EPILEPSY AND ATTENTION-DEFICIT HYPERACTIVITY DISORDER - IS METHYLPHENIDATE SAFE AND EFFECTIVE

Objective: To study the safety and efficacy of methylphenidate in chil dren with the dual diagnosis of epilepsy and attention deficit hyperac tivity disorder (ADHD). Study design: Thirty children, aged 6.4 to 16. 4 years, with epilepsy and ADHD were studied during a 4-month period. During the initial 2 months of the study, the children were treated wi th antiepileptic drugs (AEDs) only, and for the remaining 2 months, me thylphenidate was added at a morning dose of 0.3 mg/kg. They underwent neurologic assessment, brain computed tomography, IQ testing, and ass essment with the Childhood Behavior Checklist at baseline before methy lphenidate therapy. Electroencephalography, AED determinations, and th e continuous-performance task (CPT) test were done at baseline and aft er 2 months of methylphenidate therapy. A double-blind, crossover desi gn was used to compare the effects of methylphenidate versus placebo o n an electroencephalogram, AED levels, and the CPT. On the 2 days of t esting, the child received AEDs and a capsule containing either placeb o or methylphenidate. Results: None of the 25 children of this sample who were seizure free had attacks while taking methylphenidate. Of the 5 children with seizures, 3 had an increase in attacks, whereas the o ther 2 showed no change or a reduction. There were no significant chan ges in AED levels or electroencephalographic findings. Methylphenidate benefited 70% of children according to parental report; methylphenida te also enhanced performance on the CPT, Side effects of methylphenida te were mild and transient. Conclusion: Methylphenidate is effective i n treating children with epilepsy and ADHD and safe in children who ar e seizure free, Caution is warranted for those still having seizures w hile receiving AED therapy.