The impact of methylphenidate on seizure frequency and severity in children with attention-deficit-hyperactivity disorder and difficult-to-treat epilepsies.

Abstract

AIM:

Difficult-to-treat epilepsies and attention-deficit-hyperactivity disorder (ADHD) often co-occur. Because of concerns about the use of stimulants in children with this comorbidity, the impact of ADHD treatment on seizure frequency and severity is not known. This pilot study evaluated the safety and efficacy of methylphenidate in this population.

METHOD:

After a 3 month period in which antiepileptic drugs were adjusted, 22 patients recruited from a specialist outpatient clinic for severe epilepsy (16 males, six females; mean age 11 y 2 mo, SD 3 y 2 mo) received methylphenidate for 3 months in an open label, non-controlled trial; four with generalized or multifocal (symptomatic/cryptogenic) epilepsy, one with generalized (idiopathic) epilepsy, 17 with partial (symptomatic/cryptogenic) epilepsy; five with partial seizures only, 17 with primarily or secondarily generalized seizures). Epilepsy, ADHD symptoms, and side effects were assessed using the Swanson, Nolan, and Pelham Questionnaire, the Child Behavior Checklist, the Hague Seizure Severity Scale, and the Side Effects Rating Scale.

RESULTS:

Methylphenidate significantly improved ADHD. After 3 months of treatment, 73% of patients no longer had clinically significant symptoms. Methylphenidate also reduced seizure severity (9-point median decrease on the Hague Seizure Severity Scale). Seizure frequency increased in four out of 22 patients, but only one patient withdrew from the study for this reason. Most patients experienced no major side effects.

INTERPRETATION:

These data are among the first showing that low doses of methylphenidate are safe and effective to treat ADHD symptoms in patients with difficult-to-treat epilepsies. Randomized controlled trials are needed to replicate the findings.

• Authors: Kleber Santos, Andre Palmini, Ana L Radziuk, Rosana Rotert, Fernanda Bastos, Linda Booij, Brisa S Fernandes
• Journal: Developmental medicine and child neurology (Dev Med Child Neurol) Vol. 55 Issue 7 Pg. 654-60 (Jul 2013) ISSN: 1469-8749 [Electronic] England
• PMID: 23480530 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Authors. Developmental Medicine & Child Neurology © 2013 Mac Keith Press.

Chemical References

• Central Nervous System Stimulants
• Methylphenidate

Topics

• Adolescent
• Attention Deficit Disorder with Hyperactivity (drug therapy, epidemiology)
• Central Nervous System Stimulants (administration & dosage, adverse effects, pharmacology)
• Child
• Comorbidity
• Epilepsy (classification, drug therapy, epidemiology)
• Female
• Humans
• Male
• Methylphenidate (administration & dosage, adverse effects, pharmacology)
• Pilot Projects
• Seizures (diagnosis, drug therapy, epidemiology)
• Severity of Illness Index
• Treatment Outcome