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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: Genetic History and Comorbidity in AD/HD diagnosis I have a five-year old son who has been diagnosed with severe ADHD, but according to some clinicians, has an as yet unidentified co-morbid condition. It took nine months to get the pediatrician to refer him to a child psychiatrist, even after both the school district and his therapist had requested it. Before the appointment with the psychiatrist (1/12/99), I would like some information. The school district thought my child may have OCD or ODD or a conduct disorder, because he is aggressive and accelerates rapidly. The therapist had suggested that my son may have Bi-Polar Disorder co-existing with the ADHD. The pediatrician believed he could have TLE, because he becomes very aggressive in play, and has referred him to a neurologist, but did mention referral to Dr. Daniel Amen, because he "has never seen so severe a case in a child so young." My son has a history of Hypotonia, walking at 18 months, through interventions by an RT and an OT. He also has sensory integration issues, which, by the way, is hard to research on-line. His father has migraines, dysarthria, dysfluency and myoclonus, and can have wide mood swings (no dx for this). His paternal aunt has a mild form of myasthenia gravis; one of her sons was thought to have ADHD and the other had seizures at a young age (2 - 4 yoa). The paternal grandmother has Parkinson's, which is progressing. The paternal grandfather is a neurologist (so I can't ask him). My sister's first child was found to have had petite mal seizures in early childhood, and was put on phenobarbitol, but no longer exhibits symptoms and was removed from the meds. My son is on meds, which are Paxil and Clonidine. We tried Dextrostat and Cylert without positive results, and Tenex failed after 2 months. The pediatrician was reluctant to treat or diagnose BP in him, and had continued to search for an answer, thus the mention of Dr. Amen. In researching ADHD and BP, as well as diseases in the family, I have noted a correlation between dopamine and acetylcholine, and some of these disorders/diseases. It is interesting to me that these conditions all involve muscles, impulsivity, weakening of control, and seem to involve the same area of the brain. I realize ADHD has a genetic component. Is it coincidence that the genetic history is so intertwined with the dopamine issue? The sensory issues and TLE have me curious. The differences between temporal lobe ADHD and TLE are difficult for me to distinguish as well. Has anyone researched the relationships of the disorders to dopamine, and documented a commonality? I apologize for the length of this post, but this puzzle has me baffled, and my son's future is important. Thank you. Dear Patricia: Sorry to hear about your son. ADHD is not temperol lobe, it is thought to be a brainstem reticular activiting problem although the actual neurological deficit is not known. Those compounds that we use to activate the brain in ADHD work in this area. Temproal lobe epilepsy is a distinct problem. There are forms that arise for the hippocampal formation and some that arise from the temporal lobe itself. This has its manifestations as seizures. As you do not describe seizure events, I would doubt that your son has temporal lobe epilepsy. Dopamine is a neurotransmitter mostly found in the basal ganglia. It is the neurotransmitter deficient in Parkinson's Disease. It seems to control fine motor movements and the control of our coordination. Acetylcholine is involved in neuromuscular processess and is not found in the basal ganglia but in neuromuscular junctions. I think it is a good idea to see a child psychiatrist. If your son has a conduct disorder along with ADHD then this might prove to be fruitful. It sounds like they are already treating your son for obsessive compulsive disorder (OCD) as he is on Paxil, is this true? What sort of obsessive behaviors does he have? Does your son have wide mood swings? Does he have any tic like behavior? Be sure to take all the medical information to the child psychiatrist when you go on your visit. Sorry, it is impossible to know what to tell you when I haven't examined your son neurologically. As you have already seen a pediatric neurologist, I am assumig that metabolic issues have been ruled out. Best of luck, let us know if we can help in any other way. Sincerely, CCF Neuro[P] MD |
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