第十七屆 注意力不足過動症孩童的腦波異常表現

注意力不足過動症孩童的腦波異常表現

The Electroencephalographic Abnormalities in Children with Attention Deficit Hyperactivity Disorder

李逸瑋^1*、陳慧如^1,2,3、洪焜隆^1,4

Yi-Wei Li¹*, Hui-Ju Chen^1,2,3, Kun-Long Hung^1,4

¹國泰綜合醫院小兒科、²馬偕兒童醫院小兒神經科、³台北醫學大學臨床醫學研究所、⁴輔仁大學醫學院

¹Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan,² Department of Pediatric Neurology, MacKay Children's Hospital, Taipei, Taiwan, ³Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,⁴School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan

Background and Purpose: Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood with the characterized symptoms of inattention, hyperactivity, and impulsivity. Few studies have drawn attention to the frequent occurrence of epileptic seizures and electroencephalographic abnormalities in children with ADHD. However, the role of electroencephalography in children with ADHD is still controversial. We conducted a prospective study to explore the clinical significance of epileptiform discharges in children with ADHD.

Methods: We enrolled all ADHD children who visited the early intervention clinic or pediatric neurology clinic at Cathay General Hospital between January, 2014 and June, 2016. We excluded patients with history of intellectual disabilities, epilepsy and congenital anomalies. All ADHD patients met the DSM-IV criteria and underwent the awake and sleep electroencephalography examination. No patient had seizure history before the examination.

Results: A total of 113 patients diagnosed as ADHD were included. 86 patients were male and 27 patients were female. The mean age of these patients was 6.6±2.6 years. Twenty five patients (22%) disclosed electroencephalographic abnormalities . Of these, 3 (12%) had generalized epileptiform discharges and 22 (88%) had focal epileptiform discharges. The focal epileptiform discharges were most prevalent from the rolandic area (12/25) and frontal area (5/25), followed by parietal area (4/25) and occipital region (1/25). In particular, 12(48%) of these 25 patients had abnormal electroencephalographic findings only during sleep recordings.

Conclusion: The electroencephalographic focal abnormalities were found in 22% of ADHD patients and 48% of the electroencephalographic abnormalities appeared only during sleep recording. The most common electroencephalographic abnormality was focal rolandic spikes, followed by frontal spikes. We concluded an electroencephalography with sleep and awake recording should be part of the assessment in children with ADHD, regardless lack of overt seizures or other neurological conditions. In ADHD patients who do not respond well to traditional ADHD drugs, treatment for the paroxysmal electroencephalographic abnormalities should be considered.

Keywords: Electroencephalography, Attention deficit hyperactivity disorder