[Methylphenidat (Ritalin) as a psychotropic drug in children with minimal brain dysfunction and epilepsy]

In the USA children with minimal brain dysfunction and with epilepsy have been treated with stimulants for some years now, whereas this type of treatment is not current in Switzerland and western Germany. The problems of treatment with amphetamines in children are discussed on the basis of 2 years' experience with methylphenidate (Ritalin). In children with minimal brain dysfunction methylphenidate acts against excessive motor and affective impulsivity and inability to concentrate. In epileptic children amphetamines act against drowsiness or irritability. There is no danger of addiction in the pediatric age group. No toxic side effects occur, except for growth inhibition when high doses of amphetamines are administered. Drug interaction with anticonvulsants occurs only in the case of hydantoins. Methylphenidate is given in 1-3 daily doses; treatment is commenced with small doses, and after 2-4 days the dosage is increased until behaviour changes. Dosage must be adapted to the individual, the recommended daily dose being 0.3-1.0 mg/kg. Depressive or autistic behaviours are symptoms of overdosage. In childhood treatment with amphetamines should be considered only if other types of treatment have failed. drug therapy should be accompanied by continuous advice to parents on educational and school problems. It should not be attempted if the parents are not wholly reliable.