Article

The frequency, complications and aetiology of ADHD in new onset paediatric epilepsy

Matthews Neuropsychology Lab, Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
Brain (Impact Factor: 10.23). 01/2008; 130(Pt 12):3135-48. DOI: 10.1093/brain/awm227
Source: PubMed

ABSTRACT Recent studies suggest that Attention Deficit Hyperactivity Disorder (ADHD) is a common comorbid condition in childhood epilepsy, but little is known regarding the nature, frequency and timing of associated neurobehavioural/cognitive complications or the underlying aetiology of ADHD in epilepsy. This investigation examined: (i) the prevalence of ADHD and its subtypes; (ii) the association of ADHD with abnormalities in academic, neuropsychological, behavioural and psychiatric status and (iii) the aetiology of ADHD in paediatric epilepsy. Seventy-five children (age 8-18) with new/recent onset idiopathic epilepsy and 62 healthy controls underwent structured interview (K-SADS) to identify the presence and type of DSM-IV defined ADHD, neuropsychological assessment, quantitative MR volumetrics, characterization of parent observed executive function, review of academic/educational progress and assessment of risk factors during gestation and delivery. The results indicate that ADHD is significantly more prevalent in new onset epilepsy than healthy controls (31% versus 6%), characterized predominantly by the inattentive variant, with onset antedating the diagnosis of epilepsy in the majority of children. ADHD in childhood epilepsy is associated with significantly increased rates of school based remedial services for academic underachievement, neuropsychological consequences with prominent differences in executive function, and parent-reported dysexecutive behaviours. ADHD in paediatric epilepsy is neither associated with demographic or clinical epilepsy characteristics nor potential risk factors during gestation and birth. Quantitative MRI demonstrates that ADHD in epilepsy is associated with significantly increased gray matter in distributed regions of the frontal lobe and significantly smaller brainstem volume. Overall, ADHD is a prevalent comorbidity of new onset idiopathic epilepsy associated with a diversity of salient educational, cognitive, behavioural and social complications that antedate epilepsy onset in a significant proportion of cases, and appear related to neurodevelopmental abnormalities in brain structure.

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    • "The amygdala has previously been reported to show either no significant changes in gray matter volume [Castellanos et al., 1996; Filipek et al., 1997] or a decrease in volume [Lim et al., 2013; Plessen et al., 2006]. There are fewer known group level abnormalities in white matter as it is less frequently investigated using structural MRI [Hermann et al., 2007]. Although no differences in white matter volume were reported in one small study [Carmona et al., 2005], a larger study described significantly reduced total white matter volume and significant reductions in the frontal, parietal, temporal, and occipital lobes in ADHD [Castellanos et al., 2002]. "
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