Association between epilepsy and attention deficit/hyperactivity disorder – correlation between interictal epileptiform discharges and behavioral disturbances

Abstract

A relationship between epileptic activities and neuropsychological dysfunction has been indicated in epileptic children. Epileptic activities including frequent/prolonged seizures and severe EEG abnormalities could be associated with cognitive decline and behavioral disturbances. Frequent, prolonged seizures could induce growth disturbances in the prefrontal cortex, leading to behavioral disturbance. Meanwhile, frequent epileptic seizures or EEG abnormalities, including interictal epileptiform discharges (IEDs), are evident in attention deficit/hyperactivity disorder (ADHD). Subclinical IEDs could lead to neuropsychological dysfunction in epileptic and ADHD children. The concurrence of IED frequency and prolonged periods of high-frequency IEDs may predict the atypical evolution of self-limited epilepsy with centrotemporal spikes. In developmental and epileptic encephalopathy with spike-wave activation during sleep, cognitive/behavioral disturbances correlate with frequent IEDs such as secondary bilateral synchrony (SBS). On the other hand, EEG manifestations, particularly IED locations, could represent important predictors of optimal outcome in epilepsy and ADHD. Abnormal paroxysms in the frontal region could lead to neuropsychological dysfunctions, so frontal IEDs could be associated with cognitive/behavioral disturbances in epilepsy and ADHD. Frontal IEDs could predict atypical clinical features including behavioral disturbance and ultimate neuropsychological outcomes in epileptic/ADHD children. Early remission of clinical seizures and reduction of IEDs might be necessary to accomplish optimal outcomes for children presenting with behavioral disturbances. A therapeutic strategy comprising prompt suppression of IEDs (including frontal IEDs/SBS) could improve quality of life in at least some children with epilepsy and ADHD.