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Methylphenidate treatment of attention deficit hyperactivity disorder in young people with learning disability and difficult-to-treat epilepsy: evidence of clinical benefit.

Fosi T, Lax-Pericall MT, Scott RC, Neville BG, Aylett SE - Epilepsia (2013)

Bottom Line: MPH adverse effects led to treatment cessation in three patients (dysphoria in two, anxiety in one).Methylphenidate with behavioral management was associated with benefit in the management of ADHD in more than half of a group of children with severe epilepsy and additional cognitive impairments.Eighteen percent had significant side effects but no attributable increase in seizures.

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: To establish the efficacy and safety of methylphenidate (MPH) treatment for attention deficit hyperactivity disorder (ADHD) in a group of children and young people with learning disability and severe epilepsy.

Methods: This retrospective study systematically reviewed the case notes of all patients treated with methylphenidate (MPH) for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) ADHD at a specialist epilepsy center between 1998 and 2005. Treatment efficacy was ascertained using clinical global impressions (CGI) scores, and safety was indexed by instances of >25% increase in monthly seizure count within 3 months of starting MPH.

Key findings: Eighteen (18) patients were identified with refractory epilepsies (14 generalized, 4 focal), IQ <70, and ADHD. Male patients predominated (13:5) and ADHD was diagnosed at a median age of 11.5 years (range 6–18 years). With use of a combination of a behavioral management program and MPH 0.3–1 mg/kg/day, ADHD symptoms improved in 61% of patients (11/18; type A intraclass correlation coefficient of CGI 0.85, 95% confidence interval [CI] 0.69–0.94). Daily MPH dose, epilepsy variables, and psychiatric comorbidity did not relate to treatment response across the sample. MPH adverse effects led to treatment cessation in three patients (dysphoria in two, anxiety in one). There was no statistical evidence for a deterioration of seizure control in this group with the use of MPH.

Significance: Methylphenidate with behavioral management was associated with benefit in the management of ADHD in more than half of a group of children with severe epilepsy and additional cognitive impairments. Eighteen percent had significant side effects but no attributable increase in seizures. Methylphenidate is useful in this group and is likely to be under employed.

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Related in: MedlinePlus

Seizure frequency of patient 7 on MPH and dexamphetamine. ▲MPH started (0.1 mg/kg/day). ▼MPH stopped (0.1 mg/kg/day).  Dexamphetamine started (0.2 mg/kg/day).  Dexamphetamine stopped (0.4 mg/kg/day).
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fig01: Seizure frequency of patient 7 on MPH and dexamphetamine. ▲MPH started (0.1 mg/kg/day). ▼MPH stopped (0.1 mg/kg/day). Dexamphetamine started (0.2 mg/kg/day). Dexamphetamine stopped (0.4 mg/kg/day).

Mentions: Eighteen patients with epilepsy (13 boys, 5 girls: all with combined-type ADHD) were treated with MPH, of a population of 198 children admitted to the center between 1998 and 2005. The median age at ADHD diagnosis was 11.5 years (range 6–18 years) and the median duration of stay at the center prior to the diagnosis of ADHD being made was 1 year (range 0.1–11.0 years; mean 1.6, standard deviation [SD] 2.9 years: Fig. 1). The median duration of treatment with MPH was 12 months (range 2–108 months), and the median maximum dose of MPH attained during treatment was 0.5 mg/kg/day (range 0.2–1.2 mg/kg/day). Nearly all patients (16/18) had at least one other DSM-IV psychiatric diagnosis. The psychiatric comorbidities seen, in descending frequency were the following: oppositional defiant disorder, autism spectrum disorder, conduct disorder, mood disorders, and tic disorder. All patients had LD. This was severe in two thirds (12/18), with the remaining patients being equally distributed between moderate LD (3/18) and mild LD (3/18) groups. These are summarized in Tables 1 and 2.


Methylphenidate treatment of attention deficit hyperactivity disorder in young people with learning disability and difficult-to-treat epilepsy: evidence of clinical benefit.

Fosi T, Lax-Pericall MT, Scott RC, Neville BG, Aylett SE - Epilepsia (2013)

Seizure frequency of patient 7 on MPH and dexamphetamine. ▲MPH started (0.1 mg/kg/day). ▼MPH stopped (0.1 mg/kg/day).  Dexamphetamine started (0.2 mg/kg/day).  Dexamphetamine stopped (0.4 mg/kg/day).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4209117&req=5

fig01: Seizure frequency of patient 7 on MPH and dexamphetamine. ▲MPH started (0.1 mg/kg/day). ▼MPH stopped (0.1 mg/kg/day). Dexamphetamine started (0.2 mg/kg/day). Dexamphetamine stopped (0.4 mg/kg/day).
Mentions: Eighteen patients with epilepsy (13 boys, 5 girls: all with combined-type ADHD) were treated with MPH, of a population of 198 children admitted to the center between 1998 and 2005. The median age at ADHD diagnosis was 11.5 years (range 6–18 years) and the median duration of stay at the center prior to the diagnosis of ADHD being made was 1 year (range 0.1–11.0 years; mean 1.6, standard deviation [SD] 2.9 years: Fig. 1). The median duration of treatment with MPH was 12 months (range 2–108 months), and the median maximum dose of MPH attained during treatment was 0.5 mg/kg/day (range 0.2–1.2 mg/kg/day). Nearly all patients (16/18) had at least one other DSM-IV psychiatric diagnosis. The psychiatric comorbidities seen, in descending frequency were the following: oppositional defiant disorder, autism spectrum disorder, conduct disorder, mood disorders, and tic disorder. All patients had LD. This was severe in two thirds (12/18), with the remaining patients being equally distributed between moderate LD (3/18) and mild LD (3/18) groups. These are summarized in Tables 1 and 2.

Bottom Line: MPH adverse effects led to treatment cessation in three patients (dysphoria in two, anxiety in one).Methylphenidate with behavioral management was associated with benefit in the management of ADHD in more than half of a group of children with severe epilepsy and additional cognitive impairments.Eighteen percent had significant side effects but no attributable increase in seizures.

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: To establish the efficacy and safety of methylphenidate (MPH) treatment for attention deficit hyperactivity disorder (ADHD) in a group of children and young people with learning disability and severe epilepsy.

Methods: This retrospective study systematically reviewed the case notes of all patients treated with methylphenidate (MPH) for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) ADHD at a specialist epilepsy center between 1998 and 2005. Treatment efficacy was ascertained using clinical global impressions (CGI) scores, and safety was indexed by instances of >25% