ADHD and Epilepsy Often Co-Occur — Here’s What Experts Know About the Link

ADHD and Epilepsy Often Co-Occur — Here’s What Experts Know About the Link

Around 1.2% of people in the United States live with epilepsy, a neurological condition that causes recurring seizures.

If you number among those 3.4 million people, you might be much more likely to have attention deficit hyperactivity disorder (ADHD) than the general population.

Like epilepsy, ADHD affects your brain, though it doesn’t cause seizures. ADHD symptoms typically relate to your ability to concentrate and focus your attention, though you might also experience hyperactivity and impulsivity.

Experts have yet to determine exactly why these two conditions appear together so often, since neither condition directly causes the other. Rather, they seem to share biological roots.

Read on to learn more about the shared risk factors for ADHD and epilepsy, as well as how certain medications may have an impact on your symptoms.

FYI

ADHD, which affects 8.4% of kids and 2.5% of adults, is more common than epilepsy.

Because of this difference, most studies measure how many people with epilepsy also have ADHD, rather than the other way around.

What’s the connection?

The same factors that cause epilepsy may also increase your chances of developing ADHD.

These include:

  • genetics
  • brain structure differences
  • brain injury
  • prenatal exposure to drugs or toxins, especially alcohol

If you have both epilepsy and ADHD, you may also have neurological differences that factor into certain ADHD symptoms:

  • Less thalamus volume: One small 2012 study suggested that fewer nerve fibers coming out of the thalamus may lead to inattention symptoms.
  • Less gray matter in the frontal lobe: The frontal lobe helps you make decisions. A small 2016 study linked less gray matter in this area to the inattentive subtype of ADHD.
  • Less brain stem volume: If you have a smaller brain stem, you may have a harder time staying alert, according to a small 2014 study.

In adults vs. kids

Children with epilepsy tend to have much higher rates of co-occurring ADHD than adults with epilepsy. While up to 40% of children with epilepsy also have an ADHD diagnosis, only 13% to 18% of adults with epilepsy have an ADHD diagnosis.

Of course, some of this reported difference may relate to the fact that both epilepsy and ADHD are often diagnosed in young childhood.

The average age of onset for epilepsy is 3.7 years old, and the average age of onset for ADHD is 6 years old. As such, most screening for these conditions happens in childhood.

As an added complication, adult ADHD tends to be underdiagnosed. Symptoms like inattention and hyperactivity can be more subjective than seizures. So, you may get a diagnosis of epilepsy before an ADHD diagnosis, even if you have both conditions.

Does ADHD type make a difference?

People with epilepsy may be more likely to have the inattentive type of ADHD. Inattentive type ADHD mostly involves symptoms that relate to attention and focus, so you may notice few, if any, hyperactivity symptoms.

It’s certainly possible to have epilepsy and combined type ADHD, though — and when these conditions occur together, they may involve more severe symptoms.

According to one 2007 study, children with both inattention and hyperactivity symptoms may be more likely to have:

  • generalized seizures
  • earlier symptom onset
  • drug-resistant epilepsy

Family history can increase risk of comorbidity

No evidence suggests epilepsy can cause ADHD, or vice versa. Yet, since the conditions often appear around the same time, it can certainly seem like one condition triggers the other.

Your family history plays a major role in whether you have both conditions. According to a 2017 study, if you have epilepsy, your chances of developing ADHD go up by:

  • 56% if you have a sibling with epilepsy
  • 64% if your father has epilepsy
  • 85% if your mother has epilepsy

Having a family member with epilepsy or ADHD doesn’t guarantee you’ll develop either condition yourself. But if you have a family history of one or both conditions, paying attention to early signs of epilepsy and ADHD can help you get the right diagnosis and treatment sooner rather than later.

Can having both conditions worsen symptoms?

Your ADHD symptoms may worsen if you also have epilepsy.

Research from 2015T suggests epilepsy can make it difficult to sustain attention, especially if you have generalized seizures. You may also have trouble with short-term memory.

Having ADHD and epilepsy together can also be more difficult to manage than either condition alone. A study from 2015 compared adults with only epilepsy and adults with epilepsy and co-occurring ADHD symptoms. People with both conditions reported:

  • a lower quality of life
  • worse physical health
  • more difficulties with social function
  • a higher chance of being unable to work due to disability

Does medication have an impact?

Medication often plays an essential role in both ADHD and epilepsy treatment. However, the medication for one condition may worsen symptoms of the other condition.

Can antiepileptic drugs worsen ADHD?

