Mulas Fernando, Roca Patricia, Ros-Cervera Gonzalo, Gandía-Benetó Rubén, Ortiz-Sánchez Pedro
Instituto Valenciano de Neurologia Pediatrica (INVANEP), 46010 Valencia, Espana.
Rev Neurol. 2014 Feb 24;58 Suppl 1:S43-9.
The prevalence of attention deficit hyperactivity disorder (ADHD) in patients with epilepsy stands at around 30-40%, especially the inattentive subtype, while other studies on children diagnosed with ADHD show figures that vary from 6.1% to 30% which present alterations in the electroencephalogram and epilepsy problems. Although clinical practice guidelines advise against treatment with psychostimulants in ADHD that is comorbid with epilepsy, especially when the latter is not considered active, some researchers and practitioners recommend caution as regards beginning this pharmacological therapy, while less research has been conducted on the use of non-psychostimulants.
To review the patient records of children with epilepsy and ADHD who received pharmacological treatment with psychostimulants and non-psychostimulants for an attention disorder.
The study involved a sample of 23 patients aged 5-16 years. The type of epilepsy and the clinical course and electroencephalogram were analysed at both one and two years after beginning pharmacological treatment of ADHD.
At two years, one patient presented a crisis and two patients continued to display paroxysmal activity in the electroencephalogram.
The data presented show that pharmacological treatment of ADHD does not exacerbate the epilepsy in well-controlled patients, although it is advisable to take into account factors such as the type of antiepileptic drug, the type of drug for ADHD and the cognitive profile, in order to favour a satisfactory development. In epileptic children with learning difficulties, it is necessary to evaluate the mechanisms involved in attentional processes, since they may well be compromised and in need of a more specific treatment.
癫痫患者中注意力缺陷多动障碍（ADHD）的患病率约为30%-40%，尤其是注意力不集中亚型，而其他针对被诊断为ADHD儿童的研究显示，患病率在6.1%至30%之间，这些儿童脑电图存在改变且有癫痫问题。尽管临床实践指南建议不要对合并癫痫的ADHD患者使用精神兴奋剂进行治疗，尤其是在癫痫不被认为处于活动期时，但一些研究人员和从业者建议在开始这种药物治疗时要谨慎，而关于使用非精神兴奋剂的研究较少。
回顾接受精神兴奋剂和非精神兴奋剂药物治疗注意力障碍的癫痫合并ADHD儿童的病历。
该研究纳入了23名年龄在5至16岁的患者样本。在开始ADHD药物治疗后的1年和2年，分析癫痫类型、临床病程及脑电图情况。
在2年时，1名患者出现发作，2名患者脑电图持续显示阵发性活动。
所呈现的数据表明，在病情得到良好控制的患者中，ADHD的药物治疗不会加重癫痫，尽管考虑抗癫痫药物类型、ADHD用药类型及认知特征等因素有助于实现令人满意的发育过程是明智的。对于有学习困难的癫痫儿童，有必要评估注意力过程中涉及的机制，因为这些机制很可能受到损害且需要更具针对性的治疗。
