Attention-Deficit Hyperactivity Disorder in Pediatric Epilepsy

Attention-Deficit Hyperactivity Disorder (ADHD) ranks among the most frequent neurodevelopmental comorbidities in children with epilepsy, affecting an estimated 20–50 per cent of this population. The coexistence of ADHD and epilepsy complicates both diagnosis and management, as attentional deficits, impulsivity and hyperactive behaviour may overlap with seizure manifestations and medication side effects. Neurobiological mechanisms include shared genetic susceptibilities, perturbations in neurotransmitter systems and the impact of recurrent epileptiform activity on frontal networks. Clinically, unrecognised ADHD may hinder seizure control, educational attainment and psychosocial adaptation, while seizure treatments can exacerbate attentional symptoms. Early identification through systematic screening and a multidisciplinary approach that balances anti-seizure therapy with tailored behavioural or pharmacological ADHD interventions is essential to optimise long-term cognitive, social and quality-of-life outcomes.

Research from Nature Portfolio

A cross-sectional study in a tertiary centre in New Delhi reported that nearly one in four children with active epilepsy meets diagnostic criteria for ADHD, most commonly the inattentive subtype. Lower cognitive scores, epileptiform electroencephalogram findings, disrupted schooling and male sex emerged as significant risk factors for comorbidity, emphasising the need for routine neurodevelopmental assessment in resource-limited settings.

In a hospital-based survey of children attending a paediatric seizure clinic in Ethiopia, ADHD was identified in over 40 per cent of patients, with the inattentive presentation predominating. Familial history of seizure disorders or psychiatric illness, uncontrolled seizures and sudden onset were linked to higher ADHD prevalence, underscoring the interplay between seizure control and behavioural health in diverse global contexts.

Attention-Deficit Hyperactivity Disorder in Pediatric Epilepsy publication trend

The graph below shows the total number of articles in attention-deficit hyperactivity disorder in pediatric epilepsy across all publications each year (not limited to Nature Index journals).

Technical terms

Attention-Deficit Hyperactivity Disorder (ADHD): A neurodevelopmental condition marked by inattention, hyperactivity and impulsivity.

Epilepsy: A neurological disorder characterised by recurrent, unprovoked seizures.

Comorbidity: The simultaneous presence of two or more disorders in one individual.

Electroencephalogram (EEG): A diagnostic test recording electrical activity of the brain.

Interictal Epileptiform Discharges: Abnormal EEG waveforms occurring between seizures, indicative of cortical hyperexcitability.

Focal Epilepsy: Seizures originating in a specific brain region.

Genetic Correlation: A measure of shared genetic influences between two traits.

Mendelian Randomisation: A method using genetic variants to infer causal relationships between risk factors and health outcomes.

References

1. Psychiatric comorbidities in epilepsy: population co-occurrence, genetic correlations and causal effects. General Psychiatry (2024).
2. Epilepsy and Attention Deficit Hyperactivity Disorder: Connection, Chance, and Challenges. International Journal of Molecular Sciences (2023).
3. Childhood epilepsy and ADHD comorbidity in an Indian tertiary medical center outpatient population. Scientific Reports (2018).
4. Causal effect of psychiatric disorders on epilepsy: A two‐sample Mendelian randomization study. Brain and Behavior (2023).
5. Epilepsy and attention-deficit/hyperactivity disorder in children and adolescents: An overview of etiology, prevalence, and treatment. Frontiers in Human Neuroscience (2023).
6. Co-morbidity of attention deficit hyperactivity disorder among children with seizure disorders at University of Gondar referral hospital Ethiopia (2016). Scientific Reports (2021).