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Re: ADHD, psychostimulants and epilepsy

Dear Editor,

I found the article 'Attention deficit and hyperactivity disorder, methylphenidate, and epilepsy' by Appleton et al very useful and informative [1]. Now that there is more awareness of ADHD amongs the paediatricians, we clinicians involved in dianosis and monitoring of ADHD are being asked more frequently by our colleagues about use of methylphenidate in children with ADHD and co-morbid epilepsy. The article provids a detail account of the current evidence on use of methylphenidate in epilepsy.

The Summary of Product Characteristics (SPC) of Equasym (methylphenidate manufactured by UCB Celltech), Concerta XL (sustained release preparation of methylphenidate; manufactured by Janssen- Cilag) and Ritalin SR20 (the long acting methylphenidate which is unlicensed in UK and is available only on named patient basis) all recommend to use methylphenidate with caution in patients with epilepsy. This is because the clinical experience has shown that it can cause an increase in seizure frequency in a small number of such patients. If seizure frequency increases then methylphenidate should be discontinued. It is known that seizure is a rare but unwanted effect of stimulants, both methylphenidate and dexamfetamine [2].

In my clinical practice I prefer to use dexamfetamine rather than methylphenidate if a child with ADHD and epilepsy needs a stimulant medication. This is because whatever little evidence is available, it seems that dexamfetamine is a better choice than methylphenidate. I fully agree with the authors that if methylphenidate is used in such children then the seizure frequency should be monitored in the first few months after it is being prescribed. I will monitor such children for at least a couple of years to see if there is any frequency increase in seizures.

References

(1). Tan M, Appleton R. Attention deficit and hyperactivity disorder, methylphenidate, and epilepsy. Arch Dis Child 2005; 90: 57-9.