Effect of adenotonsillectomy on attention deficit-hyperactivity disorder in children with adenotonsillar hypertrophy: A prospective cohort study.

BACKGROUND: This study was conducted to explore the effect of adenotonsillectomy on the improvement of attention deficit hyperactivity disorder (ADHD) symptoms in children with adenotonsillar hypertrophy. METHODS: This prospective cohort study was conducted on 59 children aged 6-12 years with adenotonsillar hypertrophy and ADHD who were candidates for adenotonsillectomy at Besat Hospital, Hamadan University of Medical Sciences, in 2014. The status of ADHD was evaluated at baseline and one and three months after surgery using Conners' Rating Scales. RESULTS: Of 59 children with ADHD (35 boys and 24 girls), 41 improved one month after surgery and 51 after three months. Only 8 children had no improvement. The Conners' score decreased significantly from 71.37 at baseline to 61.31 (P = 0.001) and 49.14 (P = 0.001) one and three months after surgery, respectively. The score of attention deficit and hyperactivity decreased from 1.76 and 2.10 at baseline to 1.52 and 1.83 after one month (P = 0.001) and to 1.24 and 1.52 after three months (P = 0.001), respectively. The results were statistically significant for both boys and girls. CONCLUSION: This study indicated that adenotonsillectomy can significantly improve ADHD in children with adenotonsillar hypertrophy and help them return to normal life.

Effect of adenotonsillectomy on ADHD symptoms of children with adenotonsillar hypertrophy.

Adenotonsillar hypertrophy and obstructive sleep disordered breathing can lead to attention deficit/hyperactivity disorder (ADHD). The purpose of this study was to evaluate effect of adenotonsillectomy on improvement of ADHD symptoms in a quasi-experimental (before and after) study. The efficacy of adenotonsillectomy on improvement of ADHD symptoms of 35 children aged 5-12 years with adenotonsillar hypertrophy and ADHD was evaluated six months after surgery. Diagnosis of ADHD was based on the DSM-IV criteria in three subtypes (predominantly inattentive type, predominantly hyperactive-impulsive type and combined type). Seventeen boys (49%) and eighteen girls (51%) with mean (± SD) age of 7.4 ± 3.8 years (range: 1-10 years) were evaluated. Frequency of combined type of ADHD decreased significantly six months after adenotonsillectomy (54.3% versus 22.9%, P=0.003). ADHD inattention score (2.26 ± 1.93 versus 0.96 ± 0.45, P=0.005), hyperactivity score (4.23 ±3.57 versus 3.57 ±8, P=0.03) as well as ADHD combined score (9.66 ±2.58 versus 7.2 ±3.67, P=0.0001) improved significantly after surgery. Upper air way obstruction due to adenotonsillar hypertrophy might be an important and treatable cause of ADHD and should be considered in evaluation of affected children. Adenotonsillectomy in these children is associated with improvements in ADHD symptoms.

Attention-deficit/hyperactivity disorder in a prebariatric surgery sample.

BACKGROUND: Research suggests that obese children, adolescents and adults frequently suffer from attention-deficit/hyperactivity disorder (ADHD). The aim of the current study was to estimate the prevalence of adult ADHD in a group of patients with grade 3 obesity (body mass index ≥40 kg/m(2)) prior to bariatric surgery. METHOD: We assessed 116 patients for childhood and adult ADHD, co-occurring psychiatric disorders, severity of depression and daytime sleepiness. RESULTS: Fourteen participants (12.1%) screened positive for adult ADHD. Even though this rate is higher compared with prevalence rates in representative population samples, it was not elevated compared with a group of morbidly obese individuals in a German general population sample (14.3%). Adult ADHD was associated with greater severity of depressive symptoms and more psychotherapy contact in the past but not with binge eating disorder or daytime sleepiness. CONCLUSION: As ADHD appears to be a common condition in morbidly obese individuals, the impact of adult ADHD on postsurgical weight loss needs to be examined. Besides, the causal link between obesity and ADHD in adults should be further investigated.

Effect of corpus callosotomy on attention deficit and behavioral problems in pediatric patients with intractable epilepsy.

To evaluate the effect of corpus callosotomy (CC) on attention deficit and behavioral problems in pediatric patients with intractable epilepsy, we retrospectively investigated sequential patients who had undergone CC to control seizures. Between August 2005 and April 2010, a total of 15 patients aged between 3.1 and 17.9 years underwent CC at our institute. All the patients experienced either drop attacks or head nodding, which were considered to be therapeutic targets of CC. A standardized instrument, the Child Behavior Checklist (CBCL), was used to assess behavioral and emotional problems before and after surgery. On postoperative EEGs, 8 (53%) showed improvement and 7 (47%) showed no change in epileptiform discharges. The Attention Problems scale and total score on the CBCL significantly improved in patients whose postoperative EEGs showed improvement. In addition to amelioration of target seizures, CC can improve attention impairments in association with improvement in the postoperative EEG.

