Objectives and Aims A service evaluation was performed in patients with dissociative seizures to check if a screening tool was proving useful in identifying adult ADHD in this highly specialised group. The idea of using such a tool came about after several dissociative seizure patients were coincidentally diagnosed with ADHD and appeared to show improvements in seizure control and fatigue with treatment.
Methods All suitable dissociative seizure patients attending a seizure clinic between October 2019 and October 2022 underwent screening with the World Health Organisation (WHO) Adult ADHD ASRS v1.1 18-point questionnaire. Patients with co-existent epilepsy were excluded for the purposes of the service evaluation.
Results Ninety-three new and follow up patients agreed to complete the ASRS. Of these, only one felt unable to complete the screen. Of the remainder, 11/92 failed to meet the eligibility criteria for formal ADHD testing based on the 6 point ASRS mini-screen. The remaining 81 scored a mean of 80.7/90 on the ASRS, which compares with a mean score of 41/90 in the normal population and 63/90 in the adult ADHD population. Of these 81, only 13 (16%) have so far had a formal assessment for ADHD, of which 12 (92%) were confirmed to have adult ADHD. Of the remainder, two were referred for formal assessment but were refused, one because of a negative assessment in 2015, the other for unclear reasons. Another sixteen were referred over 2 years before the study ended and are either still awaiting an assessment or DNA’ed the assessment or the results are pending. The remainder (62) had been referred in the last two years and given current waiting times are not expected to have yet had a formal assessment.
Conclusions It was possible to apply the ASRS v1.1 to almost everyone in this cohort, a few face to face or over the telephone in clinic, but most self-completed in their own time and returned by post or email. The vast majority who completed the ASRS scored well within the adult ADHD range. For those who did go on to have a formal assessment, almost all ended up with a confirmed diagnosis of ADHD. This service evaluation therefore also suggests that the prevalence of ADHD in adult patients with dissociative seizures is worthy of formal study, and there are theoretical and anecdotal reasons to believe this could benefit control of the seizures themselves.
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