Research Article Volume: 3: Issue-4: October-2014 ISSN: ADHD SYMPTOMS IN ADULT EPILEPSY
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1 Research Article Volume: 3: Issue-4: October-2014 ISSN: Coden : IJAPBS ADHD SYMPTOMS IN ADULT EPILEPSY Parvin Dibajnia 1, Maryam Moghadasin 2, Alireza Zahirrodin Associate professor of Psychiatry, Shahid Beheshti University of Medical Sciences, Faculty of Rehabilitation Sciences,Tehran, Iran. Corresponding author 2 Ph.D student in Psychometric. Allameh Tabatabaie University, Tehran,Iran. 3 professor of Psychiatry. Shahid Beheshti University of Medical Sciences,Behavioral sciences Research Center, Tehran, Iran. ABSTRACT: Background: The association between attention deficit hyperactivity disorder (ADHD) and epilepsy has been the focus of numerous studies published recently.this subject have been associated with epilepsy in children, but little article about adult epilepsy are existed. Methods: In the present study 28 patients with epilepsy and 50 non epileptic psychiatry patients (7males, 43females) matched for age, level of education and social-status were enrolled.they completed Persian Adult ADHD Rating Scales-self-report (CAARS-S- SV),that assesses ADHD symptoms in adult epilepsy. Results: In epileptic patients, mean age was (SD=8.99) and in non-epileptic group was (SD=7.05). Regarding social and demographic features, no significant differences between epilepsy patients and non-epileptic group were documented. But, statistically significant differences between the two groups were found on inattention (p = 0.03), hyperactivity (p = 0.04), ADHD index (p=0.02) scales Conclusion: In the present study, statistically significant differences between two group in inattention scale, hyperactivity scale and ADHD index scale were found. Keywords: ADHD, Adults, Epilepsy. INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) symptoms have been associated with epilepsy in children, but little study has been done in the adult epilepsy setting. The association between attention deficit and hyperactivity disorder (ADHD) and epilepsy can cause significant impact on the social life of affected individuals and their families. Clinical studies suggest that 30-40% of people with epilepsy also have ADHD (1). ADHD does not always subside in adulthood: the prevalence has been found to be 1 5% in the general adult population (2). In a large survey of people with epilepsy who completed a self-report scale for ADHD; 18.4% of people with epilepsy had symptoms consistent with ADHD, much higher than would be expected in a normal population. Interestingly, no gender differences were found. Although ADHD is more common in boys and children, this was not found in adults in this study (3). Attention-deficit/hyperactivity disorder (ADHD) symptoms have been associated with epilepsy in children, but this is the first study in Iran to demonstrate an association with ADHD symptoms in adults with epilepsy. This study is important because ADHD symptoms can be treated and may be one way to improve the quality of life for some people with epilepsy. METHODS It was a causal-comparative study with conveniant sampling of patients with epilepsy that attended to the psychiatry clinic. After confirmation epilepsy diagnosis, we compared them with non- epileptic psychiatry patient that matched for age, level of education and social-status. International Journal of Analytical, Pharmaceutical and Biomedical Sciences Page 58
2 The statistical population of the research consists of 28 patients with epilepsy (12 males, 16 females) and 50 non epileptic psychiatry patients (21 males, 27 females) were subjected to evaluation for ADHD by a standardised Adult ADHD scale. A full clinical history was taken and they completed Persian Adult ADHD Rating Scales-self-report (CAARS-S- SV), that assesses ADHD symptoms in adult epilepsy.this test (CAARS-S-SV) consists of 30 items and evaluated three factor included inattention, hyperactivity-impulsivity and ADHD index. Rate symptoms on a likert scale from 0 (not at all/never) to 3 (very much / very frequently).cronbach alfa were 0.74 for inattention scale, 0.68 for hyperactivity- impulsivity scle and 0.81 for ADHD index (4). All subjects gave written consent prior to their participation in the assessment study which had been approved bythe local ethics committee. Analysis was