Lennox–Gastaut Syndrome (LGS) is a severe childhood-onset epileptic encephalopathy characterised by multiple daily seizures of varying semiology, intellectual disability, and a characteristic electroencephalographic pattern. Neuropsychiatric comorbidities - including attention-deficit/hyperactivity disorder (ADHD), autistic spectrum manifestations, and learning difficulties - are well documented in this population. Management is challenging owing to poor seizure response to conventional antiepileptic medications and the complexity introduced by co-occurring psychiatric disorders.
We report the case of a patient with LGS severely resistant to antiepileptic therapy and complicated by worsening ADHD symptoms. Following years of trialling multiple antiseizure medications with limited benefit, memantine was initiated alongside other medications and was associated with meaningful improvement in seizure frequency, cognition, and behavioural manifestations. ADHD medications were subsequently reintroduced, were well tolerated, and further improved the patient’s attention and behaviour.
This case highlights a novel application of memantine - an agent most commonly used in the management of Alzheimer’s disease - and suggests its potential utility as adjunctive therapy for improving both seizure control and neuropsychiatric symptoms in patients with LGS. Further research is warranted to evaluate this therapeutic approach systematically.
Akuti Khanna, Özge Özkan, Aditi Pajiyar et al.· Journal of Global Health Neu...· 0 citations
Background: Oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD) co-occur in roughly half of children with ADHD. Pharmacological management for both disorders typically involves stimulants or antipsychotics. However, in patients with congenital Long QT syndrome (LQTS), the use of stimulants might present an additional clinical risk for ventricular arrhythmias. Alternatives must be sought as the impact of these untreated psychiatric conditions can be significantly limiting to these patients.
Case Presentation: A 14-year-old male with ODD and comorbid ADHD was started on risperidone 0.25 mg daily for severe behavioral dysregulation following incidents of serious aggression towards an infant sibling. Electrocardiography demonstrated marked QT prolongation (QTc = 508 ms) and subsequently confirmed a diagnosis of congenital LQTS with a maternal family history over 3 generations. Risperidone was discontinued and nadolol 20 mg daily was initiated by a pediatric cardiologist. After a second psychiatric opinion for persistent ADHD, oppositionality, aggression, and suicide risk, he was started on clonidine, a possible alternative to avoind the use of stimulants or antipsychotics. At the one-month follow-up, parents reported a lessening of impulsivity, physical aggression, and improved emotional self-regulation. He is continuing with psychological and cardiac monitoring.
Discussion: This case demonstrated a different approach to treating patients with congenital LQTS and neurodevelopmental disorders when first-line pharmacotherapies present a risk to the patient. Clonidine offered clinical benefits without the risk of arrhythmia that comes with stimulants or antipsychotics. Given the lack of studies done on this population, more controlled studies are needed to study the effects of clonidine on patients with congenital LQTS and ODD with comorbid ADHD.
Conclusion: Clonidine may be a promising alternative for treating ADHD and ODD in patients with congenital Long QT syndrome, although further research is needed to confirm its safety and effectiveness.
Ahmed Tharwat Emara, Aileen Wan, Eric Wang et al.· International Journal of Adv...· 0 citations
The paper discusses an adolescent male with ASD and complexities faced in diagnosing and treating secondary BD and showcases a 16 year old male with ASD with acute aggression, suicidal ideation, and severe school refusal.
Nirmit Gajjar, M. Patel, R. Maharaj et al.· International Journal of Res...· 0 citations
