Methylphenidate treatment of attention deficit hyperactivity disorder in young people with learning disability and difficult‐to‐treat epilepsy: Evidence of clinical benefit

Abstract

PurposeTo establish the efficacy and safety of methylphenidate (MPH) treatment for attention deficit hyperactivity disorder (ADHD) in a group of children and young people with learning disability and severe epilepsy.MethodsThis retrospective study systematically reviewed the case notes of all patients treated with methylphenidate (MPH) for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) ADHD at a specialist epilepsy center between 1998 and 2005. Treatment efficacy was ascertained using clinical global impressions (CGI) scores, and safety was indexed by instances of >25% increase in monthly seizure count within 3 months of starting MPH.Key FindingsEighteen (18) patients were identified with refractory epilepsies (14 generalized, 4 focal), IQ <70, and ADHD. Male patients predominated (13:5) and ADHD was diagnosed at a median age of 11.5 years (range 6–18 years). With use of a combination of a behavioral management program and MPH 0.3–1 mg/kg/day, ADHD symptoms improved in 61% of patients (11/18; type A intraclass correlation coefficient of CGI 0.85, 95% confidence interval [CI] 0.69–0.94). Daily MPH dose, epilepsy variables, and psychiatric comorbidity did not relate to treatment response across the sample. MPH adverse effects led to treatment cessation in three patients (dysphoria in two, anxiety in one). There was no statistical evidence for a deterioration of seizure control in this group with the use of MPH.SignificanceMethylphenidate with behavioral management was associated with benefit in the management of ADHD in more than half of a group of children with severe epilepsy and additional cognitive impairments. Eighteen percent had significant side effects but no attributable increase in seizures. Methylphenidate is useful in this group and is likely to be under employed.

Parenting stress does not normalize after child's epilepsy surgery

“…Before surgery Two years after surgery children and young people with severe epilepsy [27] pleads for considering medication to support managing these behavioral problems.…”

Attention deficit/hyperactivity disorder and interictal epileptiform discharges: It is safe to use methylphenidate?

“…In this study a subgroup of 15 nonepileptic patients had epileptiform EEG at baseline and none of them had a seizure during the study period of 1 year. Several short term studies have reported that MPH is safe to use in both ADHD children with well controlled [25][26][27], and difficult to treat epilepsy [28][29][30], and that 61-73% of children with epilepsy had benefit from MPH. One study reported that use of combination of a behavioral management and MPH 0.3-1 mg/kg/day for 3 months improved ADHD symptoms in 61% of 18 patients with refractory epilepsy [29].…”

Juvenile myoclonic epilepsy and narcolepsy: A series of three cases

“…Hence, their use would unlikely change the course of narcolepsy. At the same time, CNS stimulants including methylphenidate are unlikely to worsen seizures not only in well-controlled but also in uncontrolled epilepsies [28]. …”