Do Adults with Epilepsy Have More ADHD Symptoms Than Those Without Epilepsy?

What you need to know

• Adults with epilepsy reported more symptoms of attention deficit hyperactivity disorder (ADHD) compared to adults without epilepsy.
• Adults with epilepsy also had higher levels of depression and anxiety symptoms.
• The higher rates of ADHD, depression and anxiety symptoms in adults with epilepsy do not appear to be simply side effects of anti-seizure medications.
• These findings suggest adults with epilepsy may benefit from screening and treatment for ADHD and other mental health conditions.

Background on epilepsy and mental health

Epilepsy is a brain disorder characterized by recurrent seizures. People with epilepsy often have other health conditions as well, including mental health disorders. Previous research has found that adults with epilepsy have higher rates of conditions like depression, anxiety, and ADHD compared to the general population.

ADHD is a neurodevelopmental disorder involving persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with daily functioning and development. While ADHD typically begins in childhood, symptoms can persist into adulthood for many people. Some evidence even suggests ADHD may have a late onset in adulthood for some individuals.

Several studies have found higher rates of ADHD in children with epilepsy. However, less research has examined ADHD symptoms in adults with epilepsy, particularly in Brazil. This study aimed to compare self-reported ADHD symptoms between Brazilian adults with epilepsy and adults without epilepsy.

How the study was conducted

The researchers recruited 95 adults with epilepsy from a specialized epilepsy clinic in southern Brazil. For comparison, they also recruited 100 adults without epilepsy who were accompanying patients at the hospital.

All participants completed three questionnaires:

1. The Adult ADHD Self-Report Scale (ASRS) - Measures symptoms of inattention and hyperactivity/impulsivity
2. The Hospital Anxiety and Depression Scale (HADS) - Assesses symptoms of anxiety and depression
3. The Adverse Events Profile (AEP) - Evaluates side effects commonly attributed to anti-seizure medications

The researchers compared scores on these questionnaires between the epilepsy group and the control group without epilepsy. They also looked at correlations between scores on the different questionnaires.

Key findings

Higher ADHD symptoms in adults with epilepsy

Adults with epilepsy scored significantly higher on the ADHD symptom questionnaire (ASRS) compared to the control group:

• Epilepsy group median score: 26 out of 72
• Control group median score: 17 out of 72

This suggests adults with epilepsy experience more symptoms of inattention and hyperactivity/impulsivity than adults without epilepsy.

More depression and anxiety symptoms

The epilepsy group also had higher scores on the depression and anxiety questionnaire (HADS):

• Epilepsy group median score: 14 out of 42
• Control group median score: 11 out of 42

Breaking this down further, the epilepsy group scored higher on the depression portion of the questionnaire, but the difference in anxiety scores was not statistically significant.

Higher medication side effect scores

As might be expected, the epilepsy group reported more medication side effects on the AEP questionnaire:

• Epilepsy group median score: 38 out of 76
• Control group median score: 33 out of 76

Correlations between symptoms

There were positive correlations between scores on all three questionnaires. This means people who reported more ADHD symptoms also tended to report more depression/anxiety symptoms and more medication side effects.

Relationship with seizure frequency

More frequent seizures were associated with higher scores on the symptom questionnaires. Specifically:

• More frequent focal aware seizures correlated with higher ADHD, depression/anxiety, and side effect scores
• More frequent focal impaired awareness seizures correlated with higher side effect scores
• More frequent focal to bilateral tonic-clonic seizures correlated with higher depression/anxiety and side effect scores

No clear relationship with epilepsy type

The researchers did not find significant differences in ADHD symptoms between different types of epilepsy (e.g. temporal lobe epilepsy vs. frontal lobe epilepsy). The only difference was that people with frontal lobe epilepsy had lower anxiety scores compared to other epilepsy types.

What do these findings mean?

This study provides evidence that adults with epilepsy experience more symptoms of ADHD compared to adults without epilepsy, at least in this Brazilian population. The findings are consistent with previous research showing higher rates of ADHD in people with epilepsy.

There are a few potential explanations for the link between epilepsy and ADHD symptoms:

1. Shared underlying brain mechanisms: The brain circuits involved in epilepsy may overlap with those involved in attention and impulse control.

2. Impact of seizures: Recurrent seizures may affect brain regions important for attention and executive function over time.

3. Medication effects: Anti-seizure medications could potentially contribute to attention difficulties as a side effect.

4. Stress of living with epilepsy: The challenges of managing a chronic condition like epilepsy may exacerbate attention problems.

Importantly, this study found that ADHD symptoms were not clearly correlated with anti-seizure medication use. This suggests the higher ADHD symptom levels are not simply a medication side effect. Instead, there may be common underlying factors contributing to both epilepsy and ADHD.

The study also highlights that adults with epilepsy experience more symptoms of depression compared to those without epilepsy. This aligns with substantial previous research showing higher rates of depression in people with epilepsy.

Limitations to keep in mind

There are a few limitations to consider when interpreting these results:

• The study relied on self-reported symptoms rather than clinical diagnosis of ADHD or other disorders.
• The control group excluded people with known psychiatric conditions, which may have artificially lowered ADHD symptom levels in that group.
• Symptoms of ADHD, depression and anxiety can overlap, making it difficult to clearly distinguish between these conditions using questionnaires alone.
• The study was conducted at a single epilepsy center in Brazil, so the findings may not generalize to all adults with epilepsy.

Implications for adults with epilepsy

Despite the limitations, this study adds to a growing body of evidence that adults with epilepsy are at higher risk for ADHD and other mental health symptoms. This has important implications:

• Adults with epilepsy may benefit from screening for ADHD, depression, and anxiety as part of their routine care.
• Treatment for ADHD or other mental health conditions could potentially improve quality of life for adults with epilepsy.
• Managing psychiatric symptoms may help improve seizure control in some cases.
• Clinicians should be aware that attention problems in adults with epilepsy may reflect ADHD rather than just medication side effects.

Conclusions

• Adults with epilepsy report more symptoms of ADHD compared to adults without epilepsy.
• Depression symptoms are also more common in adults with epilepsy.
• The higher rates of ADHD and depression symptoms do not appear to be simply due to anti-seizure medication effects.
• More research is needed to understand the links between epilepsy and ADHD, but screening for ADHD may be beneficial in adults with epilepsy.

This study highlights the complex relationship between epilepsy and mental health. By better understanding and addressing psychiatric symptoms in adults with epilepsy, clinicians may be able to improve overall care and quality of life for this population.