ADHD Common in Adults With Epilepsy

Megan Brooks

January 19, 2015

Nearly 20% of adult epilepsy patients report symptoms of attention-deficit/hyperactivity disorder (ADHD), a rate much higher than of the general adult population, a new study shows.

Epilepsy patients with ADHD symptoms also have higher rates of anxiety and depression and worse seizure frequency.

"Little was previously known about the prevalence of ADHD symptoms in adults with epilepsy, and the results were quite striking," first author Alan B. Ettinger, MD, director, Epilepsy Center at Neurological Surgery, PC, in Lake Success, New York, noted in a statement.

"To my knowledge, this is the first time ADHD symptoms in adults with epilepsy have been described in the scientific literature. Yet, the presence of these symptoms may have severe implications for patients' quality of life, mood, anxiety, and functioning in both their social and work lives," said Dr Ettinger, professor of clinical neurology, Albert Einstein College of Medicine, New York City.

The study was published online January 15 in Epilepsia.

Screen for Psychosocial Troubles

The investigators surveyed 1361 adults with active epilepsy as part of the Epilepsy Comorbidities and Health (EPIC) study. A total of 251 (18.4%) were classified as experiencing significant ADHD symptoms on the Adult ADHD Self-Report Scale, version 6 (ASRS-6), a rate four times higher than the 4.4% rate of ADHD in the general adult population.

Adults with epilepsy who had ADHD symptoms were nine times more likely to have depression and eight times more likely to have anxiety symptoms than their peers without ADHD symptoms. They also reported lower quality of life and worse physical and social function and were more likely to be unemployed.

"This study reinforces the fact that we have to broaden our view of what epilepsy entails," Dr Ettinger said. "Our patients may also have psychiatric comorbidities, and screening for and treating these may make a great difference to patients in their family, school, and work lives."

"Physicians who treat epilepsy often attribute depression, anxiety, reduced quality of life, and psychosocial outcomes to the effects of seizures, antiepileptic therapies, and underlying central nervous system conditions," he added.

"Our findings suggest that ADHD may also be playing a significant role. However, we don't know yet if ADHD in epilepsy is synonymous with ADHD in the general population, which is often responsive to treatment," Dr Ettinger said.

"As a next step, we need to validate measures to screen for ADHD specifically in epilepsy and clarify the nature of ADHD symptoms in adults with epilepsy. This will lay the foundation for future trials of treatments that offer the promise of rendering major improvements in the quality of life of adult epilepsy patients," he said.

The study was funded by the Leslie Munzer Neurological Institute. Janssen Scientific Affairs provided data access. Data analysis was performed by Vedanta Research. Dr Ettinger has served on advisory boards for Upsher-Smith, Eisai, Sunovion, and UCB and as a consultant to Ortho-McNeil Janssen Scientific Affairs LLC. The original article contains a complete list of author disclosures.

Epilepsia. Published online January 15, 2015. Abstract