Gagliano Antonella, Aricò Irene, Calarese Tiziana, Condurso Rosaria, Germanò Eva, Cedro Clemente, Spina Edoardo, Silvestri Rosalia
Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Italy.
Brain Dev. 2011 Jun;33(6):480-6. doi: 10.1016/j.braindev.2010.09.008. Epub 2010 Oct 14.
The comorbidity of Attention Deficit Hyperactivity Disorder (ADHD) with sleep disorders has been extensively studied. In particular, Restless Legs Syndrome (RLS) appears to be consistently more frequent in children with ADHD. Several papers also draw attention to the frequent occurrence of epileptic seizures and EEG abnormalities in ADHD children. We performed a preliminary open label study to evaluate the efficacy of Levetiracetam (LEV) to ameliorate the sleep pattern and reduce RLS symptoms in children with a complex comorbidity between Attention Deficit Hyperactivity Disorder (ADHD), RLS and focal interictal epileptic discharges (IEDs) on EEG. We recruited seven children (all males, aged between 5 and 12years) who fulfilled the following criteria: ADHD diagnosis combined subtype; presence of idiopathic RLS; and presence of focal IEDs on EEG. All children were given LEV at a starting dose of approximately 10-20mg/kg/day followed by 10mg/kg/day incrementing at 1-week intervals up to 50-60mg/kg/day given in two separate doses. At a 3 and 6month follow-up, all children showed significant improvement (p<0.05) in global International RLS Rating Scale (IRLS-RS). Parents' reports revealed improved sleep quality with fewer awakenings and restorative sleep in their children. LEV was well tolerated and no major side effects were reported. With an accessory report we observed the reduction of epileptiform EEG activity during sleep. In most patients (6 on 7) the discharges completely disappeared; in the last patient epileptiform EEG activity was significantly reduced. These children may represent a subgroup of ADHD patients in which the hyperactivity and attention difficulties might be aggravated by sleep disturbances and by IEDs. LEV could represent a therapeutic option for these comorbid conditions.
注意缺陷多动障碍（ADHD）与睡眠障碍的共病情况已得到广泛研究。特别是，不安腿综合征（RLS）在患有ADHD的儿童中似乎一直更为常见。几篇论文还提请注意ADHD儿童中癫痫发作和脑电图异常的频繁发生。我们进行了一项初步的开放标签研究，以评估左乙拉西坦（LEV）改善睡眠模式并减轻患有注意缺陷多动障碍（ADHD）、不安腿综合征（RLS）和脑电图局灶性发作间期癫痫样放电（IEDs）复杂共病儿童的RLS症状的疗效。我们招募了7名儿童（均为男性，年龄在5至12岁之间），他们符合以下标准：ADHD诊断为混合型；存在特发性RLS；脑电图上存在局灶性IEDs。所有儿童均以约10 - 20mg/kg/天的起始剂量给予LEV，随后以10mg/kg/天的剂量递增，每隔1周增加一次，直至以两个单独剂量给予50 - 60mg/kg/天。在3个月和6个月的随访中，所有儿童在全球国际不安腿综合征评定量表（IRLS - RS）上均显示出显著改善（p<0.05）。家长报告显示，他们孩子的睡眠质量有所改善，觉醒次数减少，睡眠恢复性增强。LEV耐受性良好，未报告重大副作用。通过一份辅助报告，我们观察到睡眠期间癫痫样脑电图活动减少。在大多数患者（7名中的6名）中，放电完全消失；在最后一名患者中，癫痫样脑电图活动显著减少。这些儿童可能代表了ADHD患者的一个亚组，其中多动和注意力困难可能因睡眠障碍和IEDs而加重。LEV可能是这些共病情况的一种治疗选择。
