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Wang S, Yao B, Zhang H, Xia L, Yu S, Peng X, Xiang D, Liu Z. Comorbidity of epilepsy and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Neurol 2023; 270:4201-4213. [PMID: 37326829 DOI: 10.1007/s00415-023-11794-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
Epilepsy and attention-deficit/hyperactivity disorder (ADHD) are common neurological and neuropsychiatric disorders, respectively, that can exist as comorbidities. However, the degree of comorbidity between both disorders has never been quantified based on a systematic review with meta-analysis. We performed a systematic search of the literature in Embase, PubMed, PsychINFO and the Cochrane Library on June 20, 2022. In a meta-analysis of 63 studies with a total sample size of 1,073,188 individuals (172,206 with epilepsy and 900,982 with ADHD) from 17 countries, the pooled prevalence of ADHD in epilepsy was 22.3% (95% CI 20.3-24.4%). The highest pooled prevalence was 12.7% (95% CI 9-17.1%) for ADHD-I subtype, whereas the pooled prevalence of epilepsy in ADHD was 3.4% (95% CI 2.53-4.21%). However, substantial heterogeneity in comorbidity rates was observed and partially attributed to the following factors: sample size, sample specification, geographical variations and diagnostic methods. Our study highlights the need for increased awareness of this diagnostic co-occurrence, and research is warranted to elucidate the underlying pathophysiological mechanisms.
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Affiliation(s)
- Shun Wang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Baozhen Yao
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Haiju Zhang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Liping Xia
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Shiqian Yu
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xia Peng
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Dan Xiang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Abstract
PURPOSE OF REVIEW Comorbidities are a common feature in epilepsy, but neither the entire spectrum nor the significance of such comorbidities has been fully explored. We review comorbidities associated with epilepsy and their associated burden, provide an overview of relationships, and discuss a new conceptualization of the comorbidities. RECENT FINDINGS The epidemiology of the comorbidities of epilepsy and effects on health outcomes, healthcare use, and healthcare expenditures have been partly delineated. Distinct mechanisms of the associations have been suggested but not entirely ascertained. Movement from conceptualizing epilepsy as a condition to a symptom-complex has occurred. SUMMARY Comorbidities are common among people with epilepsy and are associated with poorer clinical outcomes and quality of life, greater use of health resources, and increased expenditure. Becoming aware of the associated mechanisms and their uncertainty is central to understanding the relationships between epilepsy and comorbid health conditions, which have implications for diagnosis and screening, medical management, and surgical management. Conceptualizing comorbidities of epilepsy as precipitating factors and epilepsy as the symptom will improve the understanding of epilepsy and catalyze research and improvements in clinical practice.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103SW, The Netherlands
- Neurology Department, West of China Hospital, Sichuan University, Chengdu, China
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Samanta D, Ostendorf AP, Willis E, Singh R, Gedela S, Arya R, Scott Perry M. Underutilization of epilepsy surgery: Part I: A scoping review of barriers. Epilepsy Behav 2021; 117:107837. [PMID: 33610461 PMCID: PMC8035287 DOI: 10.1016/j.yebeh.2021.107837] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/15/2021] [Accepted: 01/30/2021] [Indexed: 12/13/2022]
Abstract
One-third of persons with epilepsy have seizures despite appropriate medical therapy. Drug resistant epilepsy (DRE) is associated with neurocognitive and psychological decline, poor quality of life, increased risk of premature death, and greater economic burden. Epilepsy surgery is an effective and safe treatment for a subset of people with DRE but remains one of the most underutilized evidence-based treatments in modern medicine. The reasons for this quality gap are insufficiently understood. In this comprehensive review, we compile known significant barriers to epilepsy surgery, originating from both patient/family-related factors and physician/health system components. Important patient-related factors include individual and epilepsy characteristics which bias towards continued preferential use of poorly effective medications, as well as patient perspectives and misconceptions of surgical risks and benefits. Health system and physician-related barriers include demonstrable knowledge gaps among physicians, inadequate access to comprehensive epilepsy centers, complex presurgical evaluations, insufficient research, and socioeconomic bias when choosing appropriate surgical candidates.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Adam P Ostendorf
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Erin Willis
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rani Singh
- Department of Pediatrics, Atrium Health/Levine Children's Hospital, USA
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University College of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, USA
| | - Ravindra Arya
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral Palsy: Current Opinions on Definition, Epidemiology, Risk Factors, Classification and Treatment Options. Neuropsychiatr Dis Treat 2020; 16:1505-1518. [PMID: 32606703 PMCID: PMC7297454 DOI: 10.2147/ndt.s235165] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/28/2020] [Indexed: 12/04/2022] Open
Abstract
Cerebral palsy (CP) is one of the most frequent causes of motor disability in children. According to the up-to-date definition, CP is a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing foetal or infant brain. The CP definition has evolved over time; the problem is aetiologically and clinically very heterogeneous. According to European data, the average frequency of CP is 2.08 per 1000 live births, but in the group of children born with a body weight below 1500 g, the frequency is 70 times higher when compared with the group of children with a body weight over 2500 g at birth. The risk factors for CP can be divided into pre-conception, prenatal, perinatal and postnatal ones. CP commonly co-exists with epilepsy, in particular drug-resistant epilepsy, but also with mental retardation, visual and hearing impairment, as well as feeding and behavioral disorders. The degree of motor problem varies from mild to very severe making the child totally dependent on caregivers. Cerebral palsy is divided into forms depending on the type of motor disorders which dominate the clinical presentation; the traditional classifications by Ingram and Hagberg have now been replaced by the Surveillance of Cerebral Palsy in Europe classification which divides CP into spastic, dyskinetic and ataxic forms. Although cerebral palsy is a clinical diagnosis, modern diagnostic imaging provides information that allows the division of the results of magnetic resonance imaging in children with cerebral palsy into five groups according to the magnetic resonance imaging classification system. Just as the clinical presentation and the factors predisposing for CP are very diverse, treatment is also a very complex problem. Modern treatment of spasticity includes both botulinum toxin therapies and surgical techniques, eg, rhizotomy. The authors present current views on definitions, risk factors, diagnostics and treatment of CP as well as comorbid problems, eg, drug-resistant epilepsy.
