Abstracts

Sleep disorders such as sleep disordered breathing (SDB) and restless leg (RLS) or periodic leg movements (PLMS) syndromes are frequently diagnosed in children affected by ADHD. Less commonly focal seizures or interictal discharges (IEDs) are reported in ADHD children although co-morbidity of ADHD with frontal and temporal epilepsy in adults has been previously acknowledged. Only recently an increased percentage of rolandic and frontal foci have been reported predominantly in the inattentive type of ADHD. In collaboration with pediatric neurology and pshychiatry in our hospital we recorded all night video polysomnography in 11 ADHD children, mean age 9.3, range 4-13, diagnosed according to DSM IV international criteria. Sleep EEG recording included 18 leads with 21 electrodes (10-20 system), EOG, submental EMG, oronasal flow, thoracic pneumogram, oxymetry, EKG and anterior tibialis EMGs. All night recording was repeated between 3 and 6 months after therapy in children assigned to levetiracetam treatment. We found IEDs in 8/11 children, 4 of which had already day time EEG abnormalities. Seven children had bilateral focal abnormalities (5 rolandic of which 2 atypical for distribution, 2 bifrontal with left predominance) while one had a single left anterior temporal focus. Nocturnal seizures were recorded in 2 patients, both with atypical rolandic spikes who displayed respectively 2 and 8 ictal sleep episodes (6 paroxysmal arousals). Seizures semeiology was typical of frontal hypermotor seizures and originated respectively from right frontal and right central leads. Neither of them had clear day time seizures but only undefined starring episodes. Disorders of arousal (DOA) were confirmed in 4 patients, enuresis, bruxism and SDB in 2 each. Eight patients, all with IEDs, had PLMS. Four of them qualified also for RLS. These 8, 2 of which were also on ritalin, were all started on levetiracetam, 250-1000 mg. depending on body weight, with divided dosing. After 3 to 6 months of therapy, they all reported improved nocturnal sleep with cessation or RLS and DOA. Upon instrumental re-evaluation no further seizures or DOA were recorded. There was a trend toward a reduced percentage of IEDs, slow wave sleep and delayed REM. PLMs remained unchanged but were not experienced as annoying during the night nor as early night restlessness by the subjects. There was a trend toward improvement on both attention and behavioral texts. Reported side effects included increased appetite and morning irritability and agressiveness. Our results show a high prevalence of sleep disorders and epileptic abnormalities in ADHD children, all responding favorably to levetiracetem treatment.