Self-reported attention and hyperactivity symptoms among adults with epilepsy

Abstract

Background Patients with epilepsy (PWE) frequently have comorbid psychiatric disorders, the most common of which are depression and anxiety. Attention deficit disorder with hyperactivity (ADHD) is also more frequent among PWE, though that condition has been scarcely studied among the adult PWE population.

Objective This study aimed to compare the presence of ADHD symptoms between adult PWE and the general population.

Methods This was an observational case-control study. Ninety-five adult PWE from a tertiary center in southern Brazil were compared with 100 healthy controls. All subjects were submitted to three structured scales: 1) the World Health Organization Adult ADHD Self-Report Scale version 1.1 (ASRS); 2) the Hospital Anxiety and Depression Scale (HADS); and 3) the Adverse Events Profile (AEP). Dichotomic variables were analyzed through chi-square test and Fisher's exact test, as appropriate, and non-parametric variables were analyzed through the Mann-Whitney U test.

Results Medians and interquartile ranges (IR) were: 1) ASRS: 26.00 (IR: 18 to 38) among PWE versus 17.00 (IR: 11 to 24) among controls, p < 0.001; 2) HADS: 14.00 (IR: 8 to 21) among PWE versus 11.00 (IR: 8 to 16) among controls, p = 0.007; 3) AEP: 3800 (IR: 31 to 49) among PWE versus 33.00 (IR: 23 to 43) among controls, p = 0.001.

Conclusion PWE showed a higher burden of symptoms of ADHD, depression, and anxiety when compared with controls, which replicates in the Brazilian population the findings of current literature that point toward a higher prevalence of such disorders among PWE.

Resumo

Antecedentes Pacientes com epilepsia (PCE) frequentemente apresentam comorbidades psiquiátricas, principalmente depressão e ansiedade. O transtorno do déficit de atenção e hiperatividade (TDAH) também é mais frequente nos PCE, porém foi pouco estudado na população adulta de PCE.

Objetivo Comparar a presença de sintomas de TDAH entre PCE adultos e a população geral.

Métodos Noventa e cinco PCE adultos de um centro terciário no Sul do Brasil foram comparados a 100 controles saudáveis. Todos os sujeitos foram submetidos a três escalas estruturadas: 1) a Escala Autorrelatada de TDAH em Adultos da Organização Mundial da Saúde, versão 1.1 (ASRS); 2) a Escala Hospitalar de Ansiedade e Depressão (HADS); e 3) o Perfil de Eventos Adversos (AEP). Variáveis dicotômicas foram analisadas através dos testes chi-quadrado e exato de Fisher, conforme apropriado, e as variáveis não paramétricas foram analisadas através do teste U de Mann-Whitney.

Resultados As medianas e os intervalos interquartis (IIQ) foram: 1) ASRS: 26.00 (IIQ: 18 a 38) em PCE versus 17.00 (IIQ: 11 a 24) nos controles, p < 0,001; 2) HADS: 14.00 (IIQ: 8 a 21) em PCE versus 11.00 (IIQ: 8 a 16) nos controles, p = 0,007; 3) AEP: 38.00 (IIQ: 31 a 49) em PCE versus 33.00 (IIQ: 23 a 43) nos controles, p = 0,001.

Conclusão PCE apresentaram uma maior carga de sintomas de TDAH, depressão e ansiedade quando comparados aos controles, o que replica na população brasileira os achados da literatura atual, que apontam para uma maior prevalência de tais transtornos entre PCE.

Keywords

Epilepsy - Attention Deficit Disorder with Hyperactivity - Mental Disorders

Palavras-chave

Epilepsia - Transtorno do Deficit de Atenção com Hiperatividade - Transtornos Mentais

Authors' Contributions

ENCB: conceptualization, data curation, formal analysis, investigation, methodology, project administration, writing (original draft) and writing (review & editing); GM: conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, writing (original draft) and writing (review & editing); GMR: conceptualization, data curation, formal analysis, investigation, methodology, project administration, writing (original draft) and writing (review & editing); KL: conceptualization, formal analysis, funding acquisition, methodology, project administration, resources, supervision, writing (original draft) and writing (review & editing).