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Affiliation(s)
- Małgorzata Sadowska
- Department of Paediatrics and Developmental Age Neurology, Upper Silesian Child Health Centre, Katowice, Poland
| | - Beata Sarecka-Hujar
- Department of Basic Biomedical Science, School of Pharmacy with the Division of Laboratory Medicine, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Ilona Kopyta
- Department of Pediatric Neurology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
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Morrison-Levy N, Go C, Ochi A, Otsubo H, Drake J, Rutka J, Weiss SK. Children with autism spectrum disorders and drug-resistant epilepsy can benefit from epilepsy surgery. Epilepsy Behav 2018; 85:200-204. [PMID: 30032808 DOI: 10.1016/j.yebeh.2018.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/31/2018] [Accepted: 06/14/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this research was to evaluate a cohort of children with both autism spectrum disorder (ASD) and drug-resistant epilepsy (DRE) after epilepsy surgery to determine predictors of best outcome. METHODS Retrospective chart review was done for 29 children ages 2 to 18 years with ASD and DRE who had neurosurgical intervention for seizure management over 15 years at one institution. All subjects had at least 1 year of follow-up. Data abstraction included demographic information, seizure diagnosis, treatment, investigations, surgical intervention, neuropsychological assessment, and outcome. Statistical analysis software (SAS) was used for statistical analysis. Engel classification was used to assess seizure outcome. RESULTS Fifteen subjects had resective surgery. Fourteen had palliative surgery with vagal nerve stimulator (VNS) insertion (13) and corpus callosotomy (1). Of the 29 subjects, 35% had class I outcome (all in the resective group). When combining all subjects (resective and palliative), 66% of subjects benefited with class I-III outcomes. In the total cohort, age at time of surgery was significant, with class I outcome more frequently seen in the younger age group when compared with classes II-IV (p = 0.01). CONCLUSION A subset of children with ASD can benefit from resective surgery, and for those who are not candidates, a VNS can offer significant improvements in seizure control.
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Affiliation(s)
- Nadine Morrison-Levy
- Divison of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Cristina Go
- Divison of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Ayako Ochi
- Divison of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Hiroshi Otsubo
- Divison of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - James Drake
- Division of Neurosurgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - James Rutka
- Division of Neurosurgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Shelly K Weiss
- Divison of Neurology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
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Taraschenko O, Pedavally S, Samson KK, Puccioni MJ, Madhavan D. Anterior corpus callosotomy in patients with drug-resistant epilepsy: Invasive EEG findings and seizure outcomes. EPILEPSY & BEHAVIOR CASE REPORTS 2017; 9:12-18. [PMID: 29692963 PMCID: PMC5913038 DOI: 10.1016/j.ebcr.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/17/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022]
Abstract
Corpus callosotomy (CC) is used in patients with drug-resistant seizures who are not candidates for excisional surgery and failed neurostimulation. We examined ictal scalp and intracranial electroencephalogram (iEEG) recordings in 16 patients being evaluated for anterior CC alone or CC in combination with focal resection, to determine the role of the iEEG in predicting postoperative seizure outcomes. In our cohort, CC improved generalized atonic seizures and focal seizures with impaired awareness but did not alter outcomes for generalized tonic–clonic or tonic seizures. Invasive EEG prior to CC did not refine the prediction of postsurgical seizure outcomes in patients with inconclusive scalp EEG. Patients with drug-resistant epilepsy achieved a significant reduction of generalized atonic and focal seizures with impaired awareness following corpus callosotomy. The age at epilepsy diagnosis or structural pathology identified on the imaging did not predict postoperative seizure status. The ictal findings on invasive EEG prior to corpus callosotomy improved lateralization of seizure onset but did not predict seizure outcomes.
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Affiliation(s)
- Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
- Corresponding author at: Comprehensive Epilepsy Program, Department of Neurological Sciences, University of Nebraska Medical Center, 988435 Nebraska Medical Center, Omaha, NE 68198-8435, United States.
| | - Swetha Pedavally
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Kaeli K. Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Mark J. Puccioni
- Division of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Deepak Madhavan
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
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