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Febrile seizures, epilepsy, and attention-deficit/hyperactivity disorder (ADHD) are among the most common neurological disorders of childhood. An association between these three conditions has not been substantiated.
In a population-based cohort study, all 906,379 children born in Denmark between 1990 and 2007 were followed up through 2012 (person-years of observation, ~10 million). Diagnoses of febrile seizure, epilepsy and ADHD were ascertained from national hospital registers that included all hospital admissions and clinic visits.
Epilepsy was diagnosed in 13,573 participants (1.5%), febrile seizure in 33,947 (3.8%), and ADHD in 21,079 (2.3%). Children with epilepsy or febrile seizure had a significantly increased incidence of subsequent ADHD compared with children without a seizure diagnosis. Risk for ADHD was 150% to 200% higher in children with epilepsy compared with children without epilepsy and 20% to 35% higher in children with febrile seizures compared with children without febrile seizures. The analysis was adjusted for socioeconomic status, perinatal risk factors, and family history of epilepsy, febrile seizures, and psychiatric disorders.
Bertelsen EN et al. Childhood epilepsy, febrile seizures, and subsequent risk of ADHD. Pediatrics 2016 Aug; 138:e20154654. (http://dx.doi.org/10.1542/peds.2015-4654)
Comment
Considering that mental health conditions and learning disabilities are associated with ADHD, it is not surprising that seizure is also a coexisting condition. Shared genetic and environmental factors that influence neurological pathways and synaptic transmission play a role in all of these disorders.
A limitation of the current study was the exclusion of children with ADHD followed in private practices. Children cared for in hospital clinics may have had more-severe forms of ADHD, which may account for the low reported incidence in this study compared with recent national data (NEJM JW Pediatr Adolesc Med Feb 2014 and J Am Acad Child Adolesc Psychiatry 2014; 53:34). In addition, the study did not distinguish types of epilepsy or simple versus complex febrile seizure. With those caveats, these findings should guide pediatricians to monitor for ADHD in all children with epilepsy or febrile seizures.