Hyperkinetic Disorder/Attention Deficit Hyperactivity Disorder in Children with Epilepsy

Authors: P. Cahová;  J. Pejčochová;  H. Ošlejšková
Authors‘ workplace: Klinika dětské neurologie LF MU a FN Brno
Published in: Cesk Slov Neurol N 2011; 74/107(2): 157-162
Category: Review Article


Hyperkinetic disorder, also known as attention deficit hyperactivity disorder (HKD/ADHD), is a neurodevelopmental disorder characterised by an age-related and inappropriate rate of hyperactivity with impulsivity together with an inability to remain focused on tasks or activities. HKP/ADHD incidence in children with epilepsy is estimated to be as high as 30%–40%. Several studies show that in children with ADHD the presence of epileptiform discharges can be found in 6%–51% of cases. The hypothesis that the comorbid incidence of epilepsy and ADHD may be merely coincidental is not accepted. Cognitive and behavioural changes in patients with epilepsy used to be explained as the consequences of recurrent seizures, the influence of antiepileptic medication and the substantial substrate of epilepsy. However, in the majority of ADHD and epilepsy children, the onset of ADHD symptomatology precedes the onset of clinical seizures. The onset of spontaneous seizures arises out of a complex process of epileptogenesis that involves a cascade of transcriptional changes involving the processes of plasticity, apoptosis and neurogenesis. All of these changes may influence the behavioural and cognitive profile before seizure onset. The pathophysiology of ADHD is explained by disturbances in the prefrontal-thalamo-striato-cortical neuronal circuits. It is the frontal lobe that is important to the understanding of the common neurobiological substrate of ADHD and epilepsy.

Key words:
hyperkinetic disorder – ADHD – epilepsy – frontal lobe epilepsy – childhood absence epilepsy – BECTS


1. Drtílková I, Šerý O et al. Hyperkinetická porucha. ADHD. 1st ed. Praha: Galén 2007.

2. Piccirilli M, D’Alessandro P, Sciarma T, Cantoni C, Dioguardi MS, Giuglietti M et al. Attention problems in epilepsy: possible significance of the epileptogenic focus. Epilepsia 1994; 35(5): 1091–1096.

3. Mezinárodní klasifikace nemocí. Duševní poruchy a poruchy chování. Popisy klinických příznaků a dia­gnostická vodítka. 10. revize. Praha: Psychiatrické centrum 2000.

4. American Psychiatric Association. Diagnostic and Statistic Manual of Mental Disorders, 4th ed (DSM-IV). Washington DC: American Psychiatric Association 1994.

5. Ounsted C. The hyperkinetic syndrome in epileptic children. Lancet 1955; 269(6885): 303–311.

6. Hesdorffer DC, Ludvigsson P, Olafsson E, Gudmundsson G Kjartansson O, Hauser A. ADHD as a risk factor for incident unprovoked seizures and epilepsy in children. Arch Gen Psychiatry 2004; 61(7): 731–736.

7. Dunn DW, Austin JK, Harezlak J, Ambrosius WT. ADHD and epilepsy in childhood. Dev Med Child Neurol 2003; 45(1): 50–54.

8. Hermann B, Jones J, Dabbs K, Chase AA, Sheth R, Fine J et al. The frequency, complications and aetiology of ADHD in new onset pediatric epilepsy. Brain 2007; 130(12): 3135–3148.

9. Thome-Souza S, Kuczynski E, Assumpcao F Jr, 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(6): 988–994.

10. Salpekar JA, Dunn DW. Psychiatric and psychosocial consequences of pediatric epilepsy. Semin Pediatr Neurol 2007; 14(4): 181–188.

11. Richer LP, Shevell MI, Rosenblatt BR. Epileptiform abnormalities in children with attention-deficit hyperactivity disorder. Pediatr Neurol 2002; 26(2): 125–129.

