Attention is the foundation of cognitive function and is often impaired in patients with epilepsy. One disorder most commonly associated with attention impairment is Attention-deficit/hyperactivity disorder (ADHD). ADHD is more prevalent among children with epilepsy than in the general population (1). This is especially true in children with absence epilepsy, in whom the brief seizures and interictal epileptiform activity can impair both fleeting and sustained attention. However, attentional impairment affects children with all seizure types and of both sexes equally (1). Antiepileptic drugs can also impair attention.

The use of central nervous system (CNS) stimulants appears to be safe in the large majority of patients with epilepsy (2). However, these drugs can cause new-onset seizures, especially in children with epileptiform activity (3), or exacerbate epilepsy, especially in children whose seizures are not fully controlled by AEDs (4). The safety and efficacy of other agents for ADHD, such as atomoxetine,(Strattera) have not been studied in epilepsy populations.

References

1. Dunn DW, Austin JK, Harezlak J, Ambrosius WT. ADHD and epilepsy in childhood. Dev Med Child Neurol 2003;45:50–4.
2. Gucuyener K, Erdemoglu AK, Senol S, Serdaroglu A, Soysal S, Kockar AI. Use of methylphenidate for attention-deficit hyperactivity disorder in patients with epilepsy or electroencephalographic abnormalities. J Child Neurol 2003;18:109–12.
3. Hemmer SA, Pasternak JF, Zecker SG, Trommer BL. Stimulant therapy and seizure risk in children with ADHD. Pediatr Neurol 2001;24:99–102.
4. Gross-Tsur V, Manor O, van der Meere J, Joseph A, Shalev RS. Epilepsy and attention deficit hyperactivity disorder: is methylphenidate safe and effective? J Pediatr 1997;130:670–4.

Reproduced and adapted with permission from Orrin Devinsky, M.D. and Epilepsia.

Topic Editor: Steven C. Schachter, M.D.
Last Reviewed:12/15/06