The safety of methylphenidate (MPH), 0.3 mg/kg, in 9 boys and 8 girls, ages 6 to 16 years, with ADHD and epilepsy, studied in Jerusalem, Israel, was reported at the Annual Meeting of the Child Neurology Society, Oct 2-8, 1994, in San Francisco, CA. Of 17 patients treated with MPH for 1-month, following a placebo period of 1-month, 15 children who were seizure-free had no recurrence of seizures, while 2 with 1 to 2 seizures weekly before MPH had a moderate exacerbation of epilepsy. The EEGs showed no “major” changes. AED levels (CBZ and VA) were therapeutic during placebo and MPH periods. ADHD symptoms were benefited by MPH in 12 patients. [1]
COMMENT. The authors recommend caution in the use of methylphenidate in ADHD children with an active seizure disorder. The PDR states that: “In the presence of seizures, the drug (MPH) should be discontinued.” Based on the present and previous reports there appears to be some justification for trials of MPH in selected patients with ADDH and epilepsy whose seizures are controlled with antiepileptic drugs. Pemoline (Cylert) is generally considered to have less tendency to lower seizure threshold than MPII. Some recommend an EEG in all ADDH patients considered for stimulant medications; those with a history of seizures and/or epileptiform discharges in the EEG should receive concomitant AED therapy. Children with ADDH have a 7% incidence of epileptiform EEGs. (Ped Neur Briefs Oct 1989; Progress in Pediatric Neurology I, 1991, p 190).