Behavior Problems In Epilepsy Children Comorbid ADHD

It is well-known that children with epilepsy have a significant risk for Attention-Deficit/Hyperactivity Disorder (ADHD), which is often accompanied with behavior problems. This article is to find out the characters of behavior problems in children with both epilepsy and ADHD and the risk factors.Part I:Behavior Problems in epilepsy childrenPurpose:Find the characteristic behavior problems of children with epilepsy and whether there are some infactors associated with the behavior problems.Method:We included206children between6and16diagnosed with epilepsy and normal IQ,58healthy control. Data on demographics, parental reports on the Children Behavior Checklist (CBCL).Result:According to the CBCL results, children with epilepsy showed difference in activities(p=0.000), school performance(p=0.000), social relations(p=0.012), attention deficit(p=0.003), aggressive behavior(p=0.044) compare to control group. Children with generalized tonic-clonic seizure(GTCS) showed difference in activities(p=0.000), school pefformance(p=0.000), anxious/depressed(p=0.035), social problems(p=0.042), attention deficit(p=0.014) compare to control group. Children with simple partial seizure showed different behavior problems in activities(p=0.000),school performance(p=0.000), social relations(p=0.037), attention deficit(p=0.026). Children with complex partial seizures(CPS) showed difference in activities(p=0.000), school performance(p=0.000), withdraw(p=0.012), anxious/depressed(p=0.015), social problems(p=0.001), attention deficit(p=0.001), aggressive behavior(p=0.005). Children with secondarily generalized tonic-clonic seizure showed difference in activities(p=0.000), school performance(p=0.001), somatic complaints(p=0.028). There was no difference between children with absence seizure and control group. Benign childhood epilepsy with centrotemporal spike (BECT) children appeared different in activities(p=0.000). Compare to the newly diagnosis patient didn’t get treatment, children treated with one antiepilepsy drugs (AEDs) showed different in school performance while those who under multi-drug treatment showed different in activities(p=0.022), social realtions(p=0.000), school performance(p=0.000), withdraw(p=0.042), anxious/depressed(p=0.013), social problems(p=0.000), thought problems(p=0.010) and attention deficit(p=0.001). For monotherapy children, those treated with Valproic acid(VPA) showed more behavior problems in activities(p=0.010), school performance(p=0.010), social realtions(p=0.012) and attention deficit(p=0.024) compare to newly diagnosis patient who didn’t get AEDs. Children treated with topiramate(TPM) performed behavior problems in social realtions(p=0.024) and school performance(p=0.011). levetiracetam(LEV), lamotrigine(LTG) and oxcarbazepine(OXC) were not associated with behavior problems.We re-test children newly diagnosis epilepsy after3months, those children all treated with VPA, the result showed no different. Children who had been seizure free for6months showed different in activities(p=0.000) and school performance(p=0.000) compared to control group while children had seizure attack in6months showed different in activities(p=0.000), school performance(p=0.000), social problems(p=0.010), attention deficit(p=0.000) and aggressive behavior(p=0.016). Boys got higher score in delinquent behavior than girls(p=0.000). Children who had abnomal perinatal period is different from children who hadn’t in social realtions(p=0.013) and school performance(p=0.030). Epilepsy family history and febrile seizures history were not associated with behavior problems.Conclusion:There is difference between epilepsy children and control group, Children with GTCS and CPS have more behavior impairment while children with BECT perform well in CBCL results. VPA, LEV, LTG and OXC show less behavior problems than TPM. Part II:Behavior problems in epilepsy children comorbid ADHDPurpose:Find the characteristic behavior problems of epilepsy children comorbid ADHD and whether there are some infactors which influence the behavior problems.Method:We included203children between6and16diagnosed with epilepsy and normal IQ,58healthy control. Data on demographics, parental reports on the Child Behavior Checklist (CBCL) and Swanson, Nolan, and Pelham, version IV scale (SNAP-IV) and ADHD Rating Scale-IV(ADHD-RS-IV)Result:Children with epilepsy comorbid ADHD-C were different from those who without ADHD in social relation(p=0.022), school performance(p=0.001), anxious/depressed(p=0.039), social problems(p=0.003), thought problems (p=0.000), attention deficit(p=0.000),delinquent behavior(p=0.000) and aggressive behavior(p=0.000). ADHD-I children showed different in social relations(p=0.000), school performance(p=0.000), withdraw(p=0.028), social problems(p=0.000), attention deficit(p=0.000), delinquent behavior(p=0.000) and aggressive behavior(p=0.000). ADHD-HI children showed different in attention deficit(p=0.017), delinquent behavior(p=0.004) and aggressive behavior(p=0.001). Boys who had both epilepsy and ADHD performs worse in attention deficit(p=0.034) and delinquent behavior(p=0.000) than girls. Children with febrile seizures history showed different in school performance(p=0.015),somatic complaints(p=0.024), social problems(p=0.008), thought problems(p=0.029), attention deficit(p=0.032) and delinquent behavior(p=0.035). Epilepsy family history and abnomal perinatal period didn’t affect the behavior problems of children with both epilepsy and ADHD.Conclusion:There is difference between epilepsy children and control group, also between children with both disease and epilepsy children without ADHD. Children with generalized tonic-clonic seizure(GTCS) and complex partial seizure(CPS) have more behavior impairment while children with BECT perform well in CBCL results. Valproic acid, levetiracetam, lamotrigine and oxcarbazepine show less behavior problems than topiramate. Epilepsy children with ADHD-C and ADHD-Ⅰ appear more behavior problems such as school activity, attention deficit, delinquent, and aggressive behavior.