Rheims Sylvain, Herbillon Vania, Villeneuve Nathalie, Auvin Stéphane, Napuri Silvia, Cances Claude, Berquin Patrick, Castelneau Pierre, Nguyen The Tich Sylvie, Villega Frédéric, Isnard Hervé, Nabbout Rima, Gaillard Ségolène, Mercier Catherine, Kassai Behrouz, Arzimanoglou Alexis
Department of Functional Neurology and Epileptology and Epilepsy Institute (IDEE), Hospices Civils de Lyon and Lyon 1 University, Lyon, France.
Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.
Epilepsia. 2016 Jul;57(7):1069-77. doi: 10.1111/epi.13420. Epub 2016 May 29.
Attention-deficit/hyperactivity disorder (ADHD) is commonly observed in children with epilepsy. However, factors associated with the development of ADHD and which might help to guide its therapeutic management, remain an issue of debate.
We conducted a multicenter prospective observational study that included children, aged 6-16 years, with both epilepsy and ADHD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. After inclusion, patients entered a 12-16 week follow-up period during which they were either treated with methylphenidate or they did not receive specific ADHD treatment. ADHD was evaluated with the ADHD Rating Scale-IV.
One hundred sixty-seven patients were included, of which 91 were seizure-free during the preinclusion baseline period. At inclusion, the ADHD Rating Scale-IV total score was 30.4 ± (standard deviation) 9.2, the inattentive subscore was 17.3 ± 4.4, and the hyperactive subscore was 13.2 ± 6.6. We did not detect any difference of ADHD Rating Scale-IV scores across patients' age or gender, age at epilepsy onset, epilepsy syndrome, seizure frequency, or number of ongoing antiepileptic drugs. Methylphenidate was initiated in 61 patients, including 55 in whom a follow-up evaluation was available. At the last follow-up, 41 patients (75%) treated with methylphenidate and 39 (42%) of those who did not received ADHD therapy demonstrated ≥25% decrease of ADHD Rating Scale-IV total score (p < 0.001). Response to methylphenidate was greater in girls but was not influenced by any epilepsy-related variables.
We did not detect any epilepsy-related factor associated with the severity of ADHD. Twenty-five percent of patients did not respond to methylphenidate. A better understanding of the pathologic process that underlies ADHD development in childhood epilepsy might be required to improve therapeutic strategies.
注意缺陷多动障碍（ADHD）在癫痫患儿中较为常见。然而，与ADHD发生相关且可能有助于指导其治疗管理的因素仍是一个有争议的问题。
我们进行了一项多中心前瞻性观察性研究，纳入年龄在6至16岁、根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准诊断为癫痫和ADHD的儿童。纳入后，患者进入12至16周的随访期，在此期间他们要么接受哌甲酯治疗，要么未接受特定的ADHD治疗。使用ADHD评定量表第四版对ADHD进行评估。
共纳入167例患者，其中91例在纳入前基线期无癫痫发作。纳入时，ADHD评定量表第四版总分是30.4±（标准差）9.2，注意力不集中子项得分是17.3±4.4，多动子项得分是13.2±6.6。我们未发现患者的年龄、性别、癫痫发病年龄、癫痫综合征、癫痫发作频率或正在使用的抗癫痫药物数量对ADHD评定量表第四版得分有任何差异。61例患者开始使用哌甲酯，其中55例有随访评估结果。在最后一次随访时，接受哌甲酯治疗的41例患者（75%）和未接受ADHD治疗的39例患者（42%）的ADHD评定量表第四版总分下降≥25%（p<0.001）。女孩对哌甲酯的反应更好，但不受任何癫痫相关变量的影响。
我们未发现任何与ADHD严重程度相关的癫痫相关因素。25%的患者对哌甲酯无反应。可能需要更好地了解儿童癫痫中ADHD发生的病理过程，以改进治疗策略。
