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Attention Deficit–Hyperactivity Disorder and the Electroencephalogram
Epilepsy & Behavior 1, 453– 454 (2000) All articles available online at http://www.idealibrary.com on
LETTERS TO THE EDITOR Attention Deficit–Hyperactivity Disorder and the Electroencephalogram onset of ADHD; (6) abnormalities on neurologic examinations indicative of brain damage or defect. An ambulatory or video-EEG may be necessary to evaluate the significance of some reported paroxysmal symptoms, a question that I refer to my colleagues Dr. Nordli and Dr. Kelly, at our Epilepsy Center. Treatment with antiepileptic drugs (AEDs) in ADHD patients with an epileptiform EEG, but without definite seizures, is a difficult and controversial decision (3). Indications to treat may include the following: (1) recurrent, clinically recognized seizures; (2) frequent episodic symptoms suggestive of seizures, not amenable to behavioral intervention; (3) treatment with stimulant and antidepressant drugs in doses known to lower the threshold to seizures. The potential toxicity, adverse effects on learning, and need for frequent monitoring of AEDs must be weighed against the possible benefits in children with ADHD.
To the Editor: The importance of the electroencephalogram (EEG) in the evaluation of children with attention deficit– hyperactivity disorder (ADHD) is frequently neglected in psychiatric studies and symposia, as, for example, in a recent NIH consensus report (1). The article by Dr. John Hughes and associates from the University of Illinois Medical Center, Chicago, draws attention to the relevance of the EEG to ADHD (2). The frequency of “noncontroversial” epileptiform activity (30.1%) among their patients was particularly striking, when compared with some previous studies. In 100 consecutive hyperactive children diagnosed with minimal brain dysfunction syndrome (now called ADHD) and first reported in 1977, I found the frequency of noncontroversial epileptiform dysrhythmias to be 7%, while 19% had moderately abnormal dysrhythmias, not diagnostic of epilepsy, a total of 26% abnormal records (3). Oettinger also reported a 7% incidence of “very specific” EEG abnormalities, compatible with a susceptibility to generalized or partial epilepsies, findings that altered his traditional approach to treatment of ADHD with stimulants (4). The difference in incidence of “epileptiform” records between my study and that of Dr. Hughes and associates may be more apparent than real, and merely a matter of interpretation. In this regard, I defer to the greater experience and opinion of Dr. Hughes. In any event, these figures are indicative of a need to consider specific indications to obtain an EEG in patients presenting with symptoms of ADHD. The following are the indications for an EEG in patients presenting at my ADD clinic: (1) a personal or close family history of seizures; (2) inattentive episodes characterized by excessive “daydreaming” and/or periodic confused states; (3) comorbid episodic, unprovoked temper or rage attacks; (4) frequently recurrent headaches; (5) a history of head trauma, encephalitis, or meningitis preceding the 1525-5050/00 $35.00 Copyright © 2000 by Academic Press All rights of reproduction in any form reserved.
REFERENCES 1. 2.
3. 4.
Ferguson JH. NIH consensus report on ADHD, with commentary. J Am Acad Child Adolesc Psychiatry 2000;39:194 –7. Hughes JR, DeLeo AJ, Melyn MA. The electroencephalogram in attention deficit– hyperactivity disorder: emphasis on epileptiform discharges. Epilepsy Behav 2000;1:271–7. Millichap JG. Attention deficit hyperactivity and learning disorders. Chicago: PNB Publishers, 1998. Oettinger F. In: Millichap JG, editor. Learning disabilities and related disorders: facts and current issues. Chicago: Year Book Medical, 1977.
J. Gordon Millichap, M.D. Division of Neurology Box 51, Children’s Memorial Hospital Northwestern University Medical School 2300 Children’s Plaza Chicago, Illinois 60614 doi:10.1006/ebeh.2000.0131
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LETTERS TO THE EDITOR Attention Deficit–Hyperactivity Disorder and the Electroencephalogram onset of ADHD; (6) abnormalities on neurologic examinations indicative of brain damage or defect. An ambulatory or video-EEG may be necessary to evaluate the significance of some reported paroxysmal symptoms, a question that I refer to my colleagues Dr. Nordli and Dr. Kelly, at our Epilepsy Center. Treatment with antiepileptic drugs (AEDs) in ADHD patients with an epileptiform EEG, but without definite seizures, is a difficult and controversial decision (3). Indications to treat may include the following: (1) recurrent, clinically recognized seizures; (2) frequent episodic symptoms suggestive of seizures, not amenable to behavioral intervention; (3) treatment with stimulant and antidepressant drugs in doses known to lower the threshold to seizures. The potential toxicity, adverse effects on learning, and need for frequent monitoring of AEDs must be weighed against the possible benefits in children with ADHD.
To the Editor: The importance of the electroencephalogram (EEG) in the evaluation of children with attention deficit– hyperactivity disorder (ADHD) is frequently neglected in psychiatric studies and symposia, as, for example, in a recent NIH consensus report (1). The article by Dr. John Hughes and associates from the University of Illinois Medical Center, Chicago, draws attention to the relevance of the EEG to ADHD (2). The frequency of “noncontroversial” epileptiform activity (30.1%) among their patients was particularly striking, when compared with some previous studies. In 100 consecutive hyperactive children diagnosed with minimal brain dysfunction syndrome (now called ADHD) and first reported in 1977, I found the frequency of noncontroversial epileptiform dysrhythmias to be 7%, while 19% had moderately abnormal dysrhythmias, not diagnostic of epilepsy, a total of 26% abnormal records (3). Oettinger also reported a 7% incidence of “very specific” EEG abnormalities, compatible with a susceptibility to generalized or partial epilepsies, findings that altered his traditional approach to treatment of ADHD with stimulants (4). The difference in incidence of “epileptiform” records between my study and that of Dr. Hughes and associates may be more apparent than real, and merely a matter of interpretation. In this regard, I defer to the greater experience and opinion of Dr. Hughes. In any event, these figures are indicative of a need to consider specific indications to obtain an EEG in patients presenting with symptoms of ADHD. The following are the indications for an EEG in patients presenting at my ADD clinic: (1) a personal or close family history of seizures; (2) inattentive episodes characterized by excessive “daydreaming” and/or periodic confused states; (3) comorbid episodic, unprovoked temper or rage attacks; (4) frequently recurrent headaches; (5) a history of head trauma, encephalitis, or meningitis preceding the 1525-5050/00 $35.00 Copyright © 2000 by Academic Press All rights of reproduction in any form reserved.
REFERENCES 1. 2.
3. 4.
Ferguson JH. NIH consensus report on ADHD, with commentary. J Am Acad Child Adolesc Psychiatry 2000;39:194 –7. Hughes JR, DeLeo AJ, Melyn MA. The electroencephalogram in attention deficit– hyperactivity disorder: emphasis on epileptiform discharges. Epilepsy Behav 2000;1:271–7. Millichap JG. Attention deficit hyperactivity and learning disorders. Chicago: PNB Publishers, 1998. Oettinger F. In: Millichap JG, editor. Learning disabilities and related disorders: facts and current issues. Chicago: Year Book Medical, 1977.
J. Gordon Millichap, M.D. Division of Neurology Box 51, Children’s Memorial Hospital Northwestern University Medical School 2300 Children’s Plaza Chicago, Illinois 60614 doi:10.1006/ebeh.2000.0131
453