performed with statistical package spss 19 software. RESULTS Participants included 28(36%) epilepsy patients with mean and standard deviation age of (8.99) and 50 (64%) non epileptic psychiatry patients with mean and standard deviation age of (7.05). Regarding social and demographic features, no significant differences between two groups were documented (Table 1). Variables Age Table 1: Socio demographic characteristics of the sample epilepsy Group Normal Group Statistic(P value/sig) (n=28) (n=50) Mean( SD) (8.99) (7.05) T= 0.87 (0.39) Gender Count (%) Male 12 (%43) 21 (%44) Female 16 (%57) 27 (%56) Marital status Count (%) Never married 15 (%54) 30 (%60) Married 13 (%46) 20 (%40) Sig* < 0.05 X2 = (0.94) X2 = 0.17 ( 0.59) In order to compare two groups for ADHD symptoms, we used dependent T- test. The results show that two groups in ADHD symptoms have significant difference (p< 0.05) with each other. In epilepsy group, inattention, hyperactivity-impulsivity and ADHD index were higher than non-epilepsy groups, on the other hand epilepsy patients have more inattention, hyperactivity and ADHD index in comparison with similar group that in all characteristics except epilepsy disorder are equal. The results of dependent T test indicated that epilepsy patients had more inattention mean(9.96) than non epilepsy group (7.45),and the difference was significant statistically.( sig =0.03, df=76, t=2.22 ) Also, they showed more hyperactivity mean (8.11) than non epilepsy group that were statically significant difference. (Sig =0.04, DF=76 t=2.03) ADHD index mean in epilepsy group (14), were higher than other group (1.82), this difference was also significant. (Sig=0.02, DF=76, t=2.27) The complete results have been shown in table 2. In Conner Adult ADHD Rating Scales, cut off point according to T-score were equal with the mean of fifty and standard deviation (10 ), in this regards individual with T-score >60 have ADHD symptoms. The results indicated that 25% epilepsy patients and 8% non epilepsy group showed inattention and hyperactivity that were statistically significant differences respevtively. (Sig =0.039, df=1, x²=4.28) (Sig =0.039, DF=1, x²=4.28) Also, significant difference were shown in ADHD index. ( Sig=0.015, df=1, x²=5.92) As it shown in Figure 1, 22%epilepsy patients and 4% non epilepsy group have ADHD index. International Journal of Analytical, Pharmaceutical and Biomedical Sciences Page 59
3 Table 2: Inattention, Hyperactivity and ADHD index scales of (CAARS S: SV) mean scores in epilepsypatients and Normal- group Variable epilepsy group Normal group T - Test Mean SD Mean SD T P inattention * hyperactivity * ADHD index * Sig* < 0.05, Sig** < 0.01 Table 3 shows means and standard deviations for T scores in the sample groups. Findings of T- test for comparison between two groups indicated that in epilepsy groups, statistically significant difference in frequency inattention, hyperactivity symptoms and ADHD index were existed. Table 3: result comparison T mean scores and frequency of person that receive (T- score >60) in Inattention, Hyperactivity and ADHD index scales of (CAARS S: SV) in epilepsy-patients and non epilepsy- group Variable Mean T score (SD) Frequency (%) (T- score X2 T Test (sig) >60) (sig) epilepsy Non-epilepsy epilepsy Non-epilepsy inattention (0.03*) 7(%25) 4(%8) 4.28 (0.39*) (10.34) (9.42) hyperactivity (0.04*) 7(%25) 4(%8) 4.28 (0.39*) (10.98) (9.09) ADHD index (11.54) (8.59) 2.27 (0.02*) 6(%22) 2(%4) 5.92 (0.015*) Sig* < 0.05, Sig** < 0.01 As it is shown in figure 1, distribution inattention, hyperactivity symptoms and ADHD index in epilepsy group were 25%, 25%, 22% respectively. Results indicated that 25% of people with epilepsy had symptoms consistent with ADHD %25 %25 %22 epilepsy %8 %8 %4 non-epilepsy inattention hyperactivity ADHD index Figure1: ADHD symptoms distribution in samples DISCUSSION International Journal of Analytical, Pharmaceutical and Biomedical Sciences Page 60
4 In the present study 25% of people with epilepsy had symptoms consistent with ADHD, much higher than would be expected in a normal population. Interestingly, no gender differences were found. Although ADHD is more common in boys and children, this was not found in adults in this study. The presence of one or more comorbid conditions may complicated epilepsy control. Comorbid conditions such as ADHD in patients with epilepsy should be evaluated and treated as soon as they are recognized. This will ensure maximum potential developmental outcome and ultimate function. This study emphasizes that comorbidities such as ADHD affect the people with epilepsy and contribute significantly to the cost of care. Different hypothesis try to explain the association between ADHD and epilepsy: the two conditions share the same neuropsychological basis, could have the same genetic predisposition; influence of antiepileptic drugs on attention and behavior could have a common physiopathology, as in frontal lobe epilepsy and also the presence of sub clinic epileptiform activity (5-9). It has also been discussed the possibility of the relationship epilepsy / ADHD be a "successive comorbidity", that is, the possibility that epilepsy lowers the threshold for the development of ADHD (10). People with epilepsy often require other psychotropic drugs, especially antidepressants and antipsychotics, which increase the concern of doctors to prescribe these medications without knowing the actual epileptogenic potential of each of these associations. (11-13). Little study has been done in the adult epilepsy setting. Our study is important because ADHD symptoms can be treated and may be one way to improve the quality of life for some people with epilepsy. The present study has some limitations. First the small sample size restrict the interpretation of our results, further studies should be conducted with a larger sample. Second, there is a lack of power to detect the effect of antiepileptic drugs on ADHD symptoms. REFERENCES [1] Koneski JA; Casella EB. Attention deficit and hyperactivity disorder in people with epilepsy: diagnosis and implications to the treatment. Arquivos De Neuro-Psiquiatria [Arq Neuropsiquiatr] 2010 Feb; Vol. 68 (1), pp [2] Kooij J.J,. Buitelaar J.K,. Van den Oor, E.J, Fure JW, Rijnders C A,. Hodiamont PP. Internal and external validity of attention-deficit hyperactivity disorder in a popula-tion-based sample of adults. Psychol Med, 35 (6) (2005), pp [3] Ettinger AB, Ottoman R, Lipton RB, Cramer J, Reed ML. Attention deficit disorder symptoms, rates and impact in adults with self-reported epilepsy: results from The National Epidemiological Survey of Epilepsy. Program and abstracts of the American Epilepsy Society 66th Annual Meeting; November 30- December 4, 2012; San Diego, California. Abstract [4] Moghadasin M. Dibajnia P,Yonesi J.Persion validation of the conners Adult ADHD Rating Scales-selfreport (CAARS-S-SV):Exploratory factor analysis and Confirmatory factor analysis. Psychometry.2012 ; 1 (1.) [5] Parisi P, Moavero R, Verrotti A, Curatolo, P. Attention deficit hyperactivity disor-der in children with epilepsy. Brain Dev 2009; in press [6] Aldenkam AP, Arzimanoglou A, Reijs R, van Mil S. Optimizing therapy of sei-zures in children and adolescents with ADHD. Neurology 2006;67 (Suppl 4): S49-S51. [7] Turky A, Beavis JM, Thapar AK, Kerr MP. Psychopathology in children and ado-lescents with epilepsy: an investigation of predictive variables. Epilepsy Behav 2008;12: [8] Hermann B, Jones J, Dabbs K, et al. Cognitive and magnetic resonance volumetric abnormalities in newonset pediatric epilepsy. Semin Pediatr Neurol 2007;14: [9] Kaufmann R, Goldberg-Stern H, Shuper A. Attention-deficit disorders and epilep-sy in childhood: incidence, causative relations and treatment possibilities. J Child Neurol 2009;24: [10] Sherman EM, Slick DJ, Connolly MB, Eyrl KL. ADHD, neurological correlates and health-related quality of life in severe pediatric epilepsy. Epilepsia 2007;48: [11] Pisani F, Oteri G, Costa C, Di Raimondo G, Di Perri R. Effects of psychotropic drugs on seizure threshold. Drug Saf 2002;25: International Journal of Analytical, Pharmaceutical and Biomedical Sciences Page 61
5 [12] Gonzalez-Heydrich J, Weiss M, Connolly M, et al. Pharmacological management of a youth with ADHD and a seizure disorder. J Am Acad Child Adolesc Psychi-atry 2006;45: [13] Patsalos PN, Berry DJ, Bourgeois BF, et al. Antiepileptic drugs--best practice guidelines for therapeutic drug monitoring: a position paper by the subcommis-sion on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia 2008;49: International Journal of Analytical, Pharmaceutical and Biomedical Sciences Page 62
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