Abstracts

Rationale: Attention deficit hyperactivity disorder (ADHD) is common in patients with epilepsy, but adult patients with possible epilepsy are not routinely screened for ADHD. We aimed to evaluate the feasibility and efficacy of two ADHD screening tools in an Epilepsy Monitoring Unit (EMU). Methods: This case-control study utilized the validated Adult ADHD Self-Report Scale version 1.1 (ASRS) screener and Conners Continuous Performance Test, 3rd edition (CPT) to screen patients who were admitted to the EMU at a Level 4 Epilepsy Center. A positive ASRS screen included patients with greater than or equal to four points on the standard ASRS scoring scale. A positive CPT screen result included patients with a moderate to very high likelihood of an attention disorder. Patients were stratified based on age, gender, handedness, ADHD history, time since last seizure, MRI findings, and clinical diagnostic category to determine risk factors for screening positive on the ASRS or CPT. Results: Seventy-seven EMU patients were screened for ADHD. 36.4% of patients screened positive using the ASRS and 51.9% of patients screened positive using the CPT. Between the patients with epilepsy and psychogenic nonepileptic seizures (PNES) only, demographic characteristics including age, gender, handedness, and date of last seizure were not significantly different. Interestingly, patients with PNES were significantly more likely than patients with epilepsy to have had a past history of ADHD (p<0.01, Fisher’s exact test) as well as a history of taking medications for ADHD (p<0.001, Fisher’s exact test). Patients with PNES only were also significantly more likely to score positive on the ASRS (71.4%) than patients with epileptic seizures only (18.6%, Fisher’s exact test, p=0.0005). However there was no significant difference in the percentage of patients with a positive CPT screen for patients with PNES (42.9%) compared to patients with epilepsy (51.2%, p=0.760, Fisher’s exact test). Overall, screening positive on the ASRS showed a low association with screening positive on the CPT (p=0.245, Chi-square test). Detectability and commissions were the only CPT measures that were associated with ASRS result (p=0.025 and p=0.007 respectively, Mann-Whitney test). Conclusions: The high positive screen rate (36.4%) of EMU patients is greater than the proportion expected in patients with epilepsy. These findings suggest that patients with PNES may be more likely to screen positive for ADHD than patients with epilepsy using the ASRS and that an EMU admission is an appropriate opportunity to screen high-risk patients for ADHD. Funding: NINDS K08 NS096029