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ADHD and epilepsy: is there a link?

Research has helpful information about why ADHD and epilepsy often occur together and how to approach treatment.

Attention deficit hyperactivity disorder (ADHD) and epilepsy often occur together. People living with ADHD have an increased risk of seizures.

ADHD is the most common concomitant disease with epilepsy, with 1 in 5 adults with self-reported symptoms of ADHD epilepsy. In comparison, 4.4% of adults in the United States have ADHD.

Studies have found that 20% to 50% of children with epilepsy have ADHD, compared to 7% to 9% of all children.

Research has provided insight into this bidirectional link between the conditions, although further studies are needed to fully understand the relationship.

Learning more about treatment considerations can help you better manage the symptoms of either disease, whether you live with one or both.

It is unclear whether ADHD and epilepsy share affected brain areas. More research is needed.

A study 2018 magnetic resonance imaging (MRI) revealed that participants with both conditions had size reductions in several areas of the brain:

  • cortical thickness (frontal, parietal and temporal areas)
  • caudate
  • thalamus
  • seahorse
  • brainstem

The same size reductions were not present in the group with epilepsy alone. Epilepsy is a medical condition affecting the brain in which irregular electrical activity causes seizures.

ADHD is a neurodevelopmental disorder that affects the way a person behaves and thinks. It causes three main categories of symptoms:

  • hyperactivity
  • impulsiveness
  • inattention

Some doctors believe that seizures can worsen the disruption of messages about behavior, potentially increasing ADHD symptoms.

People with epilepsy have a 3.47 times increased risk of ADHD. Such a large increase may give the impression that there is a causal link. That doesn’t appear to be the case, although both conditions affect the other, according to a study published in 2017.

Studies show that signs of ADHD often exist before the onset of seizures, suggesting that ADHD is a separate condition and not the result of seizures.

Parents of children with epilepsy describe their child’s ADHD as being of the inattentive type. In the general population, ADHD of the combined type, with both symptoms of inattention and hyperactivity, is the most common.

But when the researchers excluded study participants with an IQ below 80, inattentive ADHD and combined ADHD occurred at the same rate.

Although there is no evidence that seizures cause ADHD symptoms, sometimes the conditions can mimic each other.

An absence seizure (or petit mal) can feel like an ADHD moment of inattention. But there is a clear difference between the two.

A person with an absence seizure does not react to their environment during the episode, but an inattentive person with ADHD can and will.

Convulsions and hyperactivity can sometimes occur in epilepsy which is not fully managed by medication, according to a 2016 study.

Genetic and environmental factors

Although epilepsy does not appear to cause ADHD or vice versa, there may be common underlying factors at play.

A recent study found that in a cohort of people living with both epilepsy and ADHD, their family members with epilepsy also had a significantly increased risk of ADHD. This suggests the contribution of genetic factors in cases of co-occurrence of ADHD and epilepsy.

The researchers also found evidence that family members with similar environmental factors to the cohort were also more likely to live with both conditions.

Stimulant medications are a common and often helpful treatment for ADHD. It works by increasing the effect of neurotransmitters in the brain.

According to another study 2018 involving children with epilepsy, the use of stimulants does not increase the rate of hospitalization following seizures.

In fact, the rate of seizure hospitalization was slightly lower for stimulant users and ex-users than for non-users, suggesting a possible seizure-protective effect of stimulant medications.

Stimulants remain a best practice for the treatment of ADHD, even with a diagnosis of epilepsy.

Medicines for epilepsy and ADHD

While stimulants for treating ADHD are considered safe, research has found that they may be less effective in children with epilepsy.

Epilepsy drugs are also thought to worsen attention in some patients.

ADHD and epilepsy have similarities and treatment differences. Each condition requires a different approach, so it may be essential to discuss the prioritization and balance of your overall treatment approach with your doctor.

Similarities

Medications are a primary treatment for ADHD and epilepsy. In both conditions, the drugs work to correct the differences in the brain.

Sometimes antiepileptic drugs can cause ADHD symptoms. Talk with your healthcare team to make sure epilepsy medications don’t negatively impact ADHD symptoms. It may be preferable to choose an antiepileptic drug with positive or neutral psychotropic properties.

When there is a diagnosis of ADHD and epilepsy, the priority of treatment is seizure control.

In some cases, medications do not work to control seizures because the epilepsy is refractory, meaning it is not fully controlled by medication.

In other cases, epilepsy medications may not stop the seizures because they are caused by psychological factors rather than the epilepsy. These events are called seizures or psychogenic non-epileptic seizures (PNES).

It is important to know if someone has PNES instead of epilepsy. Anti-epileptic drugs do not work to treat PNES and increasing the dose may cause unwanted side effects.

Although research is limited, dietary changes can help both ADHD and epilepsy.

Some research supports the role of the ketogenic diet in treating epilepsy that is unresponsive to medication.

This diet is thought to reduce seizure frequency by altering the metabolism and excitability of brain cells. One way to do this is to reduce brain blood glucose levels that fuel seizures.

Eating for ADHD involves choosing foods like protein and complex carbohydrates, as well as nutrient-dense options like fresh fruits and vegetables. On the list of things to avoid are things like refined sugar, simple carbs, and artificial additives.

Differences

There are alternatives to drugs and diet to target brain differences in epilepsy.

  • Vagus nerve stimulator. This is a small implanted device that sends electrical impulses to your brain through your vagus nerve.
  • Brain surgery. This surgery can remove the area of ​​your brain that is causing your seizures. When the surgery is successful, it is considered curative.

Treating epilepsy and ADHD symptoms requires different medications. Talk to your doctor about which medications and dosage are right for you.

Cognitive-behavioral therapy can work well for dealing with ADHD, especially when combined with medication. ADHD therapy or coaching can teach skills that help reduce the impact of ADHD symptoms on daily life.

ADHD and epilepsy are different conditions, but they are strongly related. If you have one of these conditions, you are more likely to have the other as well.

They are both usually treatable with medication. Unlike ADHD, epilepsy is sometimes curable with surgery.

Although there is no surgical treatment for ADHD, therapy has helped many people by teaching them valuable skills for managing symptoms. It can be very effective when used with medication.