Epilepsy and attention deficit hyperactivity disorder: Is methylphenidate safe and effective?,☆☆,

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Abstract

Objective:To study the safety and efficacy of methylphenidate in children with the dual diagnosis of epilepsy and attention deficit hyperactivity disorder (ADHD).

Study design: Thirty children, aged 6.4 to 16.4 years, with epilepsy and ADHD were studied during a 4-month period. During the initial 2 months of the study, the children were treated with antiepileptic drugs (AEDs) only, and for the remaining 2 months, methylphenidate was added at a morning dose of 0.3 mg/kg. They underwent neurologic assessment, brain computed tomography, IQ testing, and assessment with the Childhood Behavior Checklist at baseline before methylphenidate therapy. Electroencephalography, AED determinations, and the continuous-performance task (CPT) test were done at baseline and after 2 months of methylphenidate therapy. A double-blind, crossover design was used to compare the effects of methylphenidate versus placebo on an electroencephalogram, AED levels, and the CPT. On the 2 days of testing, the child received AEDs and a capsule containing either placebo or methylphenidate.

Results:None of the 25 children of this sample who were seizure free had attacks while taking methylphenidate. Of the 5 children with seizures, 3 had an increase in attacks, whereas the other 2 showed no change or a reduction. There were no significant changes in AED levels or electroencephalographic findings. Methylphenidate benefited 70% of children according to parental report; methylphenidate also enhanced performance on the CPT. Side effects of methylphenidate were mild and transient.

Conclusion:Methylphenidate is effective in treating children with epilepsy and ADHD and safe in children who are seizure free. Caution is warranted for those still having seizures while receiving AED therapy. (J Pediatr 1997;130:670-4)

Section snippets

METHODS

The study group consisted of 30 children with epilepsy, aged 6.4 to 16.4 (9.8 ± 2.8) years, with a diagnosis of ADHD made by a pediatric neurologist using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (third edition, revised), 2 cognitive testing, and a behavior questionnaire (Child Behavior Checklist [CBCL]). 13 Information was available from both parents and teachers. The IQ of the children ranged from 50 to 121 (92.8 ± 20.4). None of the patients had visual or

Seizure frequency

During the no-methylphenidate period, 25 children were seizure free and 5 had a maximum of two seizures a week. None of the seizure-free children had attacks while taking methylphenidate. Of the 5 children who had had seizures in the no-methylphenidate period, 3 had an increase in seizure frequency: 2 children had three seizures a week and the other had seven a week; one child showed no change in seizure frequency during the methylphenidate period, and one child was seizure free. Results of

DISCUSSION

Methylphenidate proved beneficial to the majority (70%) of the children with ADHD who had a concurrent diagnosis of epilepsy, consistent with the percentages (70% to 80%) noted in the literature. Parents of 21 children noted improvement of the ADHD symptoms and considered it sufficient to justify continued psychostimulant treatment, even when mild or transient side effects appeared. Enhanced performance was also seen on the CPT.

The use of psychostimulants in children with the dual diagnosis of

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    Supported by the Office of the Chief Scientist, Israel Ministry of Health.

    ☆☆

    Reprint requests: Ruth Shalev, MD, Pediatric Neurobehavioral Unit, Shaare Zedek Medical Center, POB 3235, Jerusalem, Israel.

    0022-3476/97/$5.00 + 0 9/21/76846

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