Is methylphenidate contraindicated or not in comorbidity of epilepsy and attention deficit/hyperactivity disorder?

The instructions for use of methylphenidate point to a possibly increasing tendency to epileptic seizures. Hence, it is increasingly mandatory to deci de whether or not methylphenidate should be administered in patients of con comitant epilepsy and attention deficit/hyperactivity disorder, since an in creasing number of children and adults can be treated with methylphenidate for attention deficit/hyperactivity disorder. This review considers studies and case reports concerned with the administration of methylphenidate to p atients with epileptic seizures. It is a fact that there was no recurrence of seizures in patients who had been free from seizures under anticonvulsiv e treatment, if methylphenidate was additionally applied. In patients who w ere not free from seizures, a single study with few patients reported a sli ght increase in the incidence of seizures whereas in all other studies ther e was no deterioration of the disease. In striking contrast to this, some p atients with childhood absence epilepsy and juvenile myoclonic epilepsy exp erienced a clear improvement in the incidence of seizures. This phenomenon had already been reported decades ago with the administration of other stim ulants such as d-amphetamine and benzedrine. This positive effect of stimul ants in patients with some seizure types is particularly remarkable because there are considerable psychopathological similarities between patients wi th juvenile myoclonic epilepsy and those with attention deficit/hyperactivi ty disorder. Hence, the administration of methylphenidate to such patients is not only be possible but even justified in case of concomitant symptoms of attention disorders and/or hyperactivity. In all other seizure patients who are well adjusted to their medication, no risk is involved with the adm inistration of methylphenidate, as the available evidence from literature s hows, whereas in patients who are not free from seizures it may be possible that there is a slight increase in seizure incidence.