Venegas Viviana, De Pablo José María, Olbrich Carmen
Instituto de Neurocirugía Asenjo, Chile. E-mail:
Centro Avanzado de Epilepsia, Clínica Alemana, Santiago de Chile, Chile.
Medicina (B Aires). 2020;80 Suppl 2:58-62.
Epilepsy and attention deficit and hyperactivity disorder (ADHD) are frequent conditions in pediatrics. Their association is frequent and complex, often sharing psychiatric comorbidity. Patients who present epilepsy and ADHD, show equal frequency in both genders, with the inattentive type, as predominant presentation. Cognitive deficit increases the risk of associating ADHD in patients with epilepsy. There is not enough evidence for other risk factors, however there is enough information that allows to ant icipate its presence in some types of epilepsy, with neuropsychological models that evidence the underlying network dysfunction. The relationship with frequency and seizure control, electroencephalographic alterations and antiepileptic drugs (AEDs) is also reviewed. Recommendations to reduce adverse effects of AEDs are described. The diagnosis must therefore be based on suspicion, through clinical instruments and assessments of cognitive functioning. Multimodal treatment is also recommended in patients with ADHD with and without epilepsy. Psych stimulants can be used safely. The quality of life of the patients and their families is affected, so it is advisable for them to be supported by a specialized team that could provide education, early assessment and therapy. If they are omitted, the consequences can be negative at school, social environment and emotional development, which could be relevant and become persistent.
癫痫与注意力缺陷多动障碍(ADHD)是儿科常见病症。它们之间的关联常见且复杂,常伴有精神共病。患有癫痫和ADHD的患者在两性中出现频率相同,以注意力不集中型为主要表现形式。认知缺陷会增加癫痫患者患ADHD的风险。虽然尚无足够证据证明其他风险因素,但有足够信息表明在某些类型癫痫中可通过神经心理学模型预测其存在,这些模型能证明潜在的网络功能障碍。本文还综述了其与发作频率和控制、脑电图改变及抗癫痫药物(AEDs)的关系。文中描述了减少AEDs不良反应的建议。因此,诊断必须基于怀疑,借助临床工具和认知功能评估。对于患有和未患有癫痫的ADHD患者,也建议采用多模式治疗。精神兴奋剂可安全使用。患者及其家庭的生活质量会受到影响,因此建议他们得到专业团队的支持,该团队可提供教育、早期评估和治疗。如果这些被忽视,在学校、社会环境和情感发展方面可能会产生负面后果,这些后果可能很严重且会持续存在。