242
57 Hesdorffer DC, Baldin E, Caplan R, Berg AT. How do we measure psychiatric diagnoses? Implications of the choice of instruments in epilepsy. Epilepsy Behav 2014; 31: 351-355
58 Ott D, Caplan R, Guthrie D. , et al. Measures of psychopathology in children with complex partial seizures and primary generalized epilepsy with absence. J Am Acad Child Adolesc Psychiatry 2001; 40 (08) 907-914
59 Gadow KD, Sprafkin J. Child Symptom Inventory-4: Screening and Norms Manual. Stony Brook, NY: Checkmate Plus; 2002
60 Dupaul GJ, Power TJ, Anastopolous AD, Reid R. ADHD Rating Scale-IV. New York: Guilford Press; 1998
61 Swanson J, Schuck S, Porter MM. , et al. Categorical and dimensional definitions and evaluations of symptoms of ADHD: the SNAP and the SWAN ratings scales. Int J EducPsychol Assess 2012; 10 (01) 51-70
62 Perrin EC, Stein RE, Drotar D. Cautions in using the Child Behavior Checklist: observations based on research about children with a chronic illness. J Pediatr Psychol 1991; 16 (04) 411-421
63 Wright I. The validity of questionnaire-based assessment of psychopathology in children with epilepsy. Dev Med Child Neurol 2009; 51 (05) 336-337
64 Sherman EM, Brooks BL, Akdag S, Connolly MB, Wiebe S. Parents report more ADHD symptoms than do teachers in children with epilepsy. Epilepsy Behav 2010; 19 (03) 428-435
65 Kaufman J, Birmaher B, Brent D. , et al. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997; 36 (07) 980-988
66 Caplan R. Psychopathology in pediatric epilepsy: role of antiepileptic drugs. Front Neurol 2012; 3: 163
67 Fastenau PS, , Jianzhao Shen, Dunn DW, Austin JK. Academic underachievement among children with epilepsy: proportion exceeding psychometric criteria for learning disability and associated risk factors. J Learn Disabil 2008; 41 (03) 195-207
68 Berl MM, Terwilliger V, Scheller A, Sepeta L, Walkowiak J, Gaillard WD. Speed and complexity characterize attention problems in children with localization-related epilepsy. Epilepsia 2015; 56 (06) 833-840
69 Parrish J, Geary E, Jones J, Seth R, Hermann B, Seidenberg M. Executive functioning in childhood epilepsy: parent-report and cognitive assessment. Dev Med Child Neurol 2007; 49 (06) 412-416
70 Fastenau PS, Johnson CS, Perkins SM. , et al. Neuropsychological status at seizure onset in children: risk factors for early cognitive deficits. Neurology 2009; 73 (07) 526-534
71 Rzezak P, Fuentes D, Guimarães CA. , et al. Executive dysfunction in children and adolescents with temporal lobe epilepsy: is the Wisconsin card sorting test enough?. Epilepsy Behav 2009; 15 (03) 376-381
72 Kernan CL, Asarnow R, Siddarth P. , et al. Neurocognitive profiles in children with epilepsy. Epilepsia 2012; 53 (12) 2156-2163
73 Semrud-Clikeman M, Wical B. Components of attention in children with complex partial seizures with and without ADHD. Epilepsia 1999; 40 (02) 211-215
74 MacAllister WS, Vasserman M, Vekaria P, Miles-Mason E, Hochsztein N, Bender HA. Neuropsychological endophenotypes in ADHD with and without epilepsy. Appl Neuropsychol Child 2012; 1 (02) 121-128
75 MacAllister WS, Vasserman M, Rosenthal J, Sherman E. Attention and executive functions in children with epilepsy: what, why, and what to do. Appl Neuropsychol Child 2014; 3 (03) 215-225
76 Glauser TA. Effects of antiepileptic medications on psychiatric and behavioral comorbidities in children and adolescents with epilepsy. Epilepsy Behav 2004; 5 (Suppl. 03) S25-S32
77 Loring DW, Meador KJ. Cognitive side effects of antiepileptic drugs in children. Neurology 2004; 62 (06) 872-877
78 Loring DW, Marino S, Meador KJ. Neuropsychological and behavioral effects of antiepilepsy drugs. Neuropsychol Rev 2007; 17 (04) 413-425
79 Feldman H, Crumrine P, Handen BL, Alvin R, Teodori J. Methylphenidate in children with seizures and attention-deficit disorder. Am J Dis Child 1989; 143 (09) 1081-1086
80 Gross-Tsur V, Manor O, van der Meere J, Joseph A, Shalev RS. Epilepsy and attention deficit hyperactivity disorder: is methylphenidate safe and effective?. J Pediatr 1997; 130 (04) 670-674
81 Gonzalez-Heydrich J, Pandina GJ, Fleisher CA. , et al. No seizure exacerbation from risperidone in youth with comorbid epilepsy and psychiatric disorders: a case series. J Child Adolesc Psychopharmacol 2004; 14 (02) 295-310
82 Gucuyener K, Erdemoglu AK, Senol S, Serdaroglu A, Soysal S, Kockar AI. Use of methylphenidate for attention-deficit hyperactivity disorder in patients with epilepsy or electroencephalographic abnormalities. J Child Neurol 2003; 18 (02) 109-112
