주의력 결핍 과잉 행동장애가 중복된 뇌전증 소아의 특성
Characteristics of Children with Epilepsy and Concomitant Attention-Deficit Hyperactivity Disorder
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목 적 : 뇌전증으로 치료 받고 있는 환자에서 ADHD 유병률을 알아보고, 두 질환이 중복되어 있는 환자를 ADHD가 없는 환자와 비교 분석하여 특징을 알아보아 두 질환이 중복되어 있는 환자들의 치료에 도움을주고자 한다. 방 법: 2009년 3월부터 2012년 5월까지 서울성모병원 소아신경과에 등록되어 뇌전증 진단 하에 항경련제 치료를 받았던 6세에서 18세까지 환자 중에1년 이상 추적관찰이 가능하였던 184명을 대상으로의무기록을 분석하였다. 결 과: 1) 대상아 184명중 ADHD가 중복된 환아는 69명으로 37.5%를 차지하고 있었다. 2) ADHD 가 중복되지 않은 뇌전증 환아군에서의 남녀 비율은49:51로 거의 비슷하였으나, ADHD가 중복된 뇌전증 환아군에서는 67:33으로 남자에서의 발생 비율이 여자에 비해 2배 이상 높았다(P=0.022). 3) 뇌파검사에서 ADHD가 중복된 뇌전증 환아들의 병변부위로는 중심부가 39%로 가장 많았다(P=0.014). 4) ADHD가 중복되지 않은 환아들에서는 한 가지약제로 경련 조절이 가능했던 경우가 56%인 반면ADHD가 중복된 경우는 36% 이었다(P=0.001). 따라서 뇌전증 환아에서 ADHD의 유무는 항경련제 치료 반응과 관계를 가지고 있으며, 조기에 치료 반응을 예측할 수 있는 유용한 인자 중 하나라고 생각할수 있다. 결 론:뇌전증 환아에서 ADHD가 중복되는 경우는 ADHD가 중복되지 않은 경우에 비해 여러 특성이다를 뿐 아니라 뇌전증의 치료 반응도 나쁘기 때문에ADHD를 조기에 발견하여 대책을 수립하는 것이 필요하다.
Abstract
Purpose : To investigate the prevalence of ADHD (attention-deficit hyperactivity disorder) in children with epilepsy and to determine the difference of characteristics in patients with epilepsy and concomitant ADHD as opposed to the patients without ADHD for better management. Methods : We retrospectively reviewed 184 patients diagnosed as epilepsy and treated with antiepileptic drugs in pediatric neurology department of Seoul St. Mary's hospital from March, 2009 to May, 2012. Their ages ranged from 6 to 18 years. The subjects were included in the study those who made a regular visit for more than a year. Results : 1) Out of 184 patients, 69 patients (37.5%) had both ADHD and epilepsy. 2) In epilepsy children with ADHD, male outnumbered female by almost two fold (male 67: female 33) (P=0.022). 3) In epilepsy children with ADHD, epileptiform discharges on EEG was focused in central regions in 39% of them (P=0.014). 4) In 56% of patients without ADHD, their seizures remained under the control with single anticonvulsant, as opposed to 36% of patients with both ADHD and epilepsy (P=0.001). Therefore, the presence of ADHD in patients with epilepsy might be related to the therapeutic response to anticonvulsants, and be a useful predictive factor for the response to early treatment. Conclusion : Patients with epilepsy and concomitant ADHD showed a significant difference and poor response to epilepsy treatment, as opposed to patients without ADHD. Therefore, early detection and establishment of countermeasures for ADHD is necessary.
참고문헌 (28)
- Polanczyk G, "The worldwide prevalence of ADHD : a systematic review and meta regression analysis", Am J Psychiatry, 164, pp.942~948 (2007)
- Johnston C, "Families of children with attention-deficit", hyperactivity disorder : review and recommendations for future research, 2001, pp.4, 183~207
- Biederman J, "Cormorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders", Am J Psychiatry, 148, pp.564~577 (1991)
- Pliszka SR, "Comorbidity of attention-deficit", hyperactivity disorder with psychiatric disorder : an overview, 1998, pp.59(Suppl 7), 50~58
- Cowan LD, "The epidemiology of the epilepsies in children", Ment Retard Dev Disabil Res Rev, 8, pp.171~181 (2002)
- Hamoda HM, "Association between attention-deficit", hyperactivity disorder and epilepsy in pediatric populations, 2009, pp.9, 1747~1754
- American academy of Pediatrics, "Clinical practice guideline: diagnosis and evaluation of the child with attention deficit", hyperactivity disorder, 2000, pp.105, 1158~1170
- Dunn DW, "ADHD and epilepsy in childhood", Dev Med Child Neurol, 45, pp.50~54 (2003)
- 김건하, "Attention Deficit Hyperactivity Disorder in Epileptic Children", Journal of Korean Medical Science, 27(10), pp.1229~1232 (2012), 대한의학회
- Bennett-Back O, "Attentiondeficit hyperactivity disorder in children with benign epilepsy and their siblings", Pediatr Neurol, 44, pp.192~197 (2011)
- Stores G, "School children with epilepsy at risk for learning and behavior problems", Dev Med Child Neurol, 20, pp.502~508 (1978)
- Stores G, "Inattentiveness in school children with epilepsy", Epilepsia, 19, pp.169~175 (1978)
- Hesdorffer DC, "ADHD as a risk factor for incident unprovoked seizures and epilepsy in children", Arch Gen Psychiatry, 61, pp.731~736 (2004)
- Hong GE, "Korean textbook of child psychiatry", pp.220~ (2012), Joongangcopy
- Hermann B, "The frequency, complications and aetiology of ADHD in new onset paediatric epilepsy", Brain, 130(pt12), pp.3135~3148 (2007)
- Sherman EM, "neurological correlates and health related quality of life in severe pediatric epilepsy", Epilepsia, 48, pp.1083~1091 (2007)
- davis SM, "Epilepsy in children with attention-deficit", hyperactivity disorder, 2010, pp.42, 325~330
- The MTA Cooperative Group, "A 14-month randomized clinical trial of treatment strategies for attention-deficit", hyperactivity disorder, 1999, pp.56, 1073~1086
- Martin R, "Cognitive effects of topiramate, gabapentin, and lamotrigine in healthy young adults", Neurology, 52, pp.321~327 (1999)
- Mitchell WG, "Effects of antiepileptic drugs on reaction time, attention, and impulsivity in children", Pediatrics, 91, pp.101~105 (1993)
- Tinuper P, "The prognostic value of the electroencephalogram in antiepileptic drug withdrawal in partial epilepsies", Neurology, 47, pp.76~78 (1996)
- Bourgeois BF, "Antiepileptic drugs, learning, and behavior in childhood epilepsy", Epilepsia, 39, pp.913~921 (1998)
- Hempel AM, "Factors influencing the incidence of ADHD in pediatric epilepsy patients", Epilepsia, 36(Suppl 4), pp.122~ (1995)
- Millichap JG, "Attention deficit-hyperactivity disorder and the electroencephalogram. to the editor", Epilepsy Behav, 1, pp.453~454 (2000)
- Cavazzuti GB, "Longitudinal study of epileptiform EEG patterns in normal children", Epilepsia, 21, pp.43~55 (1980)
- Dunn DW, "Childhood epilepsy, attention problems, and ADHD: review and practical considerations", Semin Pediatr Neurol, 12, pp.222~228 (2005)
- Sherman EMS, "Behaviors symptomatic of ADHD in pediatric epilepsy : relationship to frontal lobe epileptiform abnormalities and other neurological predictors", Epilepsia, 41(suppl 7), pp.191~ (2000)
- Hernandez MT, "Attention, memory, and behavioral adjustment in children with frontal lobe epilepsy", Epilepsy Behav, 4, pp.522~536 (2003)