In a new study led by Alan B. Ettinger, M.D., M.B.A., Director of the Epilepsy Center at Neurological Surgery, P.C. (NSPC) and Professor of Clinical Neurology, Albert Einstein College of Medicine, nearly one in five adult epilepsy patients reported attention deficit hyperactivity disorder (ADHD) symptoms. This is four times higher than the approximate 4.4% rate of ADHD diagnosis in the general adult population.

Those in the study who experienced ADHD symptoms also reported higher rates of anxiety, depression and worse seizure frequency. The study, which involved 1,361 adult epilepsy patients, is published online January 15, 2015 in Epilepsia, the journal of the International League Against Epilepsy.

"Little was previously known about the prevalence of ADHD symptoms in adults with epilepsy, and the results were quite striking," said Dr. Ettinger, who is an internationally known epilepsy specialist whose research focuses on psychiatric disorders that may accompany epilepsy. "To my knowledge, this is the first time ADHD symptoms in adults with epilepsy have been described in the scientific literature. Yet, the presence of these symptoms may have severe implications for patients' quality of life, mood, anxiety, and functioning in both their social and work lives."

Dr. Ettinger pointed out that those who reported ADHD symptoms were nine times more likely to have depression and eight times more likely to have anxiety symptoms. They were also far less likely to be employed than others.

"This study reinforces the fact that we have to broaden our view of what epilepsy entails," he said. "Our patients may also have psychiatric comorbidities, and screening for and treating these may make a great difference to patients in their family, school and work lives."

To research these issues, Dr. Ettinger and colleagues mailed a survey to a national sample of adults who self-reported having epilepsy, as part of the Epilepsy Comorbidities and Health (EPIC) study. The survey included a number of assessments and scales with established reliability and validity, in order to measure not just ADHD symptoms, but also other factors that might impact patients' physical and mental health. These survey instruments included the Adult ADHD Self-Report Scale (ASRS-6), Physicians Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Assessment (GAD-7). Questions about past three-month seizure frequency and number of antiepileptic drugs (AEDs) were also included. Outcome measures included the Quality of Life in Epilepsy scale (QOLIE-10), Quality of Life and Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and Sheehan Disability Scale (SDS). The relationship of ADHD symptoms to quality of life outcomes was examined using statistical analyses, which also looked at sociodemographics, depression, anxiety, seizure frequency, and number of AEDs.

Among the 1,361 respondents with active epilepsy, 18.4% (n=251) were classified as experiencing significant ADHD symptoms.

"Physicians who treat epilepsy often attribute depression, anxiety, reduced quality of life and psychosocial outcomes to the effects of seizures, antiepileptic therapies and underlying central nervous system conditions. Our findings suggest that ADHD may also be playing a significant role," said Dr. Ettinger. "However, we don't know yet if ADHD in epilepsy is synonymous with ADHD in the general population, which is often responsive to treatment. As a next step, we need to validate measures to screen for ADHD specifically in epilepsy and clarify the nature of ADHD symptoms in adults with epilepsy. This will lay the foundation for future trials of treatments that offer the promise of rendering major improvements in the quality of life of adult epilepsy patients."

In the general population, ADHD is one of the most common pediatric behavioral disorders, occurring in 8-10% of children and adolescents. A diagnosis of ADHD is made in children when they have six or more inattention symptoms and/or six or more hyperactivity-impulsivity symptoms. While many consider ADHD a childhood disorder, studies have shown that some symptoms persist into adulthood in up to 66% of cases. Adults with ADHD often have difficulty functioning in their work, social and academic lives.

The study was funded by the Leslie Munzer Neurological Institute. Janssen Scientific Affairs provided data access. Data analysis was performed by Vedanta Research.