12. Hughes JR, DeLeo AJ, Melyn MA. The electroencephalogram in attention-deficit hyperaktivity disorder: emphasis on epileptiform discharges. Epilepsy Behav 2000; 1(4): 271–277.

13. Silvestri R, Gagliano A, Calarese T, Arico I, Cedro C, Condurso R et al. Ictal and interictal EEG abnormalities in ADHD children recorded over night by video-polysomnography. Epilepsy Res 2007; 75(2–3): 130–137.

14. Ambler Z, Bednařík J, Růžička E. Klinická neurologie – 1. část obecná. Praha: Triton 2004.

15. Bedard AC, Nichols S, Barbosa JA. The development of selective inhibitory control across the life span. Dev Neuropsychol 2002; 21(1): 93–111.

16. Medřická H, Kunčíková M, Novák V. ADHD. Neurol pro Praxi 2007; 8(4): 219–221.

17. Barkley RA. Attention-deficit hyperaktivity disorder: a handbook for diagnosis and treatment. 3rd ed. New Your: The Guilford Press 2006.

18. Deonna T, Zesiger P, Davidoff V, Maeder M, Mayor C, Roulet E. Benign partial epilepsy of childhood: a longitudinal neuropsychological and EEG study of cognitive function. Dev Med Chil Neurol 2000; 42(9): 595–603.

19. Cahová P, Pejčochová J, Ošlejšková H. The occurrence of epileptiform activity on EEG and epilepsy in children with hyperkinetic disorder: a retrospective study. Proceedings of the 9th European Congress on Epileptology; 2010; Rhodes, Greece. Epilepsia 2010; 51 (Suppl 4): 1–189.

20. Aldenkamp AP, Arends J, Overwg-Plandsoen TC, van Bronsvijk KC, Schyns-Soeterboek A, Linden I et al. Acute cognitive effects of nonconvulsive difficult-to-detect epileptic seizures and epileptiform electroencephalographic discharges. J Child Neurol 2001; 16(2): 119–123.

21. Semrud-Clikeman M, Wical B. Components of attention in children with complex partial seizures with and without ADHD. Epilepsia 1999; 40(2): 211–215.

22. Bourgeois BF. Antiepileptic drugs, learning, and behavior in childhood epilepsy. Epilepsia 1998; 39(9): 913–921.

23. Deltour L, Barathon M, Quagliano V, Vernier MP, Despretz P, Boucart M et al. Children with benign epilepsy with centrotemporal spikes (BECTS) show impaired attentional control: evidence from an attentional capture paradigma. Epileptic Disord 2007; 9(1): 32–38.

24. Cortez MA, Perez Velazques JL, Snead OC III. Animal models of epilepsy and progressive effects of seizures. Adv Neurol 2006; 97: 293–304.

25. Meencke HJ. Pathological findings in childhood absence epilepsy. In: Duncan JS, Panayiotopoulos CP (eds). Typical absences and related epileptic syndromes. London: Churchill Communications Europe 1995: 122–132.

26. Castellanos FX, Lee PP, Sharp W, Jeffries NO, Greenstein DK, Clasen LS et al. Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. JAMA 2002; 288(14): 1740–1748.

27. Hill DE, Yeo RA, Campbell RA, Hart B, Vigil J, Brooks W. Magnetic resonance imaging correlates of attention-deficit/hyperactivity disorder in children. Neuropsychology 2003; 17(3): 496–506.

28. Mackie S, Shaw P, Lenroot R, Pierson R, Greenstein DK, Nugent TF III et al. Cerebellar development and clinical outcome in attention deficit hyperactivity disorder. Am J Psychiatry 2007; 164(4): 647–655.

29. Ben-Yehudah G, Guediche S, Fiez JA. Cerebellar contributions to verbal working memory: beyond cognitive theory. Cerebellum 2007; 6(3): 193–201.

30. Willcutt EG, Doyle AE, Nigg JT, Faraone SV, Pennington BF. Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biol Psychiatry 2005; 57(11): 1336–1346.

