Neuropsychiatric Symptoms of Epilepsy

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D.W. Dunn and W.G. Kronenberger
and executive function defined and measured? Is the risk of ADHD and difficulties
with attention and executive function greater in people with epilepsy? What are the
potential explanations for the comorbidity of ADHD, problems with attention and
executive function in patients with epilepsy? What are the optimal treatments for
ADHD or impairments in attention and executive function in patients with epilepsy?
Are there changes over time in attention and executive function? Finally, what are
the areas needing additional research?
Attention Deficit Hyperactivity Disorder (ADHD)
The current Diagnostic and Statistical Manual of Mental Disorders, 5th edition
(DSM 5) lists ADHD as a neurodevelopmental disorder defined by the presence of
six of nine symptoms of inattention and six of nine symptoms of hyperactivity and
impulsivity, beginning prior to 12 years of age, and causing impairment of function
in at least two settings [ 1 ]. For people over 17 years of age, only five symptoms of
inattention or hyperactivity and impulsivity are needed to meet criteria for diagnosis.
If both inattention and hyperactivity/impulsivity are present, the diagnosis is
ADHD, combined presentation and if only one of the sets of symptoms meets the
threshold of 6 symptoms, the ADHD is called predominantly inattentive presentation
or predominantly hyperactive/impulsive presentation. ADHD occurs in 5–10 %
of children and 3–5 % of adults and is twice as common in males compared to
females, particularly when hyperactive-impulsive symptoms are present. In a child
and adolescent psychiatry clinic, ADHD, combined presentation is most common.
In children, ADHD is often comorbid with the disruptive behavior disorders, oppositional
defiant disorder, and conduct disorder, and specific learning disorder also
occurs more frequently when ADHD is present. Comorbidities in adults include
substance-related disorders, mood disorders, and anxiety disorders.
Attention and Executive Functioning
Attention and executive functioning are multifaceted neuropsychological ability
areas. While ADHD is a categorical measure with a diagnosis made once criteria are
met, attention and executive functioning are dimensional measures with no exact
demarcation between normal and abnormal. Attention includes the processes
involved in perceiving and selecting stimuli, maintaining and shifting focus, and
inhibiting responses to extraneous stimuli. Executive functioning is a broader term
that encompasses multiple dimensions without a single well-accepted definition [ 2 ,
3 ]. One representative definition describes executive functions as the cognitive abilities
“necessary to organize, control, and sustain the processing of information in a
planned, goal-directed manner” [ 4 ]. The core components of executive functioning
include shifting mental sets, updating and monitoring information in working