ADHD in the context of Lennox Gastaut Syndrome: A rare presentation

BACKGROUND: Lennox Gastaut Syndrome (LGS) is an age related, epileptic encephalopathy of varied etiology. The syndrome is characterized by multiple seizure types, intellectual failure and/or behavioural disturbance and by EEG abnormalities. ADHD and epilepsy are both common childhood disorders and can have negative consequences on child’s health. AIM: To highlight the psychiatric manifestations of LGS METHOD: A 11 year old male child presented with complaints of aggressiveness, self injurious behavior, increased activity, impulsive behavior since 9 years, on in-patient basis. The patient has H/o delayed cry at birth, delayed milestones, epilepsy (GTCS, myoclonic and absence seizure type). Last seizure episode is 1 month back. It is associated with severe intellectual disability. There is presence of multiple self injury marks on left foot and right thigh. Family history of intellectual disability in father and maternal uncle. Disturbed family environment is present. IQ- 32; EEG report: awaited RESULTS: The patient is on Tab Sodium Valproate 750mg, Tab Clonidine 125 g, Tab Risperidone 4mg, Tab Aripiprazole 2.5mg. Neurologist opinion Is taken. Follow up is awaited. CONCLUSION: LGS is a disease that evolves, and therefore the challenges of diagnosis can cause delays in treatment, resulting in poorer overall outcomes. Behavioural problems, including hyperactivity, agitation, aggression could be present. Hence it should be approached holistically.Ninety-nine respondents participated in the study (female: 63.6%; Malay: 41.4%; mean age: 46.4 years). The median duration of illness was 6.0 years. More respondents were taking combination therapy (59.6%). There was a statistically significant correlation between ISMI and MDIS scores (rs = 0.339, P = 0.001). On bivariate analyses, intact insight was associated with non-Malay race, combination therapy, higher average ISMI scores and subscores for alienation, stereotype endorsement, discrimination experience, and social withdrawal. Combination therapy, higher scores for alienation, and social withdrawal subscales were associated with a greater likelihood for intact insight in logistic regression model.