31. Roessner V, Becker A, Banaschewski T, Rothenberger A. Executive functions in children with chronic tic disorders with/without ADHD: new insights. Eur Child Adolesc Psychiatry 2007; 16 (Suppl 1): 36–44.

32. Bechtel N, Kobel M, Penner I-K, Klarhofer M, Scheffler K, Opis K et al. Decreased fractional anisotropy in the middle cerebellar peduncle in children with epilepsy and/or attention deficit/hyperacitivty disorder: A preliminary study. Epilepsy Behav 2009; 15(3): 294–298.

33. Ben-Ari Y, Holmes GL. Effects of seizures on developmental processes in the immature brain. Lancet Neurol 2006; 5(12): 1055–1063.

34. Hernandez MT, Sauerwein HC, Jambaque I, De Guise E, Lussier F, Lortie A et al. Deficits in executive functions and motor coordination in children with frontal lobe epilepsy. Neuropsychologia 2002; 40(4): 384–400.

35. Prevost 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.

36. Henkin Y, Sadeh M, Kvity S, Shabtai E, Kishon-Rabin L, Gadoth N. Cognitive function idiopathic generalised epilepsy of childhood. Dev Med Child Neurol 2005; 47(2): 126–132.

37. Nolan MA, Redoblado MA, Lah S, Sabaz M, Lawson JA, Cunningham AM et al. Memory function in childhood epilepsy syndromes. J Pediatr Child Health 2004; 40(1–2): 20–27.

38. Pavone P, Bianchini R, Trifiletti RR, Incorpora G, Pavone L, Parano E. Neuropsychological assessment in children with absence epilepsy. Neurology 2001; 56(8): 1047–1051.

39. Caplan R, Siddarth P, Stahl L, Lanphier E, Vona P, Gurbani S et al. Childhood absence epilepsy: behavio­ral, cognitive, and linguistic comorbidities. Epilepsia 2008; 49(11): 1838–1846.

40. Holtmann M, Becker K, Kentner-Figura B, Schmidt MH. Increased frequency of rolandic spikes in ADHD children. Epilepsia 2003; 44(9): 1241–1244.

41. Holtmann M, Matei A, Hellmann U, Becker K, Poustka F, Schmidt MH. Rolandic spikes increase impulsivity in ADHD – a neuropsychological pilot study. Brain Dev 2006; 28(10): 633–640.

42. Deltour L, Quaglino V, Barathon M, DeBroca A, Berquin P. Clinical evaluation of attentional processes in children with benign childhood epilepsy with centrotemporal spikes (BCECTS). Epileptic Disord 2007; 9(4): 424–431.

43. Stephani U, Carlsson G. The spectrum from BCECTS to LKS: The rolandic EEG trait – impact on cognition. Epilepsia 2006; 47 (Suppl 2): 67–70.

44. Deltour L, Barathon M, Quaglino V, Vernier MP, Despretz P, Boucart M et al. Children with benign epilepsy with centrotemporal spikes (BECTS) show impaired attentional control: evidence from an attentional capture paradigm. Epileptic Disord 2007; 9(1): 32–38.

45. Baglietto G, Battaglia FM, Nobili L, Totorelli S, DeNegri E, Nalevo MG et al. Neuropsychological disorders related to interictal epileptic discharges during sleep in benign epilepsy of childhood with centrotemporal or rolandic spikes. Dev Med Child Neurol 2001; 43(6): 407–412.

46. Nickels K, Wirrell E. Electrical status epilepticus in sleep. Semin Pediatr Neurol 2008; 15(2): 50–60.

47. Ryvlin P, Rheims S, Risse G. Nocturnal frontal lobe epilepsy. Epilepsia 2006; 47 (Suppl 2): 83–86.

48. Parisi P, Moavero R, Verrotti A, Curatolo P. Attention deficit hyperactivity disorder in children with epilepsy. Brain Dev 2010; 32(1): 10–16.

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