ابعاد کنترل روانشناختی والدین: ارتباطات با پرخاشگری فیزیکی و رابطه پیش دبستانی در روسیه

Purpose This study investigated whether interictal epileptiform discharges (IED) on a baseline routine EEG in children with ADHD was associated with the occurrence of epileptic seizures (Sz) or influenced the use of methylphenidate (MPH) during 2 years follow-up. Methods A retrospective chart-review of 517 ADHD children with EEG revealed IED in 39 cases. These patients (IED group) were matched on age and gender with 39 patients without IED (non-IED group). We measured at baseline, 1 year and 2 years Sz occurrence, the use of MPH and antiepileptic drug (AED). Results At baseline, 12 patients in the IED group had active epilepsy and three of them had Sz during the last year. 36 (92.3%) patients were treated with MPH. Initial positive response to MPH was achieved in 83.3% compared with 89.2% in the non-IED group. At 1 and 2 years follow-up, three patients who also had Sz at baseline and difficult to treat epilepsy, had Sz, without changes in seizure frequency. We found no statistically significant differences between the groups with respect to MPH use at 1 year and at 2 years. Ten patients from IED group, who did not have confirmed epilepsy diagnosis, temporarily used AEDs during the first year of follow-up. Conclusion Despite the occurrence of IED, the use of MPH was safe during 2 years follow-up. IED predict the Sz occurrence in children with previous epilepsy, but does not necessarily suggest an increased seizure risk. A caution is warranted in order not to overestimate the significance of temporarily occurrence of IED.

Interictal epileptiform discharges (IED) on EEG may occur in children with attention deficit/hyperactivity disorder (ADHD) and contribute to the occurrence of ADHD symptoms [1]. ADHD in children is reported to be a risk factor for incident unprovoked seizures and epilepsy [2], and suggested to predispose for epilepsy development as do autism spectrum disorder and cerebral palsy [3], [4] and [5]. EEGs performed in children with new onset seizures show IED in approximately 18–50%, and IED occurrence is predictive of seizure recurrence, particularly in patients with idiopathic epilepsy [6]. However, the prognostic value of IED in ADHD children with and without previous epilepsy, regarding occurrence of seizure during early illness course, is unknown [7]. Methylphenidate (MPH) is the psychostimulant drug most frequently used for the treatment of ADHD and there is overwhelming evidence for its benefit [8], [9] and [10]. It is considered to be safe in children without epilepsy. On the other hand, there is limited research about the use of MPH in patients with epilepsy [11], [12], [13], [14] and [15] and children with ADHD and IED [16]. A recent study found that clinicians appeared to be reluctant to diagnose and initiate treatment for ADHD in children with epilepsy [17]. It is thus of clinical importance whether it is safe to use MPH in ADHD with IED. The aims of the present study were to investigate whether IED occurrence at ADHD assessment could predict the occurrence of epileptic seizures (Sz) and influence the use of MPH during 2 years follow-up.