Association between attention-deficit/hyperactivity disorder and epilepsy in pediatric populations

Abstract

There is a bidirectional relationship between attention-deficit/hyperactivity disorder (ADHD) and epilepsy. ADHD increases seizure risk, while patients with epilepsy have an increased prevalence of ADHD. The reasons explaining this association are not fully understood. Proposed mechanisms include effects of antiepileptic medications, underlying neurodevelopmental vulnerability, the effects of chronic seizures and subclinical epileptiform activity on cognitive functions and adrenergic dysfunction. There may also be a common genetic defect underlying both disorders in some families. Antiepileptics associated with ADHD-like side effects include phenobarbital, gabapentin, vigabatrin and topiramate. Methylphenidate has been studied in a double-blind setting against placebo for treatment of ADHD comorbid with epilepsy, and has a good risk–benefit ratio. Amphetamine, atomoxetine, clonidine and guanfacine only have case series to support their use and bupropion should be avoided.

Keywords::

• ADHD
• AED
• antiepileptic medications
• epilepsy
• nonstimulant ADHD medications
• pathophysiology
• stimulant medications
• treatment of ADHD and epilepsy

Financial & competing interests disclosure

In the past year, Joseph Gonzalez-Heydrich has been a consultant to AstraZeneca. In previous years, he has served as a consultant for: Abbott Laboratories, Pfizer Inc, Johnson & Johnson (Janssen, McNeil Consumer Health), Novartis, Parke-Davis, GlaxoSmithKline, AstraZeneca, and Seaside Therapeutics, has been a speaker for Abbott Laboratories, Pfizer Inc, Novartis, and Bristol-Myers Squibb, and has received grant support from Abbott Laboratories, Pfizer Inc, Johnson & Johnson (Janssen, McNeil Consumer Health) and Akzo-Nobel/Organon. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.