Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

Stéphane Auvin; Elaine Wirrell; Kirsten A Donald; Madison Berl; Hans Hartmann; Kette D Valente; Patrick Van Bogaert; J Helen Cross; Makiko Osawa; Hideaki Kanemura; Masao Aihara; Marilisa M Guerreiro; Pauline Samia; Kollencheri Puthenveettil Vinayan; Mary Lou Smith; Lionel Carmant; Michael Kerr; Bruce Hermann; David Dunn; Jo M Wilmshurst

doi:10.1111/epi.14549

Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

Epilepsia. 2018 Oct;59(10):1867-1880. doi: 10.1111/epi.14549. Epub 2018 Sep 3.

Authors

Stéphane Auvin¹, Elaine Wirrell², Kirsten A Donald³, Madison Berl⁴, Hans Hartmann⁵, Kette D Valente⁶, Patrick Van Bogaert⁷, J Helen Cross⁸, Makiko Osawa⁹, Hideaki Kanemura¹⁰, Masao Aihara¹¹, Marilisa M Guerreiro¹², Pauline Samia¹³, Kollencheri Puthenveettil Vinayan¹⁴, Mary Lou Smith¹⁵, Lionel Carmant¹⁶, Michael Kerr¹⁷, Bruce Hermann¹⁸, David Dunn¹⁹, Jo M Wilmshurst²⁰

Affiliations

¹ Department of Pediatric Neurology, Robert-Debré University Hospital, APHP, Paris, France.
² Divisions of Child and Adolescent Neurology and Epilepsy, Mayo Clinic, Rochester, Minnesota.
³ Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Neurosciences Institute, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
⁴ Division of Pediatric Neuropsychology, Children's National Medical Center, Washington, District of Columbia.
⁵ Clinic for Pediatric Kidney, Liver and Metabolic Disorders, Hannover Medical School, Hannover, Germany.
⁶ Division of Clinical Neurophysiology, Institute and Department of Psychiatry, Clinics Hospital (HCFMUSP), Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
⁷ Department of Pediatric Neurology and Neurosurgery, University Hospital of Angers, Angers, France.
⁸ Developmental Neurosciences Programme, UCl Great Ormond Street Institute of Child Health, London & Young Epilepsy, Lingfield, UK.
⁹ Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan.
¹⁰ Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
¹¹ Graduate Faculty of Interdisciplinary Research, Graduate School, University of Amanashi, Yamanashi, Japan.
¹² Department of Neurology, University of Campinas (Unicamp), Campinas, Brazil.
¹³ Department of Paediatrics and Child Health, Aga Khan University, Nairobi, Kenya.
¹⁴ Division of Pediatric Neurology, Department of Neurology, Amrita Institute of Medical Sciences, Cochin, India.
¹⁵ Department of Psychology, The Hospital for Sick Children, University of Toronto Mississauga, Toronto, Canada.
¹⁶ Department of Neurosciences and Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Canada.
¹⁷ Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff Wales, UK.
¹⁸ Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
¹⁹ Section of Child and Adolescent Psychiatry, Departments of Psychiatry and Neurology, Indiana University School of Medicine, Indianapolis, Indiana.
²⁰ Division of Paediatric Neurology, Neuroscience Institute, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.

PMID: 30178479
DOI: 10.1111/epi.14549

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a common and challenging comorbidity affecting many children with epilepsy. A working group under the International League Against Epilepsy (ILAE) Pediatric Commission identified key questions on the identification and management of ADHD in children with epilepsy. Systematic reviews of the evidence to support approaches to these questions were collated and graded using criteria from the American Academy of Neurology Practice Parameter. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements were followed, with PROSPERO registration (CRD42018094617). No increased risk of ADHD in boys with epilepsy compared to girls with epilepsy was found (Level A). Valproate use in pregnancy is associated with inattentiveness and hyperactivity in offspring (1 class I study), and children with intellectual and developmental disabilities are at increased risk of ADHD (Level A). Impact of early seizure onset on development of ADHD was unclear (Level U), but more evident with poor seizure control (Level B). ADHD screening should be performed from 6 years of age, or at diagnosis, and repeated annually (Level U) and reevaluated after change of antiepileptic drug (AED) (Level U). Diagnosis should involve health practitioners with expert training in ADHD (Level U). Use of the Strength and Difficulties Questionnaire screening tool is supported (Level B). Formal cognitive testing is strongly recommended in children with epilepsy who are struggling at school (Level U). Behavioral problems are more likely with polytherapy than monotherapy (Level C). Valproate can exacerbate attentional issues in children with childhood absence epilepsy (Level A). Methylphenidate is tolerated and effective in children with epilepsy (Level B). Limited evidence supports that atomoxetine is tolerated (Level C). Multidisciplinary involvement in transition and adult ADHD clinics is essential (Level U). In conclusion, although recommendations could be proposed for some of the study questions, this systematic review highlighted the need for more comprehensive and targeted large-population prospective studies.

Keywords: antiepileptic drug; attention-deficit/hyperactivity disorder; children; epilepsy; methylphenidate; screening tools.

Publication types

Systematic Review

MeSH terms

Anticonvulsants / therapeutic use
Attention Deficit Disorder with Hyperactivity* / complications
Attention Deficit Disorder with Hyperactivity* / diagnosis
Attention Deficit Disorder with Hyperactivity* / epidemiology
Attention Deficit Disorder with Hyperactivity* / therapy
Central Nervous System Stimulants / therapeutic use
Disease Management*
Epilepsy* / complications
Epilepsy* / diagnosis
Epilepsy* / epidemiology
Epilepsy* / therapy
Humans

Substances

Anticonvulsants
Central Nervous System Stimulants