Epilepsy and attention deficit hyperactivity disorder: Is methylphenidate safe and effective?☆,☆☆,★
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
References (22)
- et al.
The stimulants: pediatric psychopharmocology
Psychiatr Clin North Am
(1992) - et al.
Epilepsy: frequency, causes and consequences
Diagnostic and statistical manual of mental disorders
Attention deficit hyperactivity disorder: a handbook for diagnosis and treatment
- et al.
Efficacy of methylphenidate among mentally retarded children with attention deficit hyperactivity disorder
Pediatrics
(1990) - et al.
Cognition, behavior and academic performance in children with epilepsy
- et al.
Methylphenidate in children with seizures and attention deficit disorder
Am J Dis Child
(1989) - et al.
Methylphenidate in therapeutic doses does not lower seizure threshold [abstract]
Ann Neurol
(1986) - et al.
Attention-deficit hyperactivity disorder in epileptic children: a new indication for methylphenidate?
Ann Neurol
(1995)
Methylphenidate and seizure frequency in brain-injured patients with seizure disorders
J Clin Psychiatry
Cited by (99)
Methylphenidate for attention problems in epilepsy patients: Safety and efficacy
2021, Epilepsy and BehaviorCitation Excerpt :Overall, an increased risk of seizures has not been clearly demonstrated in the literature [39,98,99]. Multiple pediatric studies in patients with epilepsy and ADHD found no effect on seizure frequency in most subjects [88,96,100–104]. In a small series of adults with epilepsy and ADHD or cognitive complaints, open-label MPH did not alter seizure frequency or severity [105–107].
Cognitive disorders in epilepsy I: Clinical experience, real-world evidence and recommendations
2020, SeizureCitation Excerpt :Clearly, these data suggest that CWE who display a clinical picture of ADHD should be considered for treatment with pharmacotherapy. This conclusion has been supported by several case series [18,19] and their use has been recommended by the Task Force of Psychiatric Comorbidities in Pediatric Epilepsy of the ILAE [20]. Yet, while comorbid ADHD has been associated with a worse AP in CWE, the existence of other comorbid psychiatric comorbidities, in particular mood and anxiety disorders should be assessed and if present, treated as they may also impact in a negative manner AP and cognitive functions.
Management of ADHD in Youth With Comorbid Epilepsy
2018, Complex Disorders in Pediatric Psychiatry: A Clinician's GuideLong-term use of methylphenidate in a boy with hypothalamic tumor, drug-resistant epilepsy and ADHD
2018, Epilepsy and Behavior Case ReportsCitation Excerpt :Patients with frequent seizures may be most likely to demonstrate uncontrolled seizures or have no change in seizures frequency. On the other hand, the use of MPH in patients with epilepsy (unrelated to HH) and ADHD has been reported in some publications [24–27]. Our patient with epilepsy caused by hypothalamic tumor, has ADHD syndrome of the combined type according to the DSM IV criteria.
Attention deficit hyperactivity disorder (ADHD) in childhood epilepsy
2011, Research in Developmental DisabilitiesCitation Excerpt :Methylphenidate (MPH), the most widely used psychostimulant is commonly believed to lower seizure threshold (Gucuyener et al., 2003; Tan & Appleton, 2005), although it has been concluded that there is little or no evidence that methylphenidate interacts significantly with the more commonly prescribed AEDs (Tan & Appleton, 2005). Gross-Tsur, Manor, van der Meere, Joseph, and Shalev (1997) reported that 70% of children with epilepsy and ADHD (IQ range 50–121) responded to methylphenidate, based on improvement on scores on the Continuous Performance Task and the CBCL. None of the children who were seizure free had seizures while on MPH.
Epilepsy and attention-deficit/hyperactivity disorder in children and adolescents: An overview of etiology, prevalence, and treatment
2023, Frontiers in Human Neuroscience
- ☆
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