Russian Journal of Child NeurologyRussian Journal of Child NeurologyРусский журнал детской неврологии2073-88032412-9178Publishing House ABV Press53210.17650/2073-8803-2025-20-3-41-54REVIEWS AND LECTURESОБЗОРЫ И ЛЕКЦИИReview ArticleEpilepsy and attention-deficit/hyperactivity disorder. Problems of antiepileptic therapyЭпилепсия и синдром дефицита внимания и гиперактивности. Вопросы противоэпилептической терапииhttps://orcid.org/0000-0002-0652-1996TomenkoT. R.ТоменкоТ. Р.
Russian Federation
trtomenko@ya.ruhttps://orcid.org/0000-0003-3594-6974BelousovaE. D.БелоусоваЕ. Д.
Russian Federation
trtomenko@ya.ruhttps://orcid.org/0000-0001-7197-6009ErmolenkoN. A.ЕрмоленкоН. А.
Russian Federation
trtomenko@ya.ruhttps://orcid.org/0000-0001-7879-315XDorofeevaM. Y.ДорофееваМ. Ю.
Russian Federation
trtomenko@ya.ruhttps://orcid.org/0000-0001-9510-4918MarkinA. V.МаркинА. В.
Russian Federation
trtomenko@ya.ruUral Federal University named after the First President of Russia B.N. YeltsinФГАОУ ВО «Уральский федеральный университет им. первого Президента России Б.Н. Ельцина»Ural State Medical University, Ministry of Health of RussiaФГБОУ ВО «Уральский государственный медицинский университет» Минздрава России“European Medical Center “UMMC-Health” LLCООО «Европейский медицинский центр «УГМК-Здоровье»Y.E. Veltishev Research and Clinical Institute for Pediatrics, N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaНаучно-исследовательский клинический институт педиатрии и детской хирургии им. акад. Ю.Е. Вельтищева ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.Н. Пирогова» Минздрава РоссииVoronezh State Medical University named after N.N. Burdenko, Ministry of Health of RussiaФГБОУ ВО «Воронежский государственный медицинский университет им. Н.Н. Бурденко» Минздрава России1912202520341541912202519122025Copyright ©; 2025, ABV-PressCopyright ©; 2025, АБВ-пресс2025ABV-PressАБВ-прессhttps://rjdn.abvpress.ru/jour/about/editorialPolicieshttps://rjdn.abvpress.ru/jour/article/view/532

This review is based on the consensus statement of the International League Against Epilepsy’s pediatric panel on the diagnosis and management of patients with epilepsy and attention-deficit/hyperactivity disorder (ADHD). The document has been expanded and supplemented by later publications.

Its main provisions:

ADHD is 3–5 times more common in children with epilepsy than in the general population; the risk of developing epilepsy in people with ADHD is also increased. No gender differences were found in the manifestations of ADHD in boys and girls with epilepsy. Taking valproate during pregnancy increases the risk of developing ADHD in the child.

The presence of intellectual and developmental disabilities, as well as poor seizure control, increase the risk of developing ADHD.

Screening for ADHD should be performed in all children with epilepsy, beginning at age 6, when the diagnosis of epilepsy is established. Children should be retested annually for ADHD symptoms, including after a change in antiepileptic medication.

The International League Against Epilepsy recommends the Strengths and Difficulties Questionnaire for ADHD screening.

Behavioral problems occur more frequently with polytherapy than with monotherapy. A number of antiepileptic drugs (for example, valproate, benzodiazepines, etc.) can worsen cognitive and behavioral problems in patients with epilepsy and ADHD. Sulthiame has good cognitive tolerability and is approved for the treatment of hyperkinetic behavior and behavioral disorders in epilepsy, making it the drug of choice for patients with epilepsy and behavioral disorders, such as ADHD.

В основу этого обзора был положен консенсус педиатрической комиссии Международной противоэпилептической лиги по диагностике и ведению пациентов с эпилепсией и синдромом дефицита внимания и гиперактивности (СДВГ). Документ был расширен и дополнен более поздними публикациями.

Основные положения:

У детей с эпилепсией СДВГ встречается в 3–5 раз чаще, чем в общей популяции; риск развития эпилепсии у лиц с СДВГ также повышен. Не выявлено половых различий в проявлениях СДВГ у мальчиков и девочек с эпилепсией. Прием вальпроата во время беременности повышает риск развития СДВГ у ребенка.

Наличие нарушений интеллекта и развития, а также плохой контроль над эпилептическими приступами повышают риск наличия СДВГ.

Скрининг на СДВГ следует проводить всем детям с эпилепсией, начиная с 6-летнего возраста, при установлении диагноза эпилепсии. Повторное тестирование детей на предмет оценки симптомов СДВГ необходимо повторять ежегодно и после смены противоэпилептического препарата.

Международная противоэпилептическая лига рекомендует применение опросника «Сильные стороны и трудности» для скрининга СДВГ.

При политерапии поведенческие проблемы возникают чаще, чем при монотерапии. Ряд противоэпилептических препаратов способны ухудшать когнитивные и поведенческие проблемы у пациентов с эпилепсией и СДВГ (например, вальпроат, бензодиазепины и др.). Сультиам имеет хорошую когнитивную переносимость и зарегистрированные показания «коррекция гиперкинетического поведения и коррекция поведенческих расстройств при эпилепсии», что делает его препаратом выбора для терапии пациентов с эпилепсией и поведенческими нарушениями, такими как СДВГ.

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