Investigators at Istanbul University, Turkey, studied sleep EEGs in 134 patients with ADHD. All patients had spike and wave paroxysms that changed with age. Half of the patients had seizures, and 38 had the EEG findings of benign focal epilepsy of childhood. Spike and wave activity evolves in time, and EEG discharges are related to neuropsychiatric symptoms even in the absence of epilepsy. It is recommended that sleep EEG be considered in all cases of ADHD. [1]

COMMENT. This study confirms previous reports of a high incidence of epileptiform abnormalities in the EEG of children with ADHD.

Valproate, EEG paroxysmal abnormality, and ADHD behavioral improvement. Of 46 ADHD children treated with valproate sodium, 16 showed EEG paroxysmal abnormality (PA). The EEG improved in 5 of 8 with frontal PA and 3 of 5 with rolandic PA. EEG improvement with AED treatment showed a high correlation with behavioral improvements. [2]

Sleep deprived EEG should be considered in children with ADHD, especially those with altered awareness or a family history of epilepsy. The AAP guideline that excludes the EEG in the workup of children with ADHD may need modification.