Clinical Characteristics And Risk Factors Of Attention Deficit Hyperactivity Disorder In Children With Epilepsy

Objective: To analyze the clinical characteristics and risk factors of primary epilepsy(EP)combined with attention deficit hyperactivity disorder(ADHD)in children,so as to improve the detection rate of epilepsy combined with ADHD,which is helpful for early identification and intervention.Methods:(1)A total of 150 children with primary epilepsy who were treated in the pediatric ward and pediatric outpatient department of our hospital from August 2020 to August 2022 were selected,aged from 4 to 14 years old.According to the diagnostic criteria of ADHD in the Diagnostic and Statistical Manual of Mental Disorders Sth Edition,54 children with epilepsy and ADHD were included in the epilepsy with ADHD group,and the remaining 96 were epilepsy non-ADHD group.Fifty children who underwent health examination in our hospital during the same period were selected as healthy control group.(2)The clinical data of children were collected :(1)Gender,age,weight,living area,family relationship,parental culture,age of onset of epilepsy,seizure type,seizure manifestation,duration of seizures,seizure frequency,duration of epilepsy,epilepsy control,antiepileptic drugs,family history and personal history,regular laboratory examination;(2)The diagnostic age,classification and behavior of ADHD in epilepsy with ADHD group were collected;(3)All children with epilepsy need to be assessed with the ADHD Dangnostic Rating Scales and parents need to fill in Conners Parent Symptom Questionnaire;(4)Neuron-specific enolase(NSE)was measured by enzyme-linked immunosorbent assay(ELISA);(5)The results of long-term video EEG(including the waveform,amplitude,frequency of EEG,epileptic wave of abnormal parts,etc.)were collected.(3)SPSS 27.0 was used for statistical analysis.Results:(1)The scores of conduct problems,learning problems,impulse-hyperactivity and hyperactivity index in the epilepsy with ADHD group were significantly higher than those in the epilepsy non-ADHD group(P < 0.05).There was no significant difference in anxiety and psychosomatic disorders between the two groups.(2)The detection rate of ADHD in children with epilepsy was 36.00 %,In present research,and the detection rate of ADHD in the healthy control group was 4.00 %.The detection rate of ADHD was significantly different between the two groups(X2 = 19.048,P < 0.05).The age of first diagnosis of ADHD in epilepsy with ADHD group mostly occurred in 7-10 years old(mean age 96.19 ± 23.4).Children with epilepsy combined with ADHD are mainly Inattentive Presentation.(3)There was no significant difference in parental education level,type of seizures,duration of seizures,vitamin D,and calcium ions between the epilepsy with ADHD group and the epilepsy non-ADHD group.It showed that there were significant differences between the two groups in living area,family relationship,family history of epilepsy,age of onset of epilepsy,duration of epilepsy,frequency of seizures,epilepsy control,antiepileptic drugs,NSE level,and EEG severity(P < 0.05).(4)Binary logistic regression analysis showed that seizure frequency > 1 time / month,poor control of epilepsy,elevated NSE level,and moderate to severe EEG abnormalities were independent risk factors for epilepsy with ADHD(OR > 1,P< 0.05).Late age of onset of epilepsy was a protective factor for epilepsy with ADHD(OR <1,P < 0.05).The ROC curve showed that the area under the ROC curve of EEG index,NSE level,NSE level combined with EEG,epilepsy control combined with EEG was0.666,0.771,0.778,0.726,respectively,and the difference was statistically significant(P <0.05).It can be used as a reference for clinical prediction of epilepsy combined with ADHD diagnosis.(5)There were significant differences in serum NSE levels among the three groups(Z = 111.432,P<0.05),and it showed that epilepsy with ADHD group > epilepsy non-ADHD group > healthy control group.The NSE levels of the two groups decreased after 6 months of treatment,but the decrease of epilepsy non-ADHD group was more obvious,and the difference was statistically significant(t =-3.707,P < 0.05).(6)There were more slow waves in the epilepsy with ADHD group than in the epilepsy non-ADHD group.There were32 cases(59.26 %)with moderate to severe EEG abnormalities in 54 cases of epilepsy with ADHD group,and only 25 cases(26.04 %)with moderate to severe EEG abnormalities in 96 cases of epilepsy non-ADHD group.The difference between the two groups was statistically significant(X2 = 16.186,P < 0.05).Conclusion:(1)Children with primary epilepsy are prone to ADHD,and Inattentive Presentation is more common.(2)The age of onset of epilepsy,clinical control of epilepsy,NSE level and EEG abnormalities are independent risk factors for epilepsy with ADHD.(3)ADHD should be actively investigated and seizures should be actively controlled for children with epilepsy,which has clinical value in reducing the occurrence and development of epilepsy comorbid ADHD.