ADHD in childhood epilepsy: Clinical determinants of severity and of the response to methylphenidate

Rheims, Sylvain; Herbillon, Vania; Villeneuve, Nathalie; Auvin, Stéphane; Napuri, Sylvia; Cancés, Claude; Berquin, Patrick; Castelneau, Pierre; Tich, Sylvie Nguyen The; Villega, Frédéric; Isnard, Hervé; Nabbout, Rima; Gaillard, Ségolène; Mercier, Catherine; Kassai, Behrouz; Arzimanoglou, Alexis

doi:10.1111/epi.13420

Cited by 33 publications

(30 citation statements)

References 32 publications

(75 reference statements)

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“…Our results provide converging evidence with a number of previous studies, but not all, 19 using varying research designs [10][11][12][13][14][15]24 and showing limited support for the hypotheses that ADHD medication in prescribed doses is associated with an increased risk of acute seizures. In addition, we were able to expand the previous literature by studying the risk across varying definitions of seizure history and epilepsy, and by including persons with a wide range of NDDs in addition to ADHD, including autism, intellectual disabilities, and tic disorders.…”

Section: Discussionsupporting

confidence: 71%

“…4 At least 2 small open-label clinical trials, one observational study, and 2 double-blind clinical trials have examined the risk of seizures in relation to stimulant ADHD medications, with little evidence for an increased risk in individuals with well-controlled epilepsy. [10][11][12][13][14] In addition, one open-label trial reported that methylphenidates, one of the most commonly used ADHD stimulant medications, were safe for patients with difficult-to-treat epilepsies. 15 Furthermore, one retrospective study reported a decreased seizure frequency associated with methylphenidate treatment in patients with brain injury and active seizures.…”

Section: Introductionmentioning

confidence: 99%

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Medication treatment for attention‐deficit/hyperactivity disorder and the risk of acute seizures in individuals with epilepsy

et al. 2019

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Summary Objective Attention‐deficit/hyperactivity disorder (ADHD) affects 10%‐30% of individuals with epilepsy, yet concerns remain regarding the safety of ADHD medication in this group. The objective of this study was to examine the risk of acute seizures associated with ADHD medication in individuals with epilepsy. Methods A total of 21 557 individuals with a seizure history born between 1987 and 2003 were identified from Swedish population registers. Within this study population, we also identified 6773 youth (<19 years of age) who meet criteria for epilepsy, and 1605 youth with continuous antiepileptic drug (AED) treatment. ADHD medication initiation and repeated medication periods were identified from the Swedish Prescribed Drug Register between January 1, 2006 and December 31, 2013. Acute seizures were identified via unplanned visits to hospital or specialist care with a primary seizure discharge diagnosis in the Swedish National Patient Register during the same period. Conditional Poisson regression was used to compare the seizure rate during the 24 weeks before and after initiation of ADHD medication with the rate during the same 48 weeks in the previous year. Cox regression was used to compare the seizure rate during ADHD medication periods with the rate during nonmedication periods. Comparisons were made within‐individual to adjust for unmeasured, time?constant confounding. Results Among 995 individuals who initiated ADHD medication during follow‐up, within‐individual analyses showed no statistically significant difference in the rate of seizures during the 24 weeks before and after medication initiation, compared to the same period in the previous year. In the full study population 11 754 seizure events occurred during 136 846 person‐years and 1855 individuals had at least one ADHD medication period. ADHD medication periods were associated with a reduced rate of acute seizures (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.57‐0.94), compared to nonmedication periods within the same individual. Similar associations were found in youth with epilepsy and continuous AED treatment, when adjusting for AEDs, and across sex, age, and comorbid neurodevelopmental disorders. Significance We found no evidence for an overall increased rate of acute seizures associated with ADHD medication treatment among individuals with epilepsy. These results suggest that epilepsy should not automatically preclude patients from receiving ADHD medications.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Medication treatment for attention‐deficit/hyperactivity disorder and the risk of acute seizures in individuals with epilepsy

et al. 2019

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“…80,87,91,92 Variation in response to treatment correlates with coexisting intellectual disabilities rather than with specific types of epilepsy or seizure characteristics. 89,93 Data in this regard are limited by variability in methodologies and the groups selected for study. Rheims and colleagues 93 excluded patients with primarily hyperactive symptoms, while Fosi et al 89 focused specifically on a population with ID and uncontrolled seizures.…”

Section: Specific Considerations For Medication Usementioning

confidence: 99%

Practical Considerations for the Assessment and Treatment of ADHD in Children with Epilepsy

Diekroger

Tangen

2018

J Pediatr Epilepsy

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Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent psychiatric comorbidities in children with epilepsy, but it is under diagnosed and under treated which can impact the quality of life. Knowledge regarding ADHD characteristics, epilepsy-related risk factors, and associations with specific types of epilepsy provide a base for assessment. Epilepsy-related variables have not consistently predicted ADHD status, so screening and assessment for ADHD in children with epilepsy should be systematic and broad. Different assessment tools and techniques can be helpful including rating scales, diagnostic interviews, and neuropsychological testing. Treatment of ADHD with methylphenidate has been found to be safe and effective including in populations with uncontrolled seizures and coexisting intellectual disability. There are limited data on other medication and behavioral treatments. To improve assessment, diagnosis and treatment, medical provider knowledge, and practices, as well as family barriers to behavioral health should be targeted.

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“…A recent multi-center prospective observational study [11] demonstrated that ADHD symptoms were not associated with underlying epilepsy syndrome, severity of epilepsy and/or use of anti-epileptic drugs. While methylphenidate resulted in clinically significant decrease of ADHD symptoms in 75% patients, it was not associated with increased risk of seizure relapse.…”

Section: Introductionmentioning

confidence: 99%

Epilepsy in Children with ADHD

Hung¹

2016

J Epilepsy

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Epilepsy is increasingly recognized as an important association with Attention Deficit/Hyperactivity Disorder (ADHD) in children. Previous studies reported the seizure occurrence in children with ADHD as 2~7%. Epilepsy in children with ADHD appears to be earlier in age onset and more difficult in seizure control than those without. The genetic and clinical information might refer to a common neurobiological basis for epilepsy and ADHD.

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ADHD in childhood epilepsy: Clinical determinants of severity and of the response to methylphenidate

Cited by 33 publications

References 32 publications

Medication treatment for attention‐deficit/hyperactivity disorder and the risk of acute seizures in individuals with epilepsy

Medication treatment for attention‐deficit/hyperactivity disorder and the risk of acute seizures in individuals with epilepsy

Practical Considerations for the Assessment and Treatment of ADHD in Children with Epilepsy

Epilepsy in Children with ADHD

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