83 Torres AR, Whitney J, Gonzalez-Heydrich J. Attention-deficit/hyperactivity disorder in pediatric patients with epilepsy: review of pharmacological treatment. Epilepsy Behav 2008; 12 (02) 217-233
84 Gonzalez-Heydrich J, Hsin O, Gumlak S. , et al. Comparing stimulant effects in youth with ADHD symptoms and epilepsy. Epilepsy Behav 2014; 36: 102-107
85 Wiggs KK, Chang Z, Quinn PD. , et al. Attention-deficit/hyperactivity disorder medication and seizures. Neurology 2018; 90 (13) e1104-e1110
86 Pliszka S. ; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2007; 46 (07) 894-921
87 Santos K, Palmini A, Radziuk AL. , et al. The impact of methylphenidate on seizure frequency and severity in children with attention-deficit-hyperactivity disorder and difficult-to-treat epilepsies. Dev Med Child Neurol 2013; 55 (07) 654-660
88 Koneski JA, Casella EB, Agertt F, Ferreira MG. Efficacy and safety of methylphenidate in treating ADHD symptoms in children and adolescents with uncontrolled seizures: a Brazilian sample study and literature review. Epilepsy Behav 2011; 21 (03) 228-232
89 Fosi T, Lax-Pericall MT, Scott RC, Neville BG, Aylett SE. Methylphenidate treatment of attention deficit hyperactivity disorder in young people with learning disability and difficult-to-treat epilepsy: evidence of clinical benefit. Epilepsia 2013; 54 (12) 2071-2081
90 Hemmer SA, Pasternak JF, Zecker SG, Trommer BL. Stimulant therapy and seizure risk in children with ADHD. Pediatr Neurol 2001; 24 (02) 99-102
91 Socanski D, Aurlien D, Herigstad A, Thomsen PH, Larsen TK. Attention deficit/hyperactivity disorder and interictal epileptiform discharges: it is safe to use methylphenidate?. Seizure 2015; 25: 80-83
92 Socanski D, Aurlien D, Herigstad A, Thomsen PH, Larsen TK. Epilepsy in a large cohort of children diagnosed with attention deficit/hyperactivity disorders (ADHD). Seizure 2013; 22 (08) 651-655
93 Rheims S, Herbillon V, Villeneuve N. , et al; investigators of the Paediatric Epilepsy REsearch NEtwork (PERENE). ADHD in childhood epilepsy: Clinical determinants of severity and of the response to methylphenidate. Epilepsia 2016; 57 (07) 1069-1077
94 Faraone SV, Buitelaar J. Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis. Eur Child Adolesc Psychiatry 2010; 19 (04) 353-364
95 Wernicke JF, Holdridge KC, Jin L. , et al. Seizure risk in patients with attention-deficit-hyperactivity disorder treated with atomoxetine. Dev Med Child Neurol 2007; 49 (07) 498-502
96 McAfee AT, Landon J, Jones M. , et al. A cohort study of the risk of seizures in a pediatric population treated with atomoxetine or stimulant medications. Pharmacoepidemiol Drug Saf 2013; 22 (04) 386-393
97 Torres A, Whitney J, Rao S, Tilley C, Lobel R, Gonzalez-Heydrich J. Tolerability of atomoxetine for treatment of pediatric attention-deficit/hyperactivity disorder in the context of epilepsy. Epilepsy Behav 2011; 20 (01) 95-102
98 Aman MG, Binder C, Turgay A. Risperidone effects in the presence/absence of psychostimulant medicine in children with ADHD, other disruptive behavior disorders, and subaverage IQ. J Child Adolesc Psychopharmacol 2004; 14 (02) 243-254
99 Handen BL, Breaux AM, Gosling A, Ploof DL, Feldman H. Efficacy of methylphenidate among mentally retarded children with attention deficit hyperactivity disorder. Pediatrics 1990; 86 (06) 922-930
100 Aman MG, Kern RA, McGhee DE, Arnold LE. Fenfluramine and methylphenidate in children with mental retardation and ADHD: clinical and side effects. J Am Acad Child Adolesc Psychiatry 1993; 32 (04) 851-859
101 Handen BL, Janosky J, McAuliffe S, Breaux AM, Feldman H. Prediction of response to methylphenidate among children with ADHD and mental retardation. J Am Acad Child Adolesc Psychiatry 1994; 33 (08) 1185-1193
102 Handen BL, Feldman H, Gosling A, Breaux AM, McAuliffe S. Adverse side effects of methylphenidate among mentally retarded children with ADHD. J Am Acad Child Adolesc Psychiatry 1991; 30 (02) 241-245
103 Shapiro BK, Batshaw ML. Developmental delay and intellectual disability. In Batshaw ML, Roizen NJ, Lotrecchiano GR. , eds. Children with Disabilities. 7th ed. Baltimore, MD: Paul H. Brookes; 2013: 291-306
104 Rodenburg R, Meijer AM, Deković M, Aldenkamp AP. Family factors and psychopathology in children with epilepsy: a literature review. Epilepsy Behav 2005; 6 (04) 488-503
105 Caplan R. ADHD in pediatric epilepsy: fact or fiction?. Epilepsy Curr 2017; 17 (02) 93-95