Attention-Deficit/Hyperactivity Disorder

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Attentional issues and ADHD are common in children with epilepsy, but there are 2 differences from the general pediatric population. First, the inattentive subtype of ADHD is more common in children with epilepsy. This subtype causes less disruption in the classroom and diagnosis can be delayed compared with those who are also hyperactive. Second, the sex ratio is equal in children with epilepsy, with girls affected as commonly as boys.

ADHD is most common with comorbid intellectual and developmental disabilities and in patients with drug-resistant epilepsy. It is recommended that all children with epilepsy be screened for ADHD starting at school entry, with screening repeated annually. In the past it had been thought that stimulant class medication could provoke or cause seizures. However, this perception is erroneous, and stimulant medications such as methylphenidate are safe and effective for comorbid ADHD in children with epilepsy. (55)

Mood/Anxiety

There is a bidirectional relationship between mood disorders and epilepsy, suggesting common pathogenic mechanisms between these 2 conditions. Persons with epilepsy are more likely to have comorbid mood disorders, and those with mood disorders are at increased risk for seizures compared with the general population. (56) Mood concerns may be exacerbated by stressors associated with having epilepsy, the need to take daily medications, medication adverse effects, and activity restrictions.

Although all antiseizure medications carry a black box warning for suicidality, certain medications may have greater potential for psychiatric adverse effects, including levetiracetam (depression and rage) and perampanel (homicidality). Given the frequency with which comorbid mood disturbances exist in children and teens with epilepsy and the potential adverse effects of antiseizure medications on mood, screening for anxiety and depression should be performed on a regular basis, with appropriate referrals to psychiatry and psychology specialists as indicated. (57)(58)

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