Some antiepileptic drugs (AEDs) cause side effects that resemble ADHD symptoms. They can also worsen existing ADHD symptoms, including:

  • trouble focusing
  • executive dysfunction, or difficulty with planning and managing impulses
  • impaired short-term memory
  • agitation or fidgeting

The AEDs most likely to exacerbate ADHD symptoms include:

  • phenobarbital
  • topiramate (Topamax)
  • valproic acid
  • phenytoin (Phenytek)

On the flip side, other AEDs may help improve ADHD symptoms. These medications include:

  • carbamazepine (Carbatrol)
  • lacosamide (Vimpat)
  • lamotrigine (Lamictal)

Carbamazepine and lamotrigine may also help enhance attention.

Can ADHD medications worsen epilepsy?

The ADHD medication atomoxetine (Strattera) may worsen seizures for some people with epilepsy.

In a 2020 study involving 105 Korean children and adolescents with epilepsy and ADHD who took atomoxetine, about 8% said their seizures became more frequent or severe. One participant stopped taking atomoxetine as a result.

For the most part, though, ADHD medications appear safe for many people with epilepsy.

A large 2018 study examined hospitalization rates among children with epilepsy over a period of more than 10 years. Children who took stimulant medications were no more likely to be hospitalized for seizures than those who didn’t take stimulant medications. These findings held after researchers controlled for participant demographics and epilepsy type.

Could ADHD medication lower seizure risk?

In a 2019 Swedish study, researchers compared periods when participants did and didn’t take ADHD medication. When they took their medication, the risk of acute seizures dropped 27%.

The researchers suggested treating ADHD symptoms may have helped participants remember to take their epilepsy medication. They also noted that improvements in ADHD symptoms may have helped ease stress and minimize alcohol use, both of which can prompt seizures.

It’s also possible that taking ADHD medication led to changes in the brain that helped reduce participants’ seizure risk.

Finding the right treatment

If you live with both ADHD and epilepsy, finding the right treatment can go a long way toward helping you manage symptoms effectively.

Treatment for comorbid ADHD and epilepsy may involve medication, therapy, and occupational interventions.

Medication

Not much research has explored the most effective combinations of AEDs and ADHD medication. Your doctor will likely prescribe medication based on the type of ADHD and epilepsy you have.

Always take your medications exactly as prescribed, since increasing or decreasing your dose on your own can have serious health consequences. If you experience uncomfortable side effects or worsened symptoms, your doctor or psychiatrist can adjust your dosages safely, with as little disruption to treatment as possible.

If you notice any change in your symptoms after starting a new medication, let your care team know right away so they can address it.

Psychotherapy

If you have both ADHD and epilepsy, therapy may help with some of your symptoms.

According to the International League Against Epilepsy Psychology Task Force, psychological interventions have the most benefit if you have:

  • depression along with these conditions
  • neurocognitive concerns, such as difficulty controlling impulses
  • difficulty taking medication as prescribed

The specific type of therapy you find most helpful can depend on the issues you want help with. If behavioral concerns or seizures disrupt home or school life, family therapy could make a difference.

On the other hand, if you need help sticking with treatment or avoiding symptom triggers, you might consider:

  • motivational interviewing
  • cognitive behavioral therapy
  • acceptance and commitment therapy

Occupational interventions

Children with both ADHD and epilepsy may need extra support in school. You can work with your child’s teachers to find the most effective accommodations for their specific needs.

Cooperating with your school becomes especially important if your child has a learning disability, such as dyslexia or dysgraphia.

According to the Learning Disabilities Association of America, almost 50% of people with epilepsy also have a learning disability. Among kids with ADHD, around 30% also have a learning disability.

As an adult with comorbid ADHD and epilepsy, you may be eligible for workplace accommodations. It’s also a good idea to let your co-workers know about potential seizure triggers, like flashing lights, to make your workplace as safe as possible for you.

The bottom line

Many people with epilepsy also have ADHD, and having both conditions can have more of an impact on your daily life than either condition alone.

That said, getting professional treatment can make a big difference in your symptoms and your overall quality of life.

Finding the right treatment approach may involve some trial and error, since some medications designed to treat one set of symptoms can worsen other symptoms. Always inform your care team about any comfortable side effects or worsening symptoms, and talk with them before you stop taking your medication.

 

Source: healthline.com, Emily Swaim  Artist: Haley Manchon

 

 

 

 

 

 

 

 

 

 

 

 

What to Do When Children and Parents Don’t Agree About Treatment

What to Do When Children and Parents Don’t Agree About Treatment

Pediatric neurologists often have to work as mediators between parents and their children, particularly when the patients cross into the teenage years. From medication adherence to epilepsy treatments to vaccines, the neurologists we interviewed said it takes time, communication, and sometimes a team approach to handle disagreements.

Pediatric neurologists often have to work as mediators between parents and their children, particularly when the patients cross into the teenage years. From medication adherence to epilepsy therapies, neurologists said it takes time, communication, and sometimes a team approach to handle disagreements.

William D. Gaillard, MD, FAES, director of the Comprehensive Pediatric Epilepsy program at Children’s National Hospital and professor of neurology and pediatrics at The George Washington University, said this is an issue that comes up with many teenage patients with medical conditions. As with all chronic disorders, the goal is to get younger patients to take ownership of their medical condition before they become teenagers.

“This is a common situation with pediatric medicine; you have to take care of the child as well as the parents. There are teenagers who are not compliant, but I find that’s pretty rare. Maybe they aren’t compliant because they are angry about their disease, or they don’t like the medicine and how it makes them feel. You have to work with them,” Dr. Gaillard said. “I remember two patients who were non-compliant. One was 30 years ago, and I asked, ‘Why don’t you take your medicine?’ and she said, ‘because it doesn’t work.’ And you know, it didn’t, so that made sense. Fortunately, she was a good candidate for epilepsy surgery, which she had and became seizure free.”

Sometimes coming to an agreement takes outside intervention. Dr. Gaillard’s other patient was a young woman whose parents wanted her to take her medication, but she refused, saying that she didn’t think her seizures were a big deal, as she felt no pain and didn’t remember them. Then she went to camp for children with epilepsy.

“She saw other kids having seizures for the first time. She went back and asked her mom and dad, ‘Is that what I do?” and they said ‘yeah,’” said Dr. Gaillard. “And you know, after that, she took her medication and she became seizure free.”

Walter J. Molofsky, MD, director of pediatric neurology at Mount Sinai Health System in New York, said patients with neurobehavioral disorders present some of the biggest challenges, particularly when it comes to medication compliance, but the challenge often stems from accepting the disorder, not the age of the patient.

“It’s a question of recognition,” Dr. Molofsky said. “Many people with these types of disorders don’t recognize, or won’t recognize that they have a problem, so when therapies are recommended, you sort of have to first work on convincing them that there is some level of dysfunction happening. It could be just talking about behavior issues or social interactions and how they engage in their environment.”

“In terms of medication specifically, I deal with a lot of ADHD medication that they either wanted, or the family feels they would benefit from, but this situation is not a medical absolute,” he said. “It’s not like insulin—some of these medications are a fielder’s choice. In that case, you can take it slow, and the most important issue is communication and reaching some common ground.”

Overwhelmingly, doctors made it clear that it’s the patient who comes first, no matter what the age. Inna Hughes, MD, PhD, an associate professor of pediatrics and neurology at the University of Rochester, said that the patient has to live with the consequences of their decision, whether that involves taking medication or having surgery.

“You have to have relatively 100 percent buy-in from pretty much everybody involved; I’ve actually had several teens specifically choose not to do laser surgery, even though it would have helped their seizures,” she said. “It was just that idea of having a surgery when they were a teen and going through high school with scars on their head and worries like that… even if their parents said ‘No, I want that thing out of their head right now.’”

Dr. Hughes said one of her young patients who had epilepsy surgery a year ago stopped taking her seizure medications, despite recommendations that she stay on them for a year post-surgery. The teen said she was tired of taking the medications, and she knew the end goal was to take her off the medicine, so she decided to stop taking it and didn’t tell anyone. The 14-year-old ended up having a non-epileptic event that was brought on, in part, by the stress of keeping that secret.

“We had a long discussion about going back on her seizure medicine,” Dr. Hughes said. “Her parent wanted her to go back on her medication; I wanted her to go back on her seizure medicine, but the patient did not,” she said. “In the end, she is the person that actually has to put the medicine in her body every day.”

Dr. Hughes said she tries to get parents to see that they’re raising successful adults, and part of being an adult is teaching them to voice their opinions and make sure their concerns are recognized. With pediatric neurology patients, that needs to start as early as possible, because those who let their parents make their decisions do not do as well when transitioning out of the home, whether it’s moving onto college or becoming a successful adult in general.

Conflicts between teenage patients and parents are fairly common, Dr. Hughes said, to the point where handling those disagreements are part of the resident training at University of Rochester.