Publication History

Received: 04 January 2023

Accepted: 24 October 2023

Article published online:
29 January 2024

• References

• 1 Keezer MR, Sisodiya SM, Sander JW. Comorbidities of epilepsy: current concepts and future perspectives. Lancet Neurol 2016; 15 (01) 106-115
• 2 Gaitatzis A, Sisodiya SM, Sander JW. The somatic comorbidity of epilepsy: a weighty but often unrecognized burden. Epilepsia 2012; 53 (08) 1282-1293
• 3 LaFrance Jr WC, Kanner AM, Hermann B. Psychiatric comorbidities in epilepsy. Int Rev Neurobiol 2008; 83: 347-383
• 4 Mula M, Kanner AM, Jetté N, Sander JW. Psychiatric Comorbidities in People With Epilepsy. Neurol Clin Pract 2021; 11 (02) e112-e120
• 5 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition.. Arlington, VA: American Psychiatric Association; 2013
• 6 Solanto MV. The Prevalence of “Late-Onset” ADHD in a Clinically Referred Adult Sample. J Atten Disord 2019; 23 (09) 1026-1034
• 7 Caye A, Rocha TB, Anselmi L. et al. Attention-Deficit/Hyperactivity Disorder Trajectories From Childhood to Young Adulthood: Evidence From a Birth Cohort Supporting a Late-Onset Syndrome. JAMA Psychiatry 2016; 73 (07) 705-712
• 8 Hesdorffer DC, Ludvigsson P, Olafsson E, Gudmundsson G, Kjartansson O, Hauser WA. ADHD as a risk factor for incident unprovoked seizures and epilepsy in children. Arch Gen Psychiatry 2004; 61 (07) 731-736
• 9 Dunn DW, Austin JK, Harezlak J, Ambrosius WT. ADHD and epilepsy in childhood. Dev Med Child Neurol 2003; 45 (01) 50-54
• 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 (06) 1083-1091
• 11 Reilly C, Atkinson P, Das KB. et al. Neurobehavioral comorbidities in children with active epilepsy: a population-based study. Pediatrics 2014; 133 (06) e1586-e1593
• 12 Ashjazadeh N, Sahraeian A, Sabzgolin I, Asadi-Pooya AA. Attention-deficit hyperactivity disorder in adults with epilepsy. Epilepsy Behav 2019; 101 (Pt A): 106543
• 13 Ettinger AB, Ottman R, Lipton RB, Cramer JA, Fanning KM, Reed ML. Attention-deficit/hyperactivity disorder symptoms in adults with self-reported epilepsy: Results from a national epidemiologic survey of epilepsy. Epilepsia 2015; 56 (02) 218-224
• 14 Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989; 30 (04) 389-399
• 15 Mattos P, Segenreich D, Saboya E, Louzã M, Dias G, Romano M. Adaptação transcultural para o português da escala Adult Self-Report Scale para avaliação do transtorno de déficit de atenção/hiperatividade (TDAH) em adultos. Arch Clin Psychiatry 2006; 33: 188-194
• 16 Kessler RC, Adler L, Ames M. et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med 2005; 35 (02) 245-256
• 17 Botega JN, Pondé MP, Medeiros P, Lima MG, Guerreiro CAM. Validação da escala hospitalar de ansiedade e depressão (HAD) em pacientes epilépticos ambulatoriais. J Bras Psiq 1998; 47: 285-289
• 18 Perucca P, Carter J, Vahle V, Gilliam FG. Adverse antiepileptic drug effects: toward a clinically and neurobiologically relevant taxonomy. Neurology 2009; 72 (14) 1223-1229
• 19 Martins HH, Alonso NB, Guilhoto LMFF, Guaranha MSB, Yacubian EMT. Adherence to Treatment in Patients with Juvenile Myoclonic Epilepsy: Correlation with Quality of Life and Adverse Effects of Medication. J Epilepsy Clin Neurophysiol 2009; 15: 192-196
• 20 Martins HH, Alonso NB, Vidal-Dourado M. et al. Are adverse effects of antiepileptic drugs different in symptomatic partial and idiopathic generalized epilepsies? The Portuguese-Brazilian validation of the Liverpool Adverse Events Profile. Epilepsy Behav 2011; 22 (03) 511-517
