Correlation between epilepsy and attention deficit hyperactivity disorder: a population-based cohort study

I-Ching Chou, Yu-Tzu Chang, Zheng-Nan Chin, Chih-Hsin Muo, Fung-Chang Sung, Huang-Tsung Kuo, Chang-Hai Tsai, Chia-Hung Kao, I-Ching Chou, Yu-Tzu Chang, Zheng-Nan Chin, Chih-Hsin Muo, Fung-Chang Sung, Huang-Tsung Kuo, Chang-Hai Tsai, Chia-Hung Kao

Abstract

Background: This study presents an evaluation of the bidirectional correlation between attention deficit hyperactivity disorder (ADHD) and epilepsy using 2 cohorts from the same population database.

Methods: We used data from the Taiwan National Health Insurance Research Database to establish 2 separate cohort studies with participants <19 years old. We subdivided Cohort 1 in 2 groups: (1) 2468 patients initially diagnosed with epilepsy during the period 1999-2008, and (2) 9810 randomly selected sex- and age-matched non-epileptic controls. We subdivided Cohort 2 into 2 groups: (1) 3664 patients with newly diagnosed ADHD and (2) 14 522 sex- and age-matched non-ADHD patients. We evaluated the risk of subsequent ADHD in relationship to epilepsy and vice versa in the 2 cohorts at the end of 2008.

Results: The ADHD incidence in Cohort 1 was 7.76 in patients with epilepsy and 3.22 in those without epilepsy (per 1000 person-years) after a median follow-up of 7-7.5 years. The adjusted hazard ratio (HR) for ADHD was 2.54 (95% CI 2.02-3.18) in the epilepsy group compared to the non-epilepsy group. In Cohort 2, the incidence of epilepsy was 3.24 in patients with ADHD and 0.78 in those without ADHD (per 1000 person-years) after a median follow-up of 3-3.5 years and an HR of 3.94 (95% CI 2.58-6.03).

Conclusion: This study shows a bidirectional association between ADHD and epilepsy in the 2 cohort studies. Causative factors may be common between these 2 disorders, leading to a cascade of transcriptional changes in the brain that alter behavior or cognition prior to seizures.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Schematic diagram of the selection…
Figure 1. Schematic diagram of the selection of study subjects.

References

    1. Williams J, Schulz EG, Griebel ML (2001) Seizure occurrence in children diagnosed with ADHD. Clin Pediatr (Phila) 40: 221–224.
    1. Aicardi J (1998) Epilepsy and other seizure disorders. In : J. Aicardi, editors. Diseases of the nervous system in childhood. 2nd ed. London: Cambridge University Press. 575–637.
    1. Aicardi J (1996) Epilepsy as a non-paroxysmal disorder. Acta Neuropediatrica 2: 249–57.
    1. Swanson JM, Sergeant JA, Taylor E, Sonuga-Barke EJ, Jensen PS, et al. (1998) Attention-deficit hyperactivity disorder and hyperkinetic disorder. Lancet 351: 429–433.
    1. Thome-Souza S, Kuczynski E, Assumpcao F Jr, Rzezak P, Fuentes D, et al. (2004) Which factors may play a pivotal role on determining the type of psychiatric disorder in children and adolescents with epilepsy? Epilepsy Behav 5: 988–994.
    1. Holdsworth L, Whitmore K (1974) A study of children with epilepsy attending ordinary schools. I: their seizure patterns, progress and behaviour in school. Dev Med Child Neurol 16: 746–758.
    1. Stores G, Hart J, Piran N (1978) Inattentiveness in schoolchildren with epilepsy. Epilepsia 19: 169–175.
    1. Richer LP, Shevell MI, Rosenblatt BR (2002) Epileptiform abnormalities in children with attention-deficit-hyperactivity disorder. Pediatr Neurol 26: 125–129.
    1. Austin JK, Harezlak J, Dunn DW, Huster GA, Rose DF, et al. (2001) Behavior problems in children before first recognized seizures. Pediatrics 107: 115–122.
    1. Dunn DW, Austin JK, Huster GA (1997) Behaviour problems in children with new-onset epilepsy. Seizure 6: 283–287.
    1. Chang YT, Chen PC, Tsai IJ, Sung FC, Chin ZN, et al. (2011) Bidirectional relation between schizophrenia and epilepsy: a population-based retrospective cohort study. Epilepsia 52: 2036–2042.
    1. NHI profile (updated 2009.06.05).Available: /webdata/AttachFiles/Attach_13787_1_NationalHealthInsuranceinTaiwan2009.Accessed 2010 Oct 5.
    1. Lu JF, Hsiao WC (2003) Does universal health insurance make health care unaffordable? Lessons from Taiwan. Health Aff (Millwood) 22: 77–88.
    1. Cowan LD (2002) The epidemiology of the epilepsies in children. Ment Retard Dev Disabil Res Rev 8: 171–181.
    1. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164: 942–948.
    1. Rappley MD (2005) Clinical practice. Attention deficit-hyperactivity disorder. N Engl J Med 352: 165–173.
    1. Diagnosis and treatment of attention deficit hyperactivity disorder (ADHD). NIH Consens Statement 16: 1–37.
    1. Aldenkamp AP, Arends J, Overweg-Plandsoen TC, van Bronswijk KC, Schyns-Soeterboek A, et al. (2001) Acute cognitive effects of nonconvulsive difficult-to-detect epileptic seizures and epileptiform electroencephalographic discharges. J Child Neurol 16: 119–123.
    1. Semrud-Clikeman M, Wical B (1999) Components of attention in children with complex partial seizures with and without ADHD. Epilepsia 40: 211–215.
    1. Austin JK, Harezlak J, Dunn DW, Huster GA, Rose DF, et al. (2001) Behavior problems in children before first recognized seizures. Pediatrics 107: 115–122.
    1. Hesdorffer DC, Ludvigsson P, Olafsson E, Gudmundsson G, Kjartansson O, et al. (2004) ADHD as a risk factor for incident unprovoked seizures and epilepsy in children. Arch Gen Psychiatry 61: 731–736.
    1. Bush G, Valera EM, Seidman LJ (2005) Functional neuroimaging of attention-deficit/hyperactivity disorder: a review and suggested future directions. Biol Psychiatry 57: 1273–1284.
    1. Rubia K, Smith AB, Brammer MJ, Toone B, Taylor E (2005) Abnormal brain activation during inhibition and error detection in medication-naive adolescents with ADHD. Am J Psychiatry 162: 1067–1075.
    1. Seidman LJ, Valera EM, Makris N (2005) Structural brain imaging of attention-deficit/hyperactivity disorder. Biol Psychiatry 57: 1263–1272.
    1. Zang YF, Jin Z, Weng XC, Zhang L, Zeng YW, et al. (2005) Functional MRI in attention-deficit hyperactivity disorder: evidence for hypofrontality. Brain Dev 27: 544–550.
    1. McIntyre DC, Gilby KL (2007) Genetically seizure-prone or seizure-resistant phenotypes and their associated behavioral comorbidities. Epilepsia 48 Suppl 930–32.
    1. Gilby KL (2008) A new rat model for vulnerability to epilepsy and autism spectrum disorders. Epilepsia 49 Suppl 8108–110.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa