ATTENTION-DEFICIT HYPERACTIVITY DISORDER ASSOCIATED WITH ORBITOFRONTAL EPILEPSY IN A FATHER AND A SON

The authors report on a father and son with frontal lobe epilepsy and symptoms of attention deficit hyperactivity disorder (ADHD). Attention deficit hyperactivity is a syndrome defined by criteria that include inattention, impulsive behavior, impaired concentration and motor rest lessness. It does not require medical or neurobehavioral evaluation to determine an underlying etiology. The father is a 45-year-old man eva luated for possible ADHD. His referral came after the diagnosis of ADH D in his 6-year-old son who responded well to treatment with methylphe nidate HCL. Neurobehavioral evaluation of the father suggested frontal lobe dysfunction. Magnetic resonance imaging and electroencephalograp hy (EEG) were normal. Brain 99mTc HMPAO single-photon emission compute d tomography (SPECT) revealed left orbitofrontal hypoperfusion. Additi onal history from his wife revealed episodic symptoms suggestive of no nconvulsive epilepsy that included nonresponsive staring, complex auto matic behavior, and amnesic lacunas. Treatment of the father with carb amazepine produced dramatic improvement. Subsequent evaluation of his son, currently on maintenance treatment with methylphenidate HCL for A DHD, elicited a history consistent with atonic and simple motor partia l epilepsy. The son's brain SPECT revealed bilateral orbitofrontal hyp operfusion defects. Attention deficit hyperactivity disorder is a synd rome that may be caused by frontal lobe lesions or epilepsy. In the se tting of possible ADHD, neurological evaluation is warranted. Although overreliance on structural imaging or EEG in such an evaluation must be discouraged, brain SPECT may be useful to evaluate patients with sy mptoms of attention disorders for frontal epilepsy.