Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

Stéphane Auvin; Elaine Wirrell; Kirsten A. Donald; Madison Berl; Hans Hartmann; Kette D. Valente; Patrick Van Bogaert; J. Helen Cross; Makiko Osawa; Hideaki Kanemura; Masao Aihara; Marilisa M. Guerreiro; Pauline Samia; Kollencheri Puthenveettil Vinayan; Mary Lou Smith; Lionel Carmant; Michael Kerr; Bruce Hermann; David Dunn; Jo M. Wilmshurst

doi:10.1111/epi.14549

Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

Stéphane Auvin, Elaine Wirrell, Kirsten A. Donald, Madison Berl, Hans Hartmann, Kette D. Valente, Patrick Van Bogaert, J. Helen Cross, Makiko Osawa, Hideaki Kanemura, Masao Aihara, Marilisa M. Guerreiro, Pauline Samia, Kollencheri Puthenveettil Vinayan, Mary Lou Smith, Lionel Carmant, Michael Kerr, Bruce Hermann, David Dunn, Jo M. Wilmshurst

Neurology

Research output: Contribution to journal › Article › peer-review

26 Scopus citations

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a common and challenging comorbidity affecting many children with epilepsy. A working group under the International League Against Epilepsy (ILAE) Pediatric Commission identified key questions on the identification and management of ADHD in children with epilepsy. Systematic reviews of the evidence to support approaches to these questions were collated and graded using criteria from the American Academy of Neurology Practice Parameter. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements were followed, with PROSPERO registration (CRD42018094617). No increased risk of ADHD in boys with epilepsy compared to girls with epilepsy was found (Level A). Valproate use in pregnancy is associated with inattentiveness and hyperactivity in offspring (1 class I study), and children with intellectual and developmental disabilities are at increased risk of ADHD (Level A). Impact of early seizure onset on development of ADHD was unclear (Level U), but more evident with poor seizure control (Level B). ADHD screening should be performed from 6 years of age, or at diagnosis, and repeated annually (Level U) and reevaluated after change of antiepileptic drug (AED) (Level U). Diagnosis should involve health practitioners with expert training in ADHD (Level U). Use of the Strength and Difficulties Questionnaire screening tool is supported (Level B). Formal cognitive testing is strongly recommended in children with epilepsy who are struggling at school (Level U). Behavioral problems are more likely with polytherapy than monotherapy (Level C). Valproate can exacerbate attentional issues in children with childhood absence epilepsy (Level A). Methylphenidate is tolerated and effective in children with epilepsy (Level B). Limited evidence supports that atomoxetine is tolerated (Level C). Multidisciplinary involvement in transition and adult ADHD clinics is essential (Level U). In conclusion, although recommendations could be proposed for some of the study questions, this systematic review highlighted the need for more comprehensive and targeted large-population prospective studies.

Original language	English (US)
Pages (from-to)	1867-1880
Number of pages	14
Journal	Epilepsia
Volume	59
Issue number	10
DOIs	https://doi.org/10.1111/epi.14549
State	Published - Oct 2018

Keywords

antiepileptic drug
attention-deficit/hyperactivity disorder
children
epilepsy
methylphenidate
screening tools

ASJC Scopus subject areas

Neurology
Clinical Neurology

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10.1111/epi.14549

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Auvin, S., Wirrell, E., Donald, K. A., Berl, M., Hartmann, H., Valente, K. D., Van Bogaert, P., Cross, J. H., Osawa, M., Kanemura, H., Aihara, M., Guerreiro, M. M., Samia, P., Vinayan, K. P., Smith, M. L., Carmant, L., Kerr, M., Hermann, B., Dunn, D., & Wilmshurst, J. M. (2018). Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission. Epilepsia, 59(10), 1867-1880. https://doi.org/10.1111/epi.14549

Auvin, S, Wirrell, E, Donald, KA, Berl, M, Hartmann, H, Valente, KD, Van Bogaert, P, Cross, JH, Osawa, M, Kanemura, H, Aihara, M, Guerreiro, MM, Samia, P, Vinayan, KP, Smith, ML, Carmant, L, Kerr, M, Hermann, B, Dunn, D & Wilmshurst, JM 2018, 'Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission', Epilepsia, vol. 59, no. 10, pp. 1867-1880. https://doi.org/10.1111/epi.14549

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title = "Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission",

abstract = "Attention-deficit/hyperactivity disorder (ADHD) is a common and challenging comorbidity affecting many children with epilepsy. A working group under the International League Against Epilepsy (ILAE) Pediatric Commission identified key questions on the identification and management of ADHD in children with epilepsy. Systematic reviews of the evidence to support approaches to these questions were collated and graded using criteria from the American Academy of Neurology Practice Parameter. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements were followed, with PROSPERO registration (CRD42018094617). No increased risk of ADHD in boys with epilepsy compared to girls with epilepsy was found (Level A). Valproate use in pregnancy is associated with inattentiveness and hyperactivity in offspring (1 class I study), and children with intellectual and developmental disabilities are at increased risk of ADHD (Level A). Impact of early seizure onset on development of ADHD was unclear (Level U), but more evident with poor seizure control (Level B). ADHD screening should be performed from 6 years of age, or at diagnosis, and repeated annually (Level U) and reevaluated after change of antiepileptic drug (AED) (Level U). Diagnosis should involve health practitioners with expert training in ADHD (Level U). Use of the Strength and Difficulties Questionnaire screening tool is supported (Level B). Formal cognitive testing is strongly recommended in children with epilepsy who are struggling at school (Level U). Behavioral problems are more likely with polytherapy than monotherapy (Level C). Valproate can exacerbate attentional issues in children with childhood absence epilepsy (Level A). Methylphenidate is tolerated and effective in children with epilepsy (Level B). Limited evidence supports that atomoxetine is tolerated (Level C). Multidisciplinary involvement in transition and adult ADHD clinics is essential (Level U). In conclusion, although recommendations could be proposed for some of the study questions, this systematic review highlighted the need for more comprehensive and targeted large-population prospective studies.",

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author = "St{\'e}phane Auvin and Elaine Wirrell and Donald, {Kirsten A.} and Madison Berl and Hans Hartmann and Valente, {Kette D.} and {Van Bogaert}, Patrick and Cross, {J. Helen} and Makiko Osawa and Hideaki Kanemura and Masao Aihara and Guerreiro, {Marilisa M.} and Pauline Samia and Vinayan, {Kollencheri Puthenveettil} and Smith, {Mary Lou} and Lionel Carmant and Michael Kerr and Bruce Hermann and David Dunn and Wilmshurst, {Jo M.}",

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AU - Berl, Madison

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AU - Cross, J. Helen

AU - Osawa, Makiko

AU - Kanemura, Hideaki

AU - Aihara, Masao

AU - Guerreiro, Marilisa M.

AU - Samia, Pauline

AU - Vinayan, Kollencheri Puthenveettil

AU - Smith, Mary Lou

AU - Carmant, Lionel

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Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

Abstract

Keywords

ASJC Scopus subject areas

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