Attention-deficit/hyperactivity disorder (
ADHD) is a common and challenging comorbidity affecting many children with
epilepsy. A working group under the International League Against
Epilepsy (ILAE) Pediatric Commission identified key questions on the identification and management of
ADHD in children with
epilepsy. Systematic reviews of the evidence to support approaches to these questions were collated and graded using criteria from the American Academy of Neurology Practice Parameter. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (
PRISMA) requirements were followed, with PROSPERO registration (CRD42018094617). No increased risk of
ADHD in boys with
epilepsy compared to girls with
epilepsy was found (Level A).
Valproate use in pregnancy is associated with inattentiveness and hyperactivity in offspring (1 class I study), and children with intellectual and
developmental disabilities are at increased risk of
ADHD (Level A). Impact of early seizure onset on development of
ADHD was unclear (Level U), but more evident with poor seizure control (Level B).
ADHD screening should be performed from 6 years of age, or at diagnosis, and repeated annually (Level U) and reevaluated after change of
antiepileptic drug (AED) (Level U). Diagnosis should involve health practitioners with expert training in
ADHD (Level U). Use of the Strength and Difficulties Questionnaire screening tool is supported (Level B). Formal cognitive testing is strongly recommended in children with
epilepsy who are struggling at school (Level U). Behavioral problems are more likely with polytherapy than monotherapy (Level C).
Valproate can exacerbate attentional issues in children with
childhood absence epilepsy (Level A).
Methylphenidate is tolerated and effective in children with
epilepsy (Level B). Limited evidence supports that
atomoxetine is tolerated (Level C). Multidisciplinary involvement in transition and adult
ADHD clinics is essential (Level U). In conclusion, although recommendations could be proposed for some of the study questions, this systematic review highlighted the need for more comprehensive and targeted large-population prospective studies.