Is it ADHD…Epilepsy…or Both?

ADHD is the current term for the neurological condition formerly known as ADD (Attention Deficit Disorder), Hyperactivity, Hyperkinesis, Organic Brain Syndrome, Minimal Brain Dysfunction, and Minimal Brain Damage.

About 5 % of children in the general population have ADHD.  However, about 30-40% of children with epilepsy may have ADHD or attention problems. Also, ADHD is seen more often in boys than in girls (some medical professionals claim this ratio to be as high 4 to 1).

Interestingly, ADHD is often confused with epilepsy. Especially for kids who have staring spells, daydreamers or those who blank out frequently during the day. (“Johnny, you’re not paying attention!”). They could actually be absence seizures.

Either condition may be misdiagnosed as the inattentive type of ADHD and both can result in learning difficulties. Most of the time, it is an underlying brain problem that causes seizures, ADHD, and trouble learning. Less often, poorly controlled seizures and the adverse effect of antiepileptic drugs may impair attention and learning.

Michael Chez, M.D., Director of Pediatric Neurology at Sutter Neuroscience Institute, Sacramento, Calif., and Associate Professor of Neurology at the University of California, Davis, Calif., cautioned that all children who are inattentive at school don’t necessarily have absence epilepsy. He said, “If a child has lapses of attention both at school and at home, the diagnosis is often absence epilepsy. But if the staring spells just occur at school, it is probably attention deficit hyperactivity disorder.”

Two behaviors identified children with seizures versus children with ADHD with 96% accuracy: Their eyes became glassy, and the child did not fidget.

Dr. Knowles offered another clinical observation, “If a child is inattentive and doesn’t respond when you call him, it may be ADHD or a seizure. But if you touch the child and he still doesn’t respond, that is more suggestive of a seizure. Children with ADHD will respond when you touch them. It’s really easy to turn off your ears, but it’s much harder to tune out touch.”

Furthermore, seizures are episodic events and ADHD is a pervasive disorder that causes symptoms that are present throughout the day.

Children with suspected attention deficient difficulties may also be referred to a neuropsychologist for a more comprehensive assessment of their cognitive, academic, and behavioral functioning.

Neuropsychological tests usually include measures of overall intellectual functioning, academic achievement, and aspects of attention, language, spatial, motor, and memory abilities. Neuropsychologists also assess the overall presence and severity of psychological and behavioral difficulties. Based on this information, an informed assessment of ADHD symptoms can be made and a diagnosis provided.

In terms of medication, Ritalin has been shown to counteract the effectiveness of Phenobarbital.  Otherwise, newer antiepileptic medications generally have far fewer cognitive side effects and less negative drug interactions than did earlier generations of AEDs. And children can lead productive lives as long as they receive treatment early on.

Phylis Feiner Johnson     www.epilepsytalk.com