title: The impact of methylphenidate on seizure frequency and severity in children with attention-deficit-hyperactivity disorder and difficult-to-treat epilepsies.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 11 y 2 mo, SD 3 y 2 mo) 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Severe Epilepsies Outpatient Clinic, Neurology Service, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Kleber
authors.initials: K
authors.lastname: Santos
authors.forename: Andre
authors.initials: A
authors.lastname: Palmini
authors.forename: Ana L
authors.initials: AL
authors.lastname: Radziuk
authors.forename: Rosana
authors.initials: R
authors.lastname: Rotert
authors.forename: Fernanda
authors.initials: F
authors.lastname: Bastos
authors.forename: Linda
authors.initials: L
authors.lastname: Booij
authors.forename: Brisa S
authors.initials: BS
authors.lastname: Fernandes
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D002648:Child; D015897:Comorbidity; D004827:Epilepsy / Q000145:classification / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D010865:Pilot Projects; D012640:Seizures / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate