The frequency of rolandic spikes in nonepileptic children with attention deficit hyperactivity disorder (ADHD) was compared with a control group of normal school-aged children in a study at the University of Frankfurt, Germany. The EEGs of 483 ADHD outpatients between 2 and 16 years evaluated prospectively showed rolandic spikes in 27 (5.6%); (23 boys and 5 girls, mean age 7.9 years). Seizures during follow-up occurred in 1 (3.7%) of the 27 patients with ADHD plus rolandic spikes, and none of the 456 ADHD children without rolandic spikes. Sex ratio and global functioning were similar in ADHD patients with and without spikes. ADHD children with spikes presented earlier and exhibited more hyperactive-impulsive symptoms than those without spikes. ADHD-combined type was more common than ADHD inattentive type in children with rolandic spikes. One third of the patients in both groups had comorbid conduct or oppositional defiant disorder. 
COMMENT. Approximately one in 20 children with ADHD have rolandic spikes in the EEG, and boys out number girls by 4:1. The authors recommend EEG recordings in ADHD patients with cognitive and behavioral problems, even without clinical seizures or family history of epilepsy. Stimulant therapy in conservative doses may be safe in children with ADHD and well-controlled epilepsy. Further study is required to determine if AED treatment is justified in ADHD patients with rolandic spikes but without seizures.