Sevim ŞAHİN, Tülay KAMAŞAK, Elif ACAR ARSLAN, Betül DİLER DURGUT, Beril DİLBER, Sema KANDİL, Ali CANSU

Çocuklarda Epilepsi ve Dikkat Eksikliği Hiperaktivite Bozukluğu Birlikteliğinin Özellikleri: Geriye Dönük İnceleme

GİRİŞ ve AMAÇ: Çocuklarda, dikkat eksikliği ve hiperaktivite bozukluğu (DEHB) epilepsiye sıklıkla eşlik etmektedir. Bu birlikteliğin nedenleri konusundaki görüşler farklıdır. Epilepsiden önce veya sonra gelişen DEHB’de, epilepsi özelliklerinin etkisi çalışılmamıştır. Bu çalışmada, DEHB ve epilepsi birlikteliği gösteren çocukların verileri, bu ilişkiye yönelik ipuçları elde etmek amacıyla incelenmiştir. YÖNTEM ve GEREÇLER: Çocuk Nörolojisi polikliniğine ardışık olarak başvuran, epilepsi ve DEHB birlikteliği gösteren 44 hastanın (33 erkek, 11 kız) verileri geriye dönük olarak incelendi. Çeşitli özelliklere göre ikili alt gruplarda istatistiksel karşılaştırma yapıldı. BULGULAR: DEHB 11 hastada (%25) epilepsi bulguları öncesinde, 33 hastada (%75) ise epilepsi sonrasında tanılanmıştı. Hastaların yaş ortalaması 11,5±2,7, ilk nöbet yaşları 5,2±3, son nöbet yaşı 9,5±2,8, antiepileptik başlama yaşı 6,6±3,4, DEHB tanı yaşı 8,4±2 yıldı. Epilepsi sonrasında DEHB tanılananlarda, antiepileptik tedavinin başlangıç yaşı ve ilk nöbet yaşı daha küçüktü (sırasıyla, p=0,004 ve p=0,002). İki gruptaki cinsiyet dağılımı, epilepsi tipi, DEHB tanı yaşı, elektroensefalografi ve beyin manyetik rezonans görüntüleme bulguları benzerdi. Epilepsi ve DEHB tanıları arasındaki sürenin anlamlı olarak kısa olduğu hastalar; ilk nöbet yaşı >5 ve antiepileptik başlama yaşı >6,5 yaş olanlardı (sırasıyla, p=0,013, p=0,000). Epilepsi ve DEHB tanıları arasındaki süre 1,5 yıldan uzun olanlarda, EEG anormalliği daha sıktı (p=0,044). Son nöbet ve AEİ başlama yaşları; DEHB tanı yaşı ile pozitif korelasyon gösterdi (r=0,389, r=0,434, p<0,05). TARTIŞMA ve SONUÇ: Çalışmamızda, epilepsiden önce veya sonra DEHB tanılanan hastalarda, DEHB tanı yaşı benzer saptandı. Ancak antiepileptik ilaç gereksinimi, erken çocukluk ve okul çağı olmak üzere, iki ayrı döneme yığılma göstermişti. Diğer epilepsi özelliklerinin benzer olması, iki hastalığın birlikteliğinde ortak patogenetik mekanizmaların rol oynayabileceğini düşündürmektedir.

Anahtar Kelimeler:

Çocuk, dikkat eksikliği ve hiperaktivite bozukluğu, epilepsi

Characteristics of Epilepsy and Attention Deficit Hyperactivity Disorder Comorbidity in Children: A Retrospective Analysis

INTRODUCTION: Epilepsy is often accompanied by attention deficit hyperactivity disorder (ADHD). There are different opinions about reasons. The effect of epilepsy features was not studied in ADHD before or after epilepsy. We aimed to obtain clues about this comorbidity in children. METHODS: Data of forty-four (33 males, 11 girls) consecutive epilepsy patients with ADHD were retrospectively reviewed. The binary subgroups were statistically compared.RESULTS: ADHD was diagnosed before epilepsy in 11 (25%) and after epilepsy in 33 (75%) patients. The mean age was 11.5±2.7, the first and last seizure ages were 5.2±3 and 9.5±2.8, antiepileptic drug (AED) starting and ADHD ages were 6.6±3.4 and 8.4±2 years respectively. In patients with ADHD after epilepsy, AED and first seizure ages were younger (p=0.004 and p=0.002, respectively). Gender, epilepsy type, ADHD age, electroencephalography and brain magnetic resonance imaging findings were similar. There was a shorter interval time between ADHD and epilepsy in patients with a first seizure age >5 and AED age >6.5 years (p=0.013 and p=0.000). EEG abnormalities were more frequent in patients with >1.5 years time interval between epilepsy and ADHD (p=0.044). The ages of last seizure and AED starting ages were positively correlated with ADHD age (r=0.389, r=0.434, p<0.05). DISCUSSION and CONCLUSION: We found similar ADHD ages in patients with ADHD before or after epilepsy. However, AEDs need was observed in two separate periods, early childhood and school age. The similarity of other features suggests that common pathogenetic mechanisms may play a role in this comorbidity.

