The frequency, complications and aetiology of ADHD in new onset paediatric epilepsy
The frequency, complications and aetiology of ADHD in new onset paediatric epilepsy
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DOI：
10.1093/brain/awm227
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发表时间：
2007-12-01
期刊：
影响因子：
14.5
通讯作者：
Seidenberg, Michael
中科院分区：
文献类型：
--
作者：
Hermann, Bruce;Jones, Jana;Seidenberg, Michael
最近的研究表明，注意力缺陷多动障碍（ADHD）是儿童癫痫的常见共病，但对相关神经行为/认知并发症的性质，频率和时间或ADHD在癫痫中的潜在病因学知之甚少。这项调查审查了：（i）ADHD及其亚型的患病率;（ii）ADHD与学术、神经心理、行为和精神状态异常的相关性;（iii）ADHD在儿科癫痫中的病因。75例新发/近期发作的特发性癫痫儿童（年龄818岁）和62例健康对照者进行了结构化访谈（K-SADS），以确定DSM-IV定义的ADHD的存在和类型，神经心理学评估，定量MR体积测量，父母观察到的执行功能的表征，学术/教育进展的审查和妊娠和分娩期间风险因素的评估。结果表明，ADHD在新发癫痫中的发病率明显高于健康对照组（31比6），其特征主要是注意力不集中，大多数儿童的癫痫诊断发生在发病前。ADHD儿童癫痫与基于学校的补救服务的学习成绩不佳，神经心理学后果与执行功能的显着差异，和父母报告的执行障碍行为的比率显着增加。儿童癫痫的ADHD与人口统计学或临床癫痫特征或妊娠和出生期间的潜在危险因素无关。定量磁共振成像显示，ADHD癫痫与额叶分布区域的灰质显著增加和脑干体积显著减小相关。总体而言，ADHD是新发特发性癫痫的一种常见合并症，与多种显著的教育、认知、行为和社会并发症相关，这些并发症在很大比例的病例中先于癫痫发作，并且似乎与大脑结构中的神经发育异常相关。
Recent studies suggest that Attention Deficit Hyperactivity Disorder (ADHD) is a common comorbid condition in childhood epilepsy, but little is known regarding the nature, frequency and timing of associated neurobehavioural/cognitive complications or the underlying aetiology of ADHD in epilepsy. This investigation examined: (i) the prevalence of ADHD and its subtypes; (ii) the association of ADHD with abnormalities in academic, neuropsychological, behavioural and psychiatric status and (iii) the aetiology of ADHD in paediatric epilepsy. Seventy-five children (age 818) with new/recent onset idiopathic epilepsy and 62 healthy controls underwent structured interview (K-SADS) to identify the presence and type of DSM-IV defined ADHD, neuropsychological assessment, quantitative MR volumetrics, characterization of parent observed executive function, review of academic/educational progress and assessment of risk factors during gestation and delivery. The results indicate that ADHD is significantly more prevalent in new onset epilepsy than healthy controls (31 versus 6), characterized predominantly by the inattentive variant, with onset antedating the diagnosis of epilepsy in the majority of children. ADHD in childhood epilepsy is associated with significantly increased rates of school based remedial services for academic underachievement, neuropsychological consequences with prominent differences in executive function, and parent-reported dysexecutive behaviours. ADHD in paediatric epilepsy is neither associated with demographic or clinical epilepsy characteristics nor potential risk factors during gestation and birth. Quantitative MRI demonstrates that ADHD in epilepsy is associated with significantly increased gray matter in distributed regions of the frontal lobe and significantly smaller brainstem volume. Overall, ADHD is a prevalent comorbidity of new onset idiopathic epilepsy associated with a diversity of salient educational, cognitive, behavioural and social complications that antedate epilepsy onset in a significant proportion of cases, and appear related to neurodevelopmental abnormalities in brain structure.