July 13, 2023 -- About 20 out of every 100 adults with epilepsy may also have attention deficit/hyperactivity disorder, or ADHD, and new research shows the more un-controlled seizures a patient has, the higher risk that patient has of having ADHD as well.
Both conditions often begin early in life – it’s estimated that 30% to 40% of children with epilepsy have ADHD. Since epilepsy is so common -- it affects about 50 million people worldwide -- researchers are striving to fgure out more about this connection.
A new study from Taiwan found that ADHD and epilepsy share a common genetic background and many of the same chromosomal abnormalities. Both genetic and environmental factors also appear to potentially play a role, the study authors suggest. For example, family history of both epilepsy and ADHD correlated for 40% of the risk of having both conditions. And the study authors cited research showing that the more air pollution you are exposed to as a child, the more likely you are to have a dual diagnosis of ADHD and epilepsy.
“An adult diagnosed with epilepsy and/or ADHD could certainly be impacted by the same factors, though research is limited,” said Erin Fedak Romanowski, DO, a pediatric neurologist in the University of Michigan Health C.S. Mott Children’s Hospital Comprehensive Pediatric Epilepsy Program in Ann Arbor. “It makes sense that many children with ADHD and chronic epilepsy grow up to be adults with ADHD and epilepsy. For the best outcomes, it is important to identify and treat both conditions early.”
Here’s what to know about the two conditions and the possible connection between them.
Which Comes First, Epilepsy or ADHD?
We don’t know for sure, but it is clear that the way epilepsy affects the brain may play a key role in the development of ADHD.
A new study from Israel points out that although one direct cause as to why epilepsy and ADHD often go hand-in-hand has not yet been determined, many combined factors come into play.
In epilepsy, the electrical pattern of the brain becomes unbalanced, leading to seizures (either generalized, affecting the cells in two parts of the brain, or focal onset, affecting the cells in just one part). Patients who have seizures affecting the frontal lobe of the brain have a high rate of ADHD. Also, the more seizures a patient has that aren’t effectively controlled by medication, the higher risk that patient has of having ADHD. This potential trigger for ADHD could be due to problems with the frontal lobe itself, electrical charges from the seizures, or undiagnosed brain lesions.
“For some individuals manifesting seizures, there is underlying brain damage,” said Elissa Yozawitz, MD, director of neonatal neurology and assistant professor of neurology and pediatrics at Montefiore Health System and Albert Einstein College of Medicine in New York City. “Some of these individuals have predominant dysfunction of inhibitory neurons leading to excitatory predominance and cerebral hyperarousal with accompanying ADHD. Those with cerebral overarousal will manifest ADHD.”
A new study from British researchers also found that epileptic spasms in infancy can lead to ADHD symptoms later in childhood and adolescence. Severe epilepsy seizures in the first 2 years of a child’s life may open a pathway that causes ADHD symptoms to subsequently develop. This is through a connection with tuberous sclerosis complex (TSC), a condition that causes gene mutations.
“There is a higher rate of psychological disorders in young people with epilepsy as compared to those with other chronic disorders, including ADHD,” said Romanowski. “The exact mechanism linking the two disorders is not completely understood. The co-existence of other developmental disorders, poor seizure control, and use of multiple antiseizure medications can all play a role in ADHD and epilepsy.”
What Are the Symptoms of Epilepsy?
Generalized seizures have six types:
- Absence seizures, which have the same symptoms as a focal onset awareness seizure
- Atonic seizures, in which your muscles weaken, causing your body to droop or making you suddenly fall to the ground
- Tonic seizures, in which your muscles stiffen
- Clonic seizures, in which your muscles making jerking motions
- Tonic-clonic seizures, in which you may lose consciousness and suffer convulsions
- Myoclonic seizures, in which your muscles jerk or twitch briefly
The symptoms of a focal onset seizure are different depending if you’re awake during the seizure or not. Signs of a focal onset aware seizure are:
- Changes in taste smell, or hearing
- Mood shifts
- Jerking of your muscles that you can’t control
- Seeing flashing lights
- Tingling sensations
A focal onset impaired awareness seizure symptoms include:
- Staring blankly
- Repetitive movements: blinking, rubbing your hands over and over, repeated mouth or finger movements
What Are the Symptoms of Attention Deficit Hyperactivity Disorder in Adults?
Signs of ADHD in an adult include:
- Acting impulsively
- Problems with organization
- Time management issues
- Poor concentration
- Multitasking problems
- Trouble with planning
- Getting frustrated easily
- Mood swings
- Problems following through on tasks
- Being quick to anger
- An inability to deal well with stress
Which Treatments Might Help Both ADHD and Epilepsy?
Recent research points to the drug methylphenidate as a possible treatment for attention deficit symptoms due to epilepsy, although more studies are needed to determine how effective it might be for most patients. Also, previous research found that the drug may increase the frequency of seizures.
For now, it's important to talk with your doctor about treatment options that can help you specifically. One very important strategy: if you have been diagnosed with epilepsy, make sure not to discontinue any medication that is already working to prevent seizures specifically, which can be dangerous. Stopping or switching medication should only be done with your doctor’s advice.
If you think you have symptoms of ADHD, get a proper diagnosis no matter what your age. You may be able to trace the root of your ADHD, which can expand your treatment options.
“ADHD causes may include environmental trauma, many different developmental disorders, psychiatric disorders, endocrine disorders, and genetic disorders,” said Yosawitz.
And avoiding triggers of both epilepsy and ADHD can make a big difference. This means managing stress, getting adequate sleep, and eating regular, nutritious meals. Making healthy lifestyle choices can be a simple but powerful prevention tool and help you gain more control.