ADHD Symptoms Common in Adult Epilepsy

January 28, 2015

Symptoms occur in nearly 1 in 5 adults who have epilepsy. Their presence may have severe implications for patients’ quality of life.

Attention deficit hyperactivity disorder (ADHD) symptoms occur in nearly 1 in 5 adults who have epilepsy, according to a new study.

“Little was previously known about the prevalence of ADHD symptoms in adults with epilepsy, and the results were quite striking,” said lead author Alan B. Ettinger, MD, MBA, Director of the Epilepsy Center at Neurological Surgery, P.C., and Professor of Clinical Neurology, Albert Einstein College of Medicine, in New York. “To my knowledge, this is the first time ADHD symptoms in adults with epilepsy have been described in the scientific literature. Yet, the presence of these symptoms may have severe implications for patients’ quality of life, mood, anxiety, and functioning in both their social and work lives.”

Those in the study who experienced ADHD symptoms also self-reported higher rates of anxiety, depression, and worse seizure frequency.

“This study reinforces the fact that we have to broaden our view of what epilepsy entails,” Dr Ettinger said. “Our patients may also have psychiatric comorbidities, and screening for and treating these may make a great difference to patients in their family, school, and work lives.”

Dr Ettinger and colleagues mailed a survey to a national sample of adults who self-reported having epilepsy as part of the Epilepsy Comorbidities and Health study. The survey included a number of assessments and scales with established reliability and validity to measure not just ADHD symptoms, but also other factors that might affect patients’ physical and mental health. Also included in the survey were questions about seizure frequency and number of antiepileptic drugs used in the past 3 months.

The relationship of ADHD symptoms to quality of life outcomes was examined using statistical analyses, which also looked at sociodemographics, depression, anxiety, seizure frequency, and number of antiepileptic drugs.

Among the 1361 respondents with active epilepsy, 18.4% were classified as experiencing significant ADHD symptoms. This is 4 times higher than the approximate 4.4% rate of ADHD diagnosis in the general adult population.

Those who self-reported ADHD symptoms were 9 times more likely to have depression and 8 times more likely to have anxiety symptoms. Controlling for all covariates, those with ADHD symptoms had lower quality of life; worse physical and social functioning; and increases in family, social, and work-related disability, compared with those who did not have symptoms.

“Physicians who treat epilepsy often attribute depression, anxiety, reduced quality of life, and psychosocial outcomes to the effects of seizures, antiepileptic therapies, and underlying central nervous system conditions. Our findings suggest that ADHD may also be playing a significant role,” said Dr Ettinger.

He noted that it is unknown whether ADHD in epilepsy is responsive to treatment.

“We need to validate measures to screen for ADHD specifically in epilepsy and clarify the nature of ADHD symptoms in adults with epilepsy,” he said. “This will lay the foundation for future trials of treatments that offer the promise of rendering major improvements in the quality of life of adult epilepsy patients.”

The researchers published their results online January 15, 2015 in Epilepsia.