title: ADHD in childhood epilepsy: Clinical determinants of severity and of the response to methylphenidate.
abstract: Attention-deficit/hyperactivity disorder (ADHD) is commonly observed in children with epilepsy. However, factors associated with the development of ADHD and which might help to guide its therapeutic management, remain an issue of debate.
  
  
  
  We conducted a multicenter prospective observational study that included children, aged 6-16 years, with both epilepsy and ADHD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. After inclusion, patients entered a 12-16 week follow-up period during which they were either treated with methylphenidate or they did not receive specific ADHD treatment. ADHD was evaluated with the ADHD Rating Scale-IV.
  
  
  
  One hundred sixty-seven patients were included, of which 91 were seizure-free during the preinclusion baseline period. At inclusion, the ADHD Rating Scale-IV total score was 30.4 ± (standard deviation) 9.2, the inattentive subscore was 17.3 ± 4.4, and the hyperactive subscore was 13.2 ± 6.6. We did not detect any difference of ADHD Rating Scale-IV scores across patients' age or gender, age at epilepsy onset, epilepsy syndrome, seizure frequency, or number of ongoing antiepileptic drugs. Methylphenidate was initiated in 61 patients, including 55 in whom a follow-up evaluation was available. At the last follow-up, 41 patients (75%) treated with methylphenidate and 39 (42%) of those who did not received ADHD therapy demonstrated ≥25% decrease of ADHD Rating Scale-IV total score (p < 0.001). Response to methylphenidate was greater in girls but was not influenced by any epilepsy-related variables.
  
  
  
  We did not detect any epilepsy-related factor associated with the severity of ADHD. Twenty-five percent of patients did not respond to methylphenidate. A better understanding of the pathologic process that underlies ADHD development in childhood epilepsy might be required to improve therapeutic strategies.
authors.affiliation: Department of Functional Neurology and Epileptology and Epilepsy Institute (IDEE), Hospices Civils de Lyon and Lyon 1 University, Lyon, France.|Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Rheims
authors.affiliation: Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.|Epilepsy, Sleep and Pediatric Neurophysiology Department, Hospices Civils de Lyon, Lyon, France.
authors.forename: Vania
authors.initials: V
authors.lastname: Herbillon
authors.affiliation: Department of Pediatric Neurology, APHM, Marseille, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Villeneuve
authors.affiliation: AP-HP, Department of Pediatric Neurology, Robert Debré Hospital, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Auvin
authors.affiliation: Department of Pediatric Neurology, Rennes University Hospital, Rennes, France.
authors.forename: Silvia
authors.initials: S
authors.lastname: Napuri
authors.affiliation: Department of Pediatric Neurology, Children Hospital, Toulouse, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Cances
authors.affiliation: Department of Pediatric Neurology, INSERM U1105 CURS, Amiens, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Berquin
authors.affiliation: Department of Pediatric Neurology, University Hospital of Tours, Tours, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Castelneau
authors.affiliation: Department of Pediatric Neurology, University Hospital of Lille, Lille, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Nguyen The Tich
authors.affiliation: Department of Pediatric Neurology, University Hospital of Bordeaux, Bordeaux, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Villega
authors.affiliation: Lyon's University Hospital, Lyon, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Isnard
authors.affiliation: Pediatric Neurology Department, Reference Center for Rare Epilepsies, Necker Hospital, Paris, France.
authors.forename: Rima
authors.initials: R
authors.lastname: Nabbout
authors.affiliation: Department of Clinical Pharmacology, EPICIME-CIC 1407 Inserm, Hospices Civils de Lyon, Lyon, France.
authors.forename: Ségolène
authors.initials: S
authors.lastname: Gaillard
authors.affiliation: Department of Biostatistics, Hospices Civils de Lyon, Lyon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mercier
authors.affiliation: Department of Clinical Pharmacology, EPICIME-CIC 1407 Inserm, Hospices Civils de Lyon, Lyon, France.
authors.forename: Behrouz
authors.initials: B
authors.lastname: Kassai
authors.affiliation: Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.|Epilepsy, Sleep and Pediatric Neurophysiology Department, Hospices Civils de Lyon, Lyon, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Arzimanoglou
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D004827:Epilepsy / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate
keywords: Attention-deficit/hyperactivity disorder; Epilepsy; Methylphenidate