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

Authors

  • Kleber Santos,

    1. Severe Epilepsies Outpatient Clinic, Neurology Service, Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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  • Andre Palmini,

    Corresponding author
    1. Porto Alegre Epilepsy Surgery Program, Hospital São Lucas da PUCRS, Porto Alegre, Brazil
    2. Department of Internal Medicine, Faculty of Medicine, PUCRS, Porto Alegre, Brazil
    3. The Brain Institute (InsCer), PUCRS, Porto Alegre, Brazil, Brazil
    • Severe Epilepsies Outpatient Clinic, Neurology Service, Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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  • Ana L Radziuk,

    1. Severe Epilepsies Outpatient Clinic, Neurology Service, Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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  • Rosana Rotert,

    1. Severe Epilepsies Outpatient Clinic, Neurology Service, Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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  • Fernanda Bastos,

    1. Severe Epilepsies Outpatient Clinic, Neurology Service, Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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  • Linda Booij,

    1. Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
    2. Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
    3. Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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  • Brisa S Fernandes

    1. Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
    2. Post-graduate Program in Biological Sciences: Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Correspondence to Dr André Palmini at Serviço de Neurologia, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, 6690 #220, 90610-000, Porto Alegre, Rio Grande do Sul, Brazil. E-mail: apalmini@uol.com.br

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 11y 2mo, SD 3y 2mo) 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.

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