Arezoo Arabzadeh
Attention deficit hyperactivity disorder (ADHD) is one of the mental health disorders
that is commonly observed among kids. According to the national 2016 parent
survey conducted by Centers for Disease Control and Prevention, the estimated
number of children who are diagnosed with ADHD is 6.1 million or 9.4% of the
world’s population (Data and statistics about ADHD, 2020). The most number of
ADHD cases is found among children aged 6-11 years, followed by those aged
12-17 years and the least is found among children aged 2-5 years. It is
reported that there is a higher prevalence of ADHD among boys (12.9%) compared
to girls (5.6%). However, it is observed that the number of children with ADHD
changes over time in US. There is an increasing pattern of it from 2003-2011,
but a slight decrease is seen in year 2016. The said survey also shows that 6
out of 10 children with ADHD suffer at least one other behavioral disorder,
such as depression, Tourette syndrome and anxiety. Aside from behavioral
disorders, children with ADHD also experience epilepsy. Studies have reported
that there is a higher incidence of epilepsy in children with ADHD (Elhady et
al., 2020).
It is said that ADHD and epilepsy
have a two-way or bidirectional relationship, which means that ADHD has effect
on epilepsy and epilepsy has effect on ADHD (Dunn, Giust, and Kronenberger,
2016). Even though an idea has been established about the correlation between
ADHD and epilepsy, the relationship is still considered complicated and poorly
understood. There are findings that suggest that co-occurrence of ADHD and
epilepsy is based on genetic connection. It was shown that epilepsy patients
have relatives with statistically significant increased risk of ADHD. Statistics
also show that the risk of ADHD in children is higher whose relatives had
epilepsy. Aside from genetic connection, the relationship between two medical
conditions is environmental-based. Half-siblings who have shared environmental
factors were predicted to have higher risk of ADHD.
Epilepsy is correlated with ADHD,
because it affects the functions of the brain and the brain itself. Epilepsy
can start and be diagnosed at any age, but commonly starts in childhood or
people aged over 60 years. The data of the CDC shows that there are about 3.5
million people with epilepsy in the US, with 65 million of epileptic patients
worldwide. It was also reported around 15 to 30% of children with intellectual
disabilities (such as ADHD) have epilepsy. Epilepsy is popularly known for its
symptom, which is seizures. The United Kingdom National Health Service defined
seizure as bursts in brain’s electrical activity that temporarily affect how
brain works. Simply, the brain’s electrical signals have error or scrambled or
have bursts that causes seizures. There are two main types of seizures, namely
generalized and focal or partial seizures (Pietrangelo, 2018). The generalized
seizures are known to have effects on the whole brain, while the focal or
partial seizures affect a particular brain area or region. Seizures are
characterized by spasms or uncontrollable muscle twitches that can last a few
seconds to minutes. During seizure, people lose consciousness or not aware of
what’s happening. There are six types of generalized seizures, which are
absence, tonic, atonic, clonic, myoclonic and tonic-clonic seizures, and these
differ according to the degree of muscle spasm or twitches. The focal seizures
have two primary types, namely simple partial and complex partial. Patients who
suffer a simple partial seizure do not lose consciousness. Instead, they
experience limb twitching, tingling and dizziness. Patients who have complex
partial seizures lose consciousness, stare blankly, and perform repetitive
movements. The frequency of seizures depend on the degree of epilepsy. Low
seizure threshold corresponds to frequent seizures and high threshold is equivalent
to occasional seizures.
The
causes of most cases of epilepsy cannot be determined. There are a lot of
possible things or processes that causes epilepsy, but stroke is considered the
leading cause of epilepsy. The other
causes are brain injury, brain cyst or tumor, extremely high fever, Alzheimer’s
disease or dementia, and infectious disease like meningitis and AIDS. The
occurrence of epilepsy in people can also be based on neurological, genetic or
developmental conditions. Correlating epilepsy with genetic pathologies means
that epilepsy occurs at circuit and receptor levels to abnormal ionic channel
function. It is possible that epilepsy is caused by abnormal synaptic
connectivity in cortical dysplasia, γ-aminobutyric acid (GABA) receptor subunit
dysfunction, mutations in potassium channels or structural modification of
hippocampal circuitry. Epilepsy is prevalent is said to prevalent in very
young, developing brains, because of the early development of excitatory
synaptic function than its inhibitory counterpart, leading to enhanced
excitation and therefore, seizure. The presence of neurotransmitter GABA also
causes excitation that leads to seizure. A recent information provided shows
that epilepsy is also caused by both monogenic and polygenic mutations. Elhady
and the colleagues also demonstrated that there is a high level of IL-6 and
TNF-α in children with ADHD and epilepsy.
Epilepsy
is diagnosed using the detailed clinical history of the patient and by conducting
ancillary confirmatory testing. Details about states of consciousness and
postictal are also valuable. Physical examination and blood tests are also
done. Electroencephalogram (EEG) is also performed, in which electrodes are
attached to the scalp of the patients. Other modes of diagnoses are CT scan,
MRI, PET and single-photon emission computerized tomography (Pietrangelo, 2018).
Accurate diagnoses is a must, because mild symptoms of epilepsy are similar as
of migraine. Attacks of migraine are generally longer than epileptic seizures,
and nausea and vomiting are correlated with migraine. Feeling ill or prolonged
confusion after the attack favors epilepsy.
There
is no cure for epilepsy, but it can be managed using several treatments.
Anti-epileptic drugs are recommended to epileptic patients to decrease the
frequency of seizure (Pietrangelo, 2018). The effects can be varying from
eliminating the seizures to reducing the number of seizures. Specifically,
children with ADHD can take tricyclic antidepressants and bupropion.
Methylphenidate and amphetamine are also recommended (Dunn, Giust, and
Kronenberger, 2016). Vagus nerve stimulator is also suggested. This is a device
that is surgically placed under the chest and stimulated the nerve located in
the neck to prevent seizures. Ketogenic diet is also advised to epileptic
patients, especially when medications are not effective. Brain surgery is also
recommended to remove the area of the brain related to seizures. New researches
have showed promising treatment methods, such as deep brain stimulation,
pacemaker-like device and radiosurgery (Yan et al., 2020).
