Methylphenidate improves the quality of life of children and adolescents with ADHD and difficult-to-treat epilepsies.
OBJECTIVE
Comorbidity between difficult-to-treat epilepsies and ADHD is frequent and impacts negatively on quality of life. The commonly held (yet poorly substantiated) view that stimulants may worsen seizure control has prevented studies from evaluating the impact of such treatment in this population. Our aim was to study the effect of methylphenidate on the quality of life of children and adolescents with difficult-to-treat epilepsies and comorbid ADHD.


METHODS
The study was an open-label, noncontrolled trial with intention-to-treat analysis following 30 patients for 6months. Subjects received methylphenidate following 3months of baseline, during which antiepileptic drugs (AEDs) were adjusted and epilepsy, ADHD, and quality-of-life variables were assessed. Multivariate regression analysis identified the main variables correlated with outcome.


RESULTS
Only one patient withdrew because of seizure worsening. Following methylphenidate introduction, doses were titrated up to 0.40-0.50mg/kg/day. A marked improvement in quality-of-life scores and a significant reduction in seizure frequency and severity were observed. Female sex, reduction of core ADHD symptoms, and tolerability to adequate doses of methylphenidate were significantly associated with improved quality-of-life scores.


CONCLUSIONS
These preliminary data suggest that methylphenidate treatment is safe and effective in patients with ADHD and difficult-to-treat epilepsies, positively impacting on quality-of-life scores.
Severe and Refractory Epilepsies Outpatient Clinic, Neurology Service, Hospital São Lucas, Faculty of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Ana Lucia
AL
Radziuk
Severe and Refractory Epilepsies Outpatient Clinic, Neurology Service, Hospital São Lucas, Faculty of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil. Electronic address: rrkieling@gmail.com.
Renata Rocha
RR
Kieling
Severe and Refractory Epilepsies Outpatient Clinic, Neurology Service, Hospital São Lucas, Faculty of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Kleber
K
Santos
Severe and Refractory Epilepsies Outpatient Clinic, Neurology Service, Hospital São Lucas, Faculty of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Rosana
R
Rotert
Severe and Refractory Epilepsies Outpatient Clinic, Neurology Service, Hospital São Lucas, Faculty of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Fernanda
F
Bastos
Severe and Refractory Epilepsies Outpatient Clinic, Neurology Service, Hospital São Lucas, Faculty of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
André Luis
AL
Palmini
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000494:pharmacology*; D002648:Child; D015897:Comorbidity; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000494:pharmacology*; D011788:Quality of Life; D016896:Treatment Outcome
D000697:Central Nervous System Stimulants; D008774:Methylphenidate
ADHD; Epilepsy; Methylphenidate; Quality of life