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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

Comments

Re: Is it ADHD…Epilepsy…or Both?

Generally speaking, epilepsy is one thing and ADHD is another. Epilepsy can show up on an EEG; ADHD does not show up on an EEG. Persons with epilepsy can occasionally show quite clear improvements due to taking the right medicine for epilepsy like Dilantin or Keppra/whatever. Persons with ADHD can occasionally show quite clear improvements due to taking the right medicine for ADHD (historically a central nervous system stimulant - alerting agent such as: coffee, caffeine compounds, Tirend, NoDoz, Ritalin, Dexedrine, Adderall and so on). There are over 10 kinds of epilepsies; there are 4 kinds of ADHD today (year 2011) including ADHD Inattentive. Books which can help clarify the differences between epilepsy and ADHD include: the Nerves In Collision book by Walter C. Alvarez, M.D. (about the many epilepsies) as well as the How To (understand) Hyperactivity book (1981) about ADHD by C. Thomas Wild (about ADHD Inattentive, central auditory processing disorder/CAPD, modern nutrition). Both books (Alvarez, Wild) can provide insights here and there (no cures). Words: Epilepsy = too much electricity in one or more parts of the brain (simplified/oversimplified) vs ADHD = lack of neurotransmitters such as dopamine (movement) and norepinephrine (alertness)(simplified/oversimplified). Also, for some with ADHD - auditory processing disorder is a part of their ADHD. - http://www.ericdigests.org/2003-5/auditory.htm - Caffeine and short term memory - http://www.rsna.org/rsna/media/pr2005/Coffee.cfm - Coffee Jump-starts Short-term Memory. Some symptoms of ADHD Inattentive (distractible, short attention span, lack of sustained attention, imperfect working memory/short term memory) can look like symptoms of petit mal/absence seizures (staring, spaced out, space cadet, daydreaming) but the two are different (see books previously mentioned). For persons with epilepsy, the central nervous system stimulants - alerting agents - from caffeine to Adderall can lower the seizure threshold. It can be extremely difficult to find professionals knowledgable about both epilepsy and ADHD and especially the gray area between the two which can share similar words such as: inattentiveness, unalertness, subtle concentration, subtle memory difficulties, space cadet, daydreaming. - http://www.pbs.org/wgbh/misunderstoodminds/attention.html -

Re: Is it ADHD…Epilepsy…or Both?

What's interesting too is that with ADHD, you experience what they call blips or staring off for a while. I've taken Ritalin, and it DOES do wonders to bring me into a world of paying attention, staying on task, reading without wandering, etc. read more!