In a recent publication in the Journal of Child Neurology, Cohen et al1 stated that by applying a unique epidemiologic approach they have provided ‘‘specific data’’ on the prevalence of attention-deficit hyperactivity disorder (ADHD) and epilepsy. The authors found a high prevalence of ADHD (12.76%), with a large proportion of cases identified among male subjects (75%). Although the authors should be commended for providing some data in an area where the scarcity of studies is the rule, some caution should be exercised in interpreting these results.
ADHD in Children and Adults: Diagnosis and Prognosis
Springer Verlag Berlin Heidelberg
Renata Kieling and Luis A. Rohde
Abstract: Attention-deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders with childhood onset, having a chronic course associated with high dysfunction and morbidity throughout life. Despite significant advances in our understanding of the neurobiological underpinnings of the disorder, diagnosis of ADHD remains strictly clinical and is based on behavioral symptoms of inattention, impulsivity, and hyperactivity. In this chapter, we review the diagnostic process and current controversies in the diagnosis of ADHD, discuss the clinical presentation of the disorder across the lifespan, and examine the patterns of comorbidity and the longitudinal predictors of outcomes. We conclude by pointing out some of the challenges that need to be addressed in future classifications systems to improve the characterization and validity of the diagnosis of ADHD.
Bilateral perisylvian ulegyria: An under-recognized, surgically remediable epileptic syndrome
Schilling LP, et al. Epilepsia. 2013.
Lucas P. Schilling, Renata R. Kieling, Tharick A. Pascoal, Hyoung-Ihl Kim, Min Cheol Lee, Yun-Hee Kim, Eliseu Paglioli, Pedro R. Neto, Jaderson C. Costa, and Andre Palmini
Abstract: Interest in the association of epilepsy and pseudobulbar palsy was rekindled since the identification through magnetic resonance imaging (MRI) of bilateral perisylvian polymicrogyria (PMG). Seizures are often intractable, but resective epilepsy surgery has not been recommended. However, a similar clinical picture can be encountered in patients with bilateral perisylvian destructive lesions, which fit the description of ulegyria (ULG).
We report a series of patients with epilepsy and pseudobulbar palsy due to bilateral perisylvian ULG (BP-ULG), show that hippocampal sclerosis (HS) is often associated and highlight the fact that in this entity, unlike in malformative bilateral perisylvian PMG, seizures may be surgically treated.
Treatment of Refractory Mesial Temporal Lobe Epilepsy
Dr Engel and colleagues presented important additional evidence on the superiority of surgical therapy over antiepileptic drugs (AEDs) in the treatment of refractory mesial temporal lobe epilepsy (MTLE). Their results corroborate and expand the findings of a previous randomized controlled trial, which led the American Academy of Neurology to issue a practice parameter in 2003 recommending surgery as the treatment of choice for pharmacoresistant MTLE.
Neurobiology of Attention Deficit Hyperactivity Disorder
Kieling C, et al. Am J Psychiatry. 2010.
Christian Kieling, MDa,*, Renata R.F. Goncalves, MAa, Rosemary Tannock, PhDb, Francisco X. Castellanos, MDc,d
Uncovering the neurobiological bases of mental disorders is a core enterprise in the contemporary psychiatric research agenda . As revisions to the diagnostic system are being debated, the transition from a phenomenologically based classification system toward an etiologic and neurodevelopmentally oriented framework will require a substantial body of evidence to be accumulated and synthesized. For the development of this novel nosologic paradigm in the field of psychiatry, it is not enough to have all the puzzle pieces, it is also important to begin to understand how they fit together.
Methylphenidate improves the quality of life of children and adolescents with ADHD and difficult-to-treat epilepsies
Radziuk AL, et al. Epilepsy Behav. 2015.
Christian Kieling, M.D., Renata R. Kieling, M.D., Luis Augusto Rohde, M.D., Ph.D., Paul J. Frick, Ph.D., Terrie Moffitt, Ph.D., Joel T. Nigg, Ph.D., Rosemary Tannock, Ph.D., and Francisco Xavier Castellanos, M.D.
Comorbidity between difficult-to-treat epilepsies and ADHD is frequent and impacts negatively on quality of life. The commonly held (yet poorly substantiated) view that stimulants may worsen seizure control has prevented studies from evaluating the impact of such treatment in this population. Our aim was to study the effect of methylphenidate on the quality of life of children and adolescents with difficult-to-treat epilepsies and comorbid ADHD.
Searching for the best approach to assess teachers’ perception of inattention and hyperactivity problems at school
Kieling RR, et al. Eur Child Adolesc Psychiatry. 2014.
Renata R. Kieling, Christian Kieling, Ana Paula Aguiar, Adriana C. Costa, Beatriz V. Dorneles, Luis A. Rohde.
Abstract Although major guidelines in the field and current diagnostic criteria clearly demand an assessment of children’s attention deficit/hyperactivity disorder (ADHD) symptoms at school, few studies address the fundamental question of which is the best approach for clinicians to get this information from teachers. Three screening strategies for ADHD were applied to teachers of 247 third grade students. They were asked (1) an overt question about potential cases of ADHD in their classroom; (2) to complete a broad-band questionnaire assessing common child mental health problems; (3) to rate ADHD-specific symptoms in a narrow-band questionnaire. Based on the overt question, teachers identified one in five students (21.1 %) as having ADHD; 28 cases (11.3 %) were identified using standard cut-offs for the narrow-band, and 13 (5.3 %) using a standard threshold for the sub-scale of hyperactivity from the broad-band questionnaire. Agreement among strategies was low (k = 0.28). A subsample of students, clinically assessed to confirm screenings, showed modest agreement with final diagnosis. The narrow-band questionnaire had the best diagnostic performance. Multivariate analysis indicated that the presence of a comorbid externalizing disorder was the only variable associated with teachers’ ascertainment of ADHD caseness or non-caseness.
Choice of screening strategy significantly affects how teachers report on ADHD symptoms at school. The halo effect of externalizing behaviors impacts the correct identification of true cases of ADHD in the school setting. Clinicians can rely on narrow-band instruments like the SNAP-IV to get information on ADHD symptoms at school from teachers.
Increasing Teachers' Knowledge About ADHD and Learning Disorders: An Investigation on the Role of a Psychoeducational Intervention
Aguiar AP, et al. J Atten Disord. 2014.
Ana P. Aguiar, Renata R. Kieling, Adriana C. Costa, Neusa Chardosim, Beatriz V. Dorneles, Mariana R. Almeida, Ana C. Mazzuca, Christian Kieling and Luis A. Rohde.
OBJECTIVE: To investigate elementary school teachers’ baseline knowledge about ADHD and learning disorders (LD) and the impact of a strategy to increase awareness of these disorders.
METHOD: A total of 37 teachers were selected from four elementary schools in the catchment area of the University Hospital, in Porto Alegre, Brazil. To evaluate teachers’ knowledge, two self-report questionnaires about ADHD and LD were applied before and after an awareness program on these disorders.
RESULTS: The intervention significantly increased teachers’ knowledge of both disorders, even after adjustment for confounding factors (p < .001). In the repeated measures ANCOVA, only teachers’ previous knowledge of ADHD/LD (p < .001) was significant in predicting score change in knowledge before and after the intervention.
CONCLUSION: Results suggest the efficacy of a brief psychoeducational intervention program for increasing teacher awareness and knowledge about ADHD and LD. Future studies are warranted to confirm the efficacy and evaluate the long-term impact of this intervention.