Keywords:

Attention deficit and hyperactivity disorder, child, epilepsy,

PDF

___

1. Chou IC, Chang YT, Chin ZN, Muo CH, Sung FC, Kuo HT, et al. Correlation between epilepsy and attention deficit hyperactivity disorder: a population-based cohort study. PLoS One 2013;8:e57926.
2. Cowan LD. The epidemiology of the epilepsies in children. Ment Retard Dev Disabil Res Rev 2002;8:171-81.
3. Thome-Souza S, Kuczynski E, Assumpção F, Rzezak P, Fuentes D, Fiore L, 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;5:988–94.
4. Swanson JM, Sergeant JA, Taylor E, Sonuga-Barke EJS, Jensen PS, Cantwell DP. Attention-deficit hyperactivity disorder and hyperkinetic disorder. Lancet 1998;351:429–33.
5. Bechtel N, Weber P. Attention problems in children with epilepsy. How is the long-term outcome? Eur J Paediatr Neurol 2015;19:383–5.
6. Davis SM, Katusic SK, Barbaresi WJ, Killian J, Weaver AL, et al. Epilepsy in children with ADHD: A population-based study. Pediatr Neurol 2010;42:325–30.
7. Hermann B, Jones J, Dabbs K, Allen CA, Sheth R, Fine J, et al. The frequency, complications and aetiology of ADHD in new onset paediatric epilepsy. Brain 2007;130:3135–48.
8. Bechtel N, Kobel M, Penner I-K, Specht K, Klarhöfer M, Scheffler K, et al. Attention-deficit/hyperactivity disorder in childhood epilepsy: A neuropsychological and functional imaging study. Epilepsia 2012;53:325–33.
9. Kaufmann R, Goldberg-Stern H, Shuper A. Attention-Deficit Disorders and Epilepsy in Childhood: Incidence, Causative Relations and Treatment Possibilities. J Child Neurol 2009;24:727–33.
10. Austin JK, Harezlak J, Dunn DW, Huster GA, Rose DF, Ambrosius WT. Behavior problems in children before first recognized seizures. Pediatrics 2001;107:115-22.
11. Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017;58:512–21.
12. 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.
13. Bennett-Back O, Keren A, Zelnik N. Attention-deficit hyperactivity disorder in children with benign epilepsy and their siblings. Pediatr Neurol 2011;44:187–92.
14. Aldenkamp A, Arends J. The relative influence of epileptic EEG discharges, short nonconvulsive seizures, and type of epilepsy on cognitive function. Epilepsia 2004;45:54–63.
15. 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;37:54–8.
16. Carrey NJ, MacMaster FP, Gaudet L, Schmidt MH. Striatal creatine and glutamate/glutamine in attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2007;17:11-7.
17. Williams AE, Giust JM, Kronenberger WG, Dunn DW. Epilepsy and attention-deficit hyperactivity disorder: Links, risks, and challenges. Neuropsychiatr Dis Treat 2016;12:287–96.
18. 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;61:731–6.
19. Dunn DW, Austin JK, Harezlak J, Ambrosius WT. ADHD and epilepsy in childhood. Dev Med Child Neurol 2003;45:50–4.
20. Vaags AK, Bowdin S, Smith M Lou, Gilbert-Dussardier B, Brocke-Holmefjord KS, Sinopoli K, et al. Absent CNKSR2 causes seizures and intellectual, attention, and language deficits. Ann Neurol 2014;76:758–64.
21. Dolan J, Mitchell KJ. Mutation of Elfn1 in mice causes seizures and hyperactivity. PLoS One 2013;8:1–15.
22. Verrotti A, Moavero R, Panzarino G, Di Paolantonio C, Rizzo R, Curatolo P. The challenge of pharmacotherapy in children and adolescents with epilepsy-ADHD comorbidity. Clin Drug Investig 2018;38:1–8.
23. Holtmann M, Becker K, Kentner-Figura B, Schmidt MH. Increased frequency of rolandic spikes in ADHD children. Epilepsia 2003;44:1241–4.
24. Gascoigne MB, Smith ML, Barton B, Webster R, Gill D, Lah S. Attention deficits in children with epilepsy: Preliminary findings. Epilepsy Behav 2017;67:7–12.
25. Cavazzuti GB, Cappella L, Nalin A. Longitudinal study of epileptiform EEG patterns in normal children. Epilepsia 1980;21:43-55.
26. Richer LP, Shevell MI, Rosenblatt BR. Epileptiform abnormalities in children with attention-deficit-hyperactivity disorder. Pediatr Neurol 2002;26125–9.
27. Kartal A, Aksoy E, Deda G. The effects of risk factors on EEG and seizure in children with ADHD. Acta Neurol Belg 2017;117:169–73.
28. Hemmer SA, Pasternak JF, Zecker SG, Trommer BL. Stimulant therapy and seizure risk in children with ADHD. Pediatr Neurol 2001;24:99–102.
29. Debicki DB. Electroencephalography after a single unprovoked seizure. Seizure 2017;49:69–73.
30. Berquin PC, Giedd JN, Jacobsen LK, Hamburger SD, Krain AL, et al. Cerebellum in attention-deficit hyperactivity disorder: a morphometric MRI study. Neurology 1998;50:1087-93.
31. Onur E, Alkın T, Ada E. Kavum septum pellusidum ile obsesif kompulsif bozukluk ve tourette bozukluğu iliþkisi : Bir olgu sunumu. Klinik Psikiyatri 2007;10:53–7.
32. 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;18:109–12.
33. Gilby KL. A new rat model for vulnerability to epilepsy and autism spectrum disorders. Epilepsia 2008;49:108–10.