title: 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, cognitive level, and medical records were searched for patients under the age of 18 with epilepsy and ADHD symptoms treated with MPH or AMP (n=36, age=10.4 ± 3.5; male=67%). "Responders" had a CGI-improvement score of ≤ 2 and did not stop medication because of adverse effects. "Worsened" patients discontinued medication because of 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 the 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 patients on AMP had increased seizures during the trial. Seizures returned to baseline frequency or less after stimulant discontinuation or anticonvulsant adjustment. Methylphenidate was associated with a higher response rate, with 12 of 19 given MPH (0.62 ± 0.28 mg/kg/day) compared with 4 of 17 given AMP (0.37 ± 0.26 mg/kg/day) responding (p=0.03). Methylphenidate 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 design.
authors.affiliation: Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: Joseph.Gonzalez-Heydrich@childrens.harvard.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Gonzalez-Heydrich
authors.affiliation: Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Olivia
authors.initials: O
authors.lastname: Hsin
authors.affiliation: Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gumlak
authors.affiliation: Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Kara
authors.initials: K
authors.lastname: Kimball
authors.affiliation: Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Rober
authors.affiliation: Albert J. Solnit Children's Center, Middletown, CT, USA.
authors.forename: Muhammad W
authors.initials: MW
authors.lastname: Azeem
authors.affiliation: Peak Development Associates, Apex, NC, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Hickory
authors.affiliation: Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Mrakotsky
authors.affiliation: Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Alcy
authors.initials: A
authors.lastname: Torres
authors.affiliation: Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Enrico
authors.initials: E
authors.lastname: Mezzacappa
authors.affiliation: Department of Epilepsy & Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Blaise
authors.initials: B
authors.lastname: Bourgeois
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Biederman
mesh_terms: D000293:Adolescent; D000661:Amphetamine / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D003071:Cognition / Q000187:drug effects; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D000661:Amphetamine
keywords: ADHD; Amphetamine; Comorbidity; Epilepsy; Methylphenidate; Pharmacotherapy; Seizures; Stimulant