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Epilepsy and attention deficit hyperactivity disorder: is methylphenidate safe and effective?
V Gross-Tsur1, O Manor, J van der Meere
1Pediatric Neurobehavioral Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
Methylphenidate is safe and effective for children with epilepsy and ADHD who are seizure-free. Caution is advised for those still experiencing seizures during treatment.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
Background:
- Epilepsy and Attention Deficit Hyperactivity Disorder (ADHD) frequently co-occur in children.
- Managing ADHD symptoms in children with epilepsy requires careful consideration of treatment safety and efficacy.
Purpose of the Study:
- To evaluate the safety and effectiveness of methylphenidate in children diagnosed with both epilepsy and ADHD.
- To assess the impact of methylphenidate on seizure control, behavior, and cognitive function in this pediatric population.
Main Methods:
- A 4-month study involving 30 children (aged 6.4-16.4 years) with epilepsy and ADHD.
- A double-blind, crossover design compared methylphenidate and placebo, alongside antiepileptic drugs (AEDs).
- Assessments included neurologic exams, IQ tests, behavioral checklists, electroencephalography (EEG), and the continuous-performance task (CPT).
Main Results:
- Methylphenidate did not increase seizures in seizure-free children; 2 of 5 children with ongoing seizures showed no change or a reduction.
- No significant changes in AED levels or EEG findings were observed.
- Parental reports indicated benefit in 70% of children, with enhanced performance on the CPT. Side effects were mild and transient.
Conclusions:
- Methylphenidate is a safe and effective treatment option for children with epilepsy and ADHD who are seizure-free.
- Careful monitoring and consideration are necessary for children with epilepsy who continue to experience seizures while on AED therapy.
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.