• 21 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition.. Washington, DC: American Psychiatric Association; 1994
• 22 WHO Collaborating Centre for Drugs Statistics Methodology and Nordic Council on Medicines. Guidelines for DDD. Oslo: WHO/NCM; 1991
• 23 Melo MC, Cristo RC, Guilhem D. Perfil sociodemográfico de acompanhantes de pacientes e suas concepções sobre atenção recebida. Revista Eletrônica Gestão & Saúde 2015; 6 (02) 1550-1564
• 24 Corbisiero S, Hartmann-Schorro RM, Riecher-Rössler A, Stieglitz RD. Screening for Adult Attention-Deficit/Hyperactivity Disorder in a Psychiatric Outpatient Population with Specific Focus on Sex Differences. Front Psychiatry 2017; 8: 115
• 25 Suzuki T, Wada K, Nakazato M, Ohtani T, Yamazaki M, Ikeda S. Associations Between Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Traits and Sociodemographic Characteristics in Japanese Workers. Neuropsychiatr Dis Treat 2023; 19: 759-773
• 26 Instanes JT, Klungsøyr K, Halmøy A, Fasmer OB, Haavik J. Adult ADHD and Comorbid Somatic Disease: A Systematic Literature Review. J Atten Disord 2018; 22 (03) 203-228
• 27 Pham C, Roy C, Tang C, Maheshwari A. Low recognition of attention deficit hyperactivity disorder in adult patients admitted to the Epilepsy Monitoring Unit. Brain Behav 2022; 12 (08) e32731
• 28 Dunbar C, Lee M, Maheshwari A. High Yield of Screening for ADHD in the Epilepsy Monitoring Unit. J Atten Disord 2021; 25 (08) 1120-1128
• 29 Alfstad KÅ, Torgersen H, Van Roy B. et al. Psychiatric comorbidity in children and youth with epilepsy: An association with executive dysfunction?. Epilepsy Behav 2016; 56: 88-94
• 30 Fiest KM, Dykeman J, Patten SB. et al. Depression in epilepsy: a systematic review and meta-analysis. Neurology 2013; 80 (06) 590-599
• 31 Scott AJ, Sharpe L, Hunt C, Gandy M. Anxiety and depressive disorders in people with epilepsy: A meta-analysis. Epilepsia 2017; 58 (06) 973-982
• 32 Bertelsen EN, Larsen JT, Petersen L, Christensen J, Dalsgaard S. Childhood Epilepsy, Febrile Seizures, and Subsequent Risk of ADHD. Pediatrics 2016; 138 (02) e20154654
• 33 Syvertsen M, Selmer K, Enger U. et al. Psychosocial complications in juvenile myoclonic epilepsy. Epilepsy Behav 2019; 90: 122-128
• 34 Hudson JM, Flowers KA, Walster KL. Attentional control in patients with temporal lobe epilepsy. J Neuropsychol 2014; 8 (01) 140-146
• 35 Berghuis B, Brilstra EH, Lindhout D, Baulac S, de Haan GJ, van Kempen M. Hyperactive behavior in a family with autosomal dominant lateral temporal lobe epilepsy caused by a mutation in the LGI1/epitempin gene. Epilepsy Behav 2013; 28 (01) 41-46
• 36 Karouni M, Henning O, Larsson PG, Johannessen SI, Johannessen Landmark C. Pharmacological treatment of psychiatric comorbidity in patients with refractory epilepsy. Epilepsy Behav 2013; 29 (01) 77-81
• 37 Montano CB, Weisler R. Distinguishing symptoms of ADHD from other psychiatric disorders in the adult primary care setting. Postgrad Med 2011; 123 (03) 88-98
• 38 Murphy KR, Adler LA. Assessing attention-deficit/hyperactivity disorder in adults: focus on rating scales. J Clin Psychiatry 2004; 65 (Suppl. 03) 12-17
• 39 Rösler M, Retz W, Thome J, Schneider M, Stieglitz RD, Falkai P. Psychopathological rating scales for diagnostic use in adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 2006; 256 (Suppl. 01) i3-i11