“We talk to our residents and students a lot about the importance of patient education and patient autonomy, and that those things have to be present starting when patients are kids,” she said. “If a kid says, ‘I don’t want to do this thing,’ you can’t force them to do it, you have to essentially talk them into it by appropriate education. If you are forcing someone to do something against their will, that’s not ethically appropriate. It’s one thing if they’re 5 years old and are just saying ‘I don’t want to,’ but it really becomes unethical when someone is at an age where we think that they should have the appropriate skill set to start to think about whether or not they can do something. When you’re talking to a 14- or 15- year-old, they’re not that cognitively far away from an 18-year-old. And we should be giving them the information and the skills to be able to make those choices.”

Edward “Rusty” Novotny, MD, FAAN, a professor of neurology and pediatrics at the University of Washington, and director of the epilepsy program at Seattle Children’s Hospital, said it’s helpful to have someone besides the physician for parents and their children to consult when making major medical decisions. At Seattle, if a patient is considering surgery to address epilepsy seizures, a social worker is also involved and so is neuropsychologist.

In one case, a 16-year-old patient was kind of “gung-ho” to have surgery, to the point of wanting to have invasive procedures done as part of the pre-surgery evaluation. His mother was supportive, but his father was “kind of dead-set against it moving forward,” said Dr. Novotny.

The team got together to come up with options.

“In this particular case, we were able to identify that the patient was eligible for a less invasive procedure called laser ablation,” he said. “Because the type of surgery was less invasive, then they, as a family, as a group, agreed to move forward.”

Vaccination of teens for COVID-19 has been another issue that has sometimes pitted parents against their children, according to a perspective published in January in the New England Journal of Medicine by Susanna McGrew and Holly A. Taylor, PhD, MPH. They noted the ability of adolescents to consent to COVID-19 vaccination is complicated by inconsistent regulations.

“Given the importance of the COVID-19 vaccination, we believe adolescents should be able to independently consent to vaccination, even when their parents don’t want them to be vaccinated,” they wrote.

But the physicians interviewed by Neurology Today said that disagreements over vaccines have not been particularly common, with the vast majority of patients, and their parents, wanting to get vaccinated. Education has been key, they said, as they point out that getting COVID-19 may exacerbate seizures and other neurologic disorders.

Dr. Molofsky noted that whether it’s working with younger patients who have bipolar disorder, epilepsy, or attention deficit hyperactivity disorder, physicians need to take stock of the maturity of their patient and communicate appropriately. For example, with a teenager who doesn’t want to take their medication for a neurobehavioral disorder he tries to understand why and address those concerns first.

“I’ll say, ‘Let’s see if we can do this together. I respect that you don’t want to change the aspects of your personality that you may find joyous, so let me tell you about my approach: I would start with a very low dose of medication, and we’ll check in, every week, every two weeks, and we’ll talk about how and if it’s helping you, and here’s my cell phone number if you need me,’” Dr. Molofsky said. “You have to understand you’re here because you can’t go on like this.”

Sometimes he finds himself up against a brick wall but tries to be respectful. And he talks to the parents and teenage patient separately and tries to shift the focus from a parent-child conflict to a doctor-patient discussion.

Dr. Gaillard added that it’s important for doctors to understand the frustration that children face when accepting that this could be a lifetime issue, whether it’s medication side effects or driving limitations or dietary restrictions. It can be overwhelming and exhausting.

“So, you’d better be talking to the patient at their level, especially teenagers,” he said. “Once kids get to the age of 13, they should have the right to contact the pediatrician’s office, no questions asked, have a visit, have the parents pay the bill, and get whatever medications and questions answered, and not involve the parents.”

“You have to respect their growing autonomy, and they have to have the ability to speak with someone, otherwise, they’re going to go to someone and not get the right care,” Dr. Gaillard said. “And the parents should understand that this is in the best interest of my child.”

 

Source: journals.lww.com, Dawn Fallik

RESEARCH: 1 in 5 Adults with Epilepsy Also Have ADHD

RESEARCH: 1 in 5 Adults with Epilepsy Also Have ADHD

adhdExperts say that controlling seizures may help alleviate other psychiatric symptoms

THURSDAY, Jan. 15, 2015 (HealthDay News) — Nearly one in five adults with epilepsy also has symptoms of attention-deficit/hyperactivity disorder (ADHD), a new study finds.

Researchers surveyed almost 1,400 adult epilepsy patients across the United States. They found that more than 18 percent had significant ADHD symptoms. In comparison, about 4 percent of American adults in the general population have been diagnosed with ADHD, the researchers noted.

Compared to other epilepsy patients, those with ADHD symptoms were also nine times more likely to have depression, eight times more likely to have anxiety symptoms, suffered more seizures and were far less likely to be employed. (more…)

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