Attention deficit disorder and epilepsy.

Countless studies have demonstrated that patients with epilepsy have a significant increase in behavioral disturbances of all kinds, including hyperactivity and inattention. This finding has been demonstrated in studies utilizing observer questionnaires and behavior rating scales, neuropsychological test batteries, and standardized tests of attention such as continuous performance tests. Multiple factors must be considered in the evaluation of a child with epilepsy and hyperactivity or inattention. For instance, inattention could be due to subclinical seizures, undiagnosed learning disabilities, disturbed sleep as a result of a side effect of antiepileptic medication, or due to an attention deficit disorder. Electroencephalographic monitoring is helpful to distinguish between behavioral inattention and partial complex or absence seizures. Electroencephalographic monitoring can also assess subclinical spike frequency, which may affect attention and other aspects of cognitive functioning in various ways, even in the absence of clinical seizures. Most antiepileptic drugs do not adversely affect attention and behavior in therapeutic doses, with the exception of phenobarbital, gabapentin, and topiramate. Some antiepileptic drugs, such as lamotrigine and carbamazepine, may even have beneficial effects. The preponderance of evidence suggests that stimulants other than bupropion are safe and effective in the treatment of attention deficit disorder in children with epilepsy, although controlled studies of dextroamphetamine in this population are lacking. So far, atomoxetine has not been demonstrated to have any adverse effect in children with epilepsy.