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Response to adrenocorticotropic in attention deficit hyperactivity disorder-like symptoms in electrical status epilepticus in sleep syndrome is related to electroencephalographic improvement: A retrospective study.
Epilepsy Behav. 2017 09; 74:161-166.EB

Abstract

INTRODUCTION

Encephalopathy with electrical status epilepticus in sleep (ESES) syndrome is a rare epilepsy syndrome of childhood that is characterized by sleep-induced epileptiform discharges and problems with cognition or behavior. The neuropsychiatric symptoms in ESES syndrome, among which the ADHD-like symptoms are prominent, bear a close resemblance to symptoms in various developmental disorders. Positive response to adrenocorticotropic hormone (ACTH) is associated with the normalization of the EEG and improvement of neuropsychiatric function. This study aimed to determine the improvement in ADHD-like symptoms in response to ACTH and establish a relationship between improvement in clinical symptoms and EEG parameters.

METHODS

Seventy-five patients with ESES syndrome, who had clinically displayed ADHD-like symptoms, had been treated with ACTH for ESES, and their medical records were retrospectively reviewed. Sleep EEGs were recorded at referral and follow-up visits, and short courses of ACTH were administered when spike-wave index (SWI) was ≥15%. The assessment of treatment effectiveness was based on reduction in SWI and the clinician-reported improvement in ADHD-like symptoms. Statistical analyses were conducted in order to investigate the relationship between the clinical and EEG parameters.

RESULTS

Following treatment with ACTH, a reduction in SWI in all the patients was accompanied by a mean improvement of 67% in ADHD-like symptoms. Disappearance/reduction of foci and cessation/reduction of seizures were achieved in patients with formerly antiepileptic-resistant seizures. Multiple linear regressions established that pretreatment SWI and treatment delay predicted posttreatment SWI, while reduction in SWI, treatment delay, and the presence of foci predicted improvement in ADHD-like symptoms.

DISCUSSION

Improvement in ADHD-like symptoms showed high correlation and was timely with the resolution of ESES. It is suggested that ESES and ADHD may be the two different expressions of a common neurobiological abnormality. With enhanced interpretation of sleep EEG, a more thorough assessment and treatment of neurodevelopmental disorders is possible.

Authors+Show Affiliations

Suadiye Mah., Ulku Sok. No: 17/1, Kadikoy, Istanbul, Turkey; Mustafa Kemal Pasa Cad. Deniz Sarayi Apt 49/7 Aksaray Fatih, Istanbul, Turkey. Electronic address: attilaaltunel@gmail.com.Suadiye Mah., Ulku Sok. No: 17/1, Kadikoy, Istanbul, Turkey. Electronic address: ozlemaltunel@gmail.com.Department of Radiology, Kadikoy Florence Nightingale Hospital, Bagdat Cad No:63, 34724 Kadikoy, Istanbul, Turkey. Electronic address: alisever.md@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28778058

Citation

Altunel, Attila, et al. "Response to Adrenocorticotropic in Attention Deficit Hyperactivity Disorder-like Symptoms in Electrical Status Epilepticus in Sleep Syndrome Is Related to Electroencephalographic Improvement: a Retrospective Study." Epilepsy & Behavior : E&B, vol. 74, 2017, pp. 161-166.
Altunel A, Altunel EÖ, Sever A. Response to adrenocorticotropic in attention deficit hyperactivity disorder-like symptoms in electrical status epilepticus in sleep syndrome is related to electroencephalographic improvement: A retrospective study. Epilepsy Behav. 2017;74:161-166.
Altunel, A., Altunel, E. Ö., & Sever, A. (2017). Response to adrenocorticotropic in attention deficit hyperactivity disorder-like symptoms in electrical status epilepticus in sleep syndrome is related to electroencephalographic improvement: A retrospective study. Epilepsy & Behavior : E&B, 74, 161-166. https://doi.org/10.1016/j.yebeh.2017.06.019
Altunel A, Altunel EÖ, Sever A. Response to Adrenocorticotropic in Attention Deficit Hyperactivity Disorder-like Symptoms in Electrical Status Epilepticus in Sleep Syndrome Is Related to Electroencephalographic Improvement: a Retrospective Study. Epilepsy Behav. 2017;74:161-166. PubMed PMID: 28778058.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Response to adrenocorticotropic in attention deficit hyperactivity disorder-like symptoms in electrical status epilepticus in sleep syndrome is related to electroencephalographic improvement: A retrospective study. AU - Altunel,Attila, AU - Altunel,Emine Özlem, AU - Sever,Ali, Y1 - 2017/08/01/ PY - 2017/03/22/received PY - 2017/06/01/revised PY - 2017/06/14/accepted PY - 2017/8/5/pubmed PY - 2018/4/6/medline PY - 2017/8/5/entrez KW - Developmental disorders KW - Epileptiform discharges KW - Neuropsychiatric symptoms KW - Sleep EEG KW - Spike–wave index KW - Treatment SP - 161 EP - 166 JF - Epilepsy & behavior : E&B JO - Epilepsy Behav VL - 74 N2 - INTRODUCTION: Encephalopathy with electrical status epilepticus in sleep (ESES) syndrome is a rare epilepsy syndrome of childhood that is characterized by sleep-induced epileptiform discharges and problems with cognition or behavior. The neuropsychiatric symptoms in ESES syndrome, among which the ADHD-like symptoms are prominent, bear a close resemblance to symptoms in various developmental disorders. Positive response to adrenocorticotropic hormone (ACTH) is associated with the normalization of the EEG and improvement of neuropsychiatric function. This study aimed to determine the improvement in ADHD-like symptoms in response to ACTH and establish a relationship between improvement in clinical symptoms and EEG parameters. METHODS: Seventy-five patients with ESES syndrome, who had clinically displayed ADHD-like symptoms, had been treated with ACTH for ESES, and their medical records were retrospectively reviewed. Sleep EEGs were recorded at referral and follow-up visits, and short courses of ACTH were administered when spike-wave index (SWI) was ≥15%. The assessment of treatment effectiveness was based on reduction in SWI and the clinician-reported improvement in ADHD-like symptoms. Statistical analyses were conducted in order to investigate the relationship between the clinical and EEG parameters. RESULTS: Following treatment with ACTH, a reduction in SWI in all the patients was accompanied by a mean improvement of 67% in ADHD-like symptoms. Disappearance/reduction of foci and cessation/reduction of seizures were achieved in patients with formerly antiepileptic-resistant seizures. Multiple linear regressions established that pretreatment SWI and treatment delay predicted posttreatment SWI, while reduction in SWI, treatment delay, and the presence of foci predicted improvement in ADHD-like symptoms. DISCUSSION: Improvement in ADHD-like symptoms showed high correlation and was timely with the resolution of ESES. It is suggested that ESES and ADHD may be the two different expressions of a common neurobiological abnormality. With enhanced interpretation of sleep EEG, a more thorough assessment and treatment of neurodevelopmental disorders is possible. SN - 1525-5069 UR - https://www.unboundmedicine.com/medline/citation/28778058/Response_to_adrenocorticotropic_in_attention_deficit_hyperactivity_disorder_like_symptoms_in_electrical_status_epilepticus_in_sleep_syndrome_is_related_to_electroencephalographic_improvement:_A_retrospective_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-5050(17)30234-2 DB - PRIME DP - Unbound Medicine ER -