Epilepsy and attention-deficit/hyperactivity disorder. Problems of antiepileptic therapy

This review is based on the consensus statement of the International League Against Epilepsy’s pediatric panel on the diagnosis and management of patients with epilepsy and attention-deficit/hyperactivity disorder (ADHD). The document has been expanded and supplemented by later publications. Its main provisions: ADHD is 3–5 times more common in children with epilepsy than in the general population; the risk of developing epilepsy in people with ADHD is also increased. No gender differences were found in the manifestations of ADHD in boys and girls with epilepsy. Taking valproate during pregnancy increases the risk of developing ADHD in the child. The presence of intellectual and developmental disabilities, as well as poor seizure control, increase the risk of developing ADHD. Screening for ADHD should be performed in all children with epilepsy, beginning at age 6, when the diagnosis of epilepsy is established. Children should be retested annually for ADHD symptoms, including after a change in antiepileptic medication. The International League Against Epilepsy recommends the Strengths and Difficulties Questionnaire for ADHD screening. Behavioral problems occur more frequently with polytherapy than with monotherapy. A number of antiepileptic drugs (for example, valproate, benzodiazepines, etc.) can worsen cognitive and behavioral problems in patients with epilepsy and ADHD. Sulthiame has good cognitive tolerability and is approved for the treatment of hyperkinetic behavior and behavioral disorders in epilepsy, making it the drug of choice for patients with epilepsy and behavioral disorders, such as ADHD.