Lexical and grammatical development in a child with cochlear implant and attention deficit: A case study.

This is the first study to explore lexical and grammatical development in a deaf child diagnosed with Attention Deficit Hyperactivity Disorder, Inattentive sub-type (ADHD/I). The child, whose family language was Spanish, was fitted with a cochlear implant (CI) when she was 18 months old. ADHD/I, for which she was prescribed medication, was diagnosed 3;6 years later. Speech samples were videotaped over the first 4 years of CI use and during a follow-up session 1 year later. Samples were transcribed according to CHAT conventions and several measures of expressive language were obtained. Receptive language was evaluated with standardized tests. Results show that while some aspects of her development seemed relatively positive (e.g., acquisition of verbal morphemes at the same auditory age as typical children), other characteristics were atypical for a CI user: (1) preference for paralexical expressions in early lexicon; (2) lexical errors in colours and other abstract words; and (3) low MLU and varied grammatical errors including disorganized discourse. Medication had a positive effect on all these characteristics, providing evidence of a link with ADHD/I. This study concludes that ADHD/I had a direct impact on the lexical and grammatical development in this child, as well as an indirect influence over her communicative style. More studies are needed to explore language characteristics of children with CI and ADHD.

Secondary tics or tourettism associated with a brain tumor.

Tourette syndrome is generally considered to be a genetic disorder, but symptoms mimicking Tourette syndrome can be secondary to an underlying lesion disrupting the basal ganglia circuitry. Described here is a case of secondary tics, or tourettism, in a child with a large oligodendroglioma of the right temporal lobe extending to the basal ganglia. He presented with attention-deficit hyperactivity disorder, obsessive-compulsive disorder, and stimulant-induced tic disorder at the age of 11 years, and later also had also seizures. The family history was unremarkable. Cranial magnetic resonance imaging disclosed a right temporal lobe tumor extending to the basal ganglia. An alpha-[(11)C]methyl-l-tryptophan positron emission tomography scan showed asymmetric uptake in the basal ganglia and intense uptake in the tumor. He had a lesionectomy, and the histopathologic diagnosis was oligodendroglioma. Neuropsychologic testing after surgery revealed no attention-deficit hyperactivity disorder symptomatology, and only minimal features of obsessive-compulsive disorder. The present case provides additional evidence supporting the role of basal ganglia circuitry in the pathophysiology of tic disorder and its comorbid states. Children who present with attention-deficit hyperactivity disorder, obsessive-compulsive disorder, and tic disorder of late onset in the absence of family history should be further investigated with neuroimaging to exclude the presence of a secondary cause.

Visual attention in patients with intracranial arachnoid cysts.

OBJECTIVE: To investigate whether intracranial arachnoid cysts (AC) compromise visual attention and if so, whether surgical cyst decompression leads to improvement in visual attention performance. METHODS: The experiments were carried out on 27 patients with temporal (n=21) or frontal (n=6) AC, and 27 healthy control subjects. All subjects were tested with two different visual attention paradigms. Patients were tested one day before and a minimum of 3 months after the surgery, with the same test-retest interval for the controls. RESULTS: AC impair both automatic and effortful attention. These attention impairments were significantly improved after surgery, also when controlling for learning and practice effects from pre- to post-surgery testing. Closer analysis showed that these effects were carried by patients with right hemisphere cysts for impairment in shift of attention, and by patients with a left hemisphere cyst for visual search. CONCLUSIONS: AC may impair visual attention. Cyst location may be of importance for the development of these attention deficits, as there were significant differences between patients with right hemisphere cysts and those with left hemisphere cysts. This dyscognition appears to be reversible following surgical decompression. Surgical decompression of AC may thus relieve not only clinical symptoms and complaints, but cognitive impairments as well.

Stereotactic operation in behaviour disorders. Amygdalotomy and hypothalamotomy.

After a survey of the anatomical and physiological basis of operative treatment of behaviour disorders by stereotactic lesions in the amygdala and the posterior medial hypothalamus the author describes his own experiences with 603 operations for control of conservatively untreatable aggressiveness. In 481 cases bilateral amygdalotomies and in 122 mostly secondary posteromedian hypothalamotomies have been performed. Initially excellent or moderate improvement was achieved in 76%. After a follow-up of more than three years this figure only slightly decreased to 70%. The group of patients who did not positively respond (30%) needs further study to discover the reasons for failure.