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

作者：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

来源：Epilepsia, 2018, 59(10): 1867-1880.

DOI：10.1111/epi.14549

<jats:title>Summary</jats:title><jats:p>Attention‐deficit/hyperactivity disorder (<jats:styled-content style="fixed-case">ADHD</jats:styled-content>) is a common and challenging comorbidity affecting many children with epilepsy. A working group under the International League Against Epilepsy (<jats:styled-content style="fixed-case">ILAE</jats:styled-content>) Pediatric Commission identified key questions on the identification and management of <jats:styled-content style="fixed-case">ADHD</jats:styled-content> 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 <jats:styled-content style="fixed-case">PROSPERO</jats:styled-content> registration (<jats:styled-content style="fixed-case">CRD</jats:styled-content>42018094617). No increased risk of <jats:styled-content style="fixed-case">ADHD</jats:styled-content> 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 <jats:styled-content style="fixed-case">ADHD</jats:styled-content> (Level A). Impact of early seizure onset on development of <jats:styled-content style="fixed-case">ADHD</jats:styled-content> was unclear (Level U), but more evident with poor seizure control (Level B). <jats:styled-content style="fixed-case">ADHD</jats:styled-content> screening should be performed from 6 years of age, or at diagnosis, and repeated annually (Level U) and reevaluated after change of antiepileptic drug (<jats:styled-content style="fixed-case">AED</jats:styled-content>) (Level U). Diagnosis should involve health practitioners with expert training in <jats:styled-content style="fixed-case">ADHD</jats:styled-content> (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 <jats:styled-content style="fixed-case">ADHD</jats:styled-content> 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.</jats:p>

• 出版日期2018-10
• 单位南方医科大学