Comparing stimulant effects in youth with ADHD symptoms and epilepsy

Abstract

To retrospectively examine response to stimulant treatment in patients with epilepsy and ADHD symptoms as predicted by seizure freedom for six months, use of methylphenidate (MPH) versus amphetamine (AMP) preparations, and cognitive level, medical records were searched for patients under age 18 with epilepsy and ADHD symptoms treated with MPH or AMP (n = 36, age 10.4±3.5; 67% male). “Responders” had a CGI-Improvement score of ≤2 and did not stop medication due to adverse effects. “Worsened” patients discontinued medication due to agitation/emotional lability. Seizure freedom did not predict treatment response. Lower cognitive level was associated with increased rate of worsening (p=0.048). No patients who were seizure-free at start of the medication trial experienced an increase in seizures. Of the patients having seizures at the start of trial, one patient on MPH and two on AMP had increased seizures during the trial. Seizures returned to baseline frequency or less after stimulant discontinuation or anticonvulsant adjustment. MPH was associated with a higher response rate, with 12 of 19 given MPH 0.62±0.28mg/kg/day compared to 4 of 17 given AMP 0.37±0.26mg/kg/day responding (p=0.03). MPH treatment and higher cognitive level were associated with improved treatment outcome while seizure freedom had no clear effect. Confidence in these findings is limited by the study’s small, open label, and uncontrolled nature.

Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

“…One adult-based class III study comparing response to methylphenidate versus amphetamines found greater efficacy in the methylphenidate group. 80 Two class III and one class IV study reviewed response to atomoxetine in a pediatric population with epilepsy and ADHD; 59% and 82% reported benefit, with the remaining study reporting that 37% continued therapy but actual efficacy was not quantified. 78,81,82 In conclusion, Level B evidence supports efficacy of methylphenidate in children with epilepsy and comorbid ADHD.…”

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

“…Previous studies have shown that treatment with MPH results in clinically significant decrease of ADHD symptoms in 60-80% of children with epilepsy and ADHD. [7][8][9][10][11][12][13] Although it has been suggested that efficacy of MPH might be lower in patients with idiopathic generalized epilepsy or in patients with predominantly inattentive subtype ADHD, 8 this observation has not been confirmed by others. 7,9 However the sample size of these studies, which ranged from 12 to 33 patients, [7][8][9][10][11][12][13] might have been too small to identify factors associated with response to MPH.…”

“…2,4,5 Similarly, the clinical determinants of the response to methylphenidate (MPH), the firstline pharmacologic treatment of ADHD with or without epilepsy, 6 remain unknown. 7,9 However the sample size of these studies, which ranged from 12 to 33 patients, [7][8][9][10][11][12][13] might have been too small to identify factors associated with response to MPH. [7][8][9][10][11][12][13] Although it has been suggested that efficacy of MPH might be lower in patients with idiopathic generalized epilepsy or in patients with predominantly inattentive subtype ADHD, 8 this observation has not been confirmed by others.…”

The pharmacological management of psychiatric comorbidities in patients with epilepsy

“…Three randomised, double-blind, placebo-controlled, cross-over trials showed that methylphenidate 0.3-1 mg/kg/day is effective and well tolerated in children with epilepsy and ADHD with response rates ranging between 60% and 70% (73)(74)(75). For amphetamine, there is just a retrospective study of 36 patients with epilepsy and ADHD that compared response rates of amphetamine and methylphenidate and showed a significant improvement in 63% of patients taking methylphenidate versus 24% of those on amphetamine (76).…”