title: Epilepsy, Attention-Deficit/Hyperactivity Disorder and Methylphenidate: Critical Examination of Guiding Evidence.
abstract: OBJECTIVE
  Attention-Deficit/Hyperactivity Disorder (ADHD) and epilepsy are commonly comorbid; yet in the psychiatric literature, there is a remarkable paucity of guiding evidence regarding the safety and efficacy of treatment using methylphenidate (MPH) in this population. The objective of this review is to critically appraise evidence regarding the treatment of ADHD in the context of seizure disorders in order to better inform management considerations and practices.
  
  
  METHODS
  A comprehensive search of the Central, Embase, Medline, and Web of Science databases identified 349 references. After a thorough review, only nine relevant references contributing new information and providing reliable and interpretable data were identified; seven were prospective studies (two double-blind placebo controlled trials, five open-label trials) and two were retrospective reviews. Prospective studies were then reviewed in detail, critically appraised, and interpreted.
  
  
  RESULTS
  All studies reported no increase in seizure rates in a majority of participants after exposure to MPH. MPH was effective in treating ADHD symptoms. However, the following major limitations to the studies impede drawing confident conclusions: small sample sizes, lack of uniformity regarding seizure type and severity, seizure-free period pre-stimulant treatment, and low baseline seizure rates.
  
  
  CONCLUSIONS
  Given the academic, social, emotional, and functional impact of untreated ADHD, a watchful approach to the use of MPH in children with stable epilepsy who are impaired by ADHD symptoms is justified.
authors.affiliation: Department of Psychiatry, Hospital for Sick Children and University of Toronto, Toronto, Ontario.
authors.forename: Monidipa
authors.initials: M
authors.lastname: Ravi
authors.affiliation: Department of Psychiatry, Hospital for Sick Children and University of Toronto, Toronto, Ontario.
authors.forename: Abel
authors.initials: A
authors.lastname: Ickowicz
keywords: ADHD; attention-deficit/hyperactivity disorder; epilepsy; methylphenidate; seizure; stimulant