Background: Psychostimulant drugs such as methylphenidate are increasingly being used in patients with traumatic brain injury or other brain injuries for a variety of cognitive and behavioral problems. However, there is some reluctance among clinicians and family members to use methylphenidate in brain injured patients because of warnings of seizure occurrence, which are prominently reported by the product labeling included in the Physicians' Desk Reference.
Method: We retrospectively studied the use of methylphenidate in 30 consecutive patients with active seizure disorders. We compared the seizure frequency in the 3 months before and after methylphenidate with the seizure frequency during methylphenidate treatment, using the Wilcoxon signed-rank test.
Results: Overall, the findings demonstrated a trend toward a lesser incidence of seizures in patients during methylphenidate treatment. Only 4 patients had greater seizure frequency during methylphenidate treatment, and 3 of these 4 were receiving tricyclic antidepressants.
Conclusion: Methylphenidate can be safely used in brain injured patients, even those at high risk for seizures, as it was associated with a trend toward reduction (rather than increase) in seizure frequency in this population.