The prevalence and characteristics of ADHD in children with benign epilepsy and in their nonepileptic siblings were compared in a prospective study at Carmel Medical Center, Haifa, Israel. Of 40 patients with benign epilepsy, 21 (52.5%) had generalized seizures, 16 (40%) had partial seizures, 8 (20%) had absence epilepsy, and 5 (12.5%) benign epilepsy with centrotemporal spikes. Of 28 (70%) diagnosed with ADHD, 19 had the inattentive type, 1 with hyperactive type, and 8 with the combined type. Of 12 nonepileptic siblings in the control group, only 2 (16.7%) had ADHD (P<0.03). Children with seizures more resistant and requiring more than 1 AED showed a trend toward an increased risk of attention disorder. Children with more epileptiform discharges in their EEGs were more likely to have ADHD. Of patients with normal EEGs, 50% had ADHD whereas of children with >6 interictal spikes or S/W complexes per minute, 92% had ADHD. Learning disabilities were more common in the epilepsy group (42.5% vs 25% in the control group, P<0.05). [1]

COMMENT. The prevalence of ADHD in school-age children with epilepsy is between 20% (Gross-Tsur et al. 1997) and 60% (Sherman et al. 2007). The prevalence of epileptiform EEGs in nonepileptic children evaluated for ADHD is 26%, compared to 3.5-6.5% in healthy children (Kaufmann et al. 2009; Millichap et al. 2010). The present report shows an increased risk of attention disorder in children with AED-resistant seizures and having more frequent epileptiform discharges in the EEG. ADHD is particularly common in benign epilepsy of childhood with centrotemporal spikes and frontal lobe epilepsy. The comorbidity of ADHD and epilepsy may depend on the effects of AEDs, psychosocial aspects of epilepsy, the type and localization of epileptogenic foci, or even common genetic factors.(Kaufmann R et al. 2009).

Frontal/prefrontal lobe growth retardation is reported in children with BCECTS complicated by cognitive impairments and behavioral problems compared with BCECTS patients without neuropsychiatric deficits [2]. Impaired frontal lobe growth is associated with frequent seizures and spike/wave discharges and neuropsychological problems. A small percentage of BCECTS patients may require early control of seizures to prevent frontal lobe growth retardation and associated cognitive and behavioral problems.