PROBLEMS WITH ATTENTION IN CHILDREN WITH EPILEPSY

Children with epilepsy are at increased risk of attention deficit hyperactivity disorder and problems with attention. Studies of clinical samples using DSM criteria have found that approximately 1/3 of children with epilepsy have problems with attention. Inattention seems to be more common than hyperactivity or impulsivity and deficits are more often found in sustained attention. Studies of children with new-onset seizures have shown that problems with attention are present at onset and may be a risk factor for the development of seizures. In addition, epileptiform activity has been found in 5–7% of electroencephalograms of children with ADHD.

Risk factors for attention problems are additional neurological deficits, intractable seizures, and certain antiepileptic drugs including Phenobarbital, benzodiazepines, and topiramate.

Therapy should include maximizing seizure control and modification of AEDs if attention seems related to AEDs. Behavioral therapy may be helpful but has not been as effective as psychopharmacologic treatment. Stimulants may be effective and safe for children with well controlled seizures. There is concern that stimulants may increase seizure frequency in children with intractable seizures. Early data on atomoxetine has not found an increase in risk for seizures. Bupropion and the tricyclic antidepressants may lower seizure threshold and should be avoided.

Educational Objectives:

• Participants will become aware of the prevalence and risk factors for problems with attention in children with epilepsy.

• Participants will be exposed to studies evaluating effectiveness and risk of medications for attention problems in children with epilepsy.