Review article Attention deficit hyperactivity disorder in children with epilepsy Pasquale Parisi a , Romina Moavero c , Alberto Verrotti b , Paolo Curatolo c, * a Department of Pediatrics – ‘‘La Sapienza” University of Rome, Rome, Italy b Department of Pediatrics, University of Chieti, Chieti, Italy c Department of Neuroscience, Pediatric Neurology, Psychiatric Unit, ‘‘Tor Vergata” University of Rome, Rome 00133, Italy Received 21 January 2009; received in revised form 17 March 2009; accepted 22 March 2009 Abstract Attention deficit hyperactivity disorder (ADHD) is more frequent in children with epilepsy than in general pediatric population. Several factors may contribute to this comorbidity, including the underlying brain pathology, the chronic effects of seizures and of the epileptiform EEG discharges, and the effects of antiepileptic drugs. Symptoms of ADHD are more common in some specific types of epilepsies, such as frontal lobe epilepsy, childhood absence epilepsy and Rolandic epilepsy, and may antedate seizure onset in a significant proportion of cases. In epileptic children with symptoms of ADHD, treatment might become a challenge for child neurologists, who are forced to prescribe drugs combinations, to improve the long-term cognitive and behavioral prognosis. Treat- ment with psychotropic drugs can be initiated safely in most children with epilepsy and ADHD symptoms. Ó 2009 Elsevier B.V. All rights reserved. Keywords: ADHD; Frontal lobe epilepsy; Childhood absence epilepsy; Rolandic epilepsy; Methylphenidate; Antiepileptic drugs 1. Introduction Attention deficit/hyperactivity disorder (ADHD) is a common brain disorder with onset in early childhood, due to structural and functional abnormalities in wide- spread, but specific areas of the brain [1]. ADHD is a frequent comorbidity experienced by children with epi- lepsy, has a negative impact on their quality of life, and represents a significant risk factor for academic underachievement [2]. ADHD has been reported in epilepsy since the Fifties of the 20th century [3]. More recently a high association between the two disorders, with an increasing evidence of a bidirectional relationship, has been postulated [4– 7]. The mechanisms underlying attention deficits are still unknown and appear to be different between focal and generalized epilepsies. In the clinical practice, this associ- ation may represent a challenge for child neurologists since antiepileptic therapy and drugs used to treat ADHD may aggravate the clinical picture of each other [8,9]. The purpose of this article is to discuss the current understanding of the pathogenesis and the neurobiologi- cal links among ADHD and epilepsy, and provide a practical review of the major considerations that guide child neurologists to tailor treatments according to clin- ical needs. 2. Literature search strategy A scoping search on PubMed was undertaken to identify pertinent articles using ‘‘epilepsy and ADHD” as key words. Trials recruiting only patients with single seizure or febrile convulsions, people over 18 years old and mixed age groups were not considered. 3. Epidemiology An increased risk for seizures is a symptom that is often associated with ADHD [10]. In ADHD children 0387-7604/$ - see front matter Ó 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.braindev.2009.03.005 * Corresponding author. Tel.: +39 6 20900249; fax: +39 6 20900018. E-mail address: curatolo@uniroma2.it (P. Curatolo). www.elsevier.com/locate/braindev Brain & Development 32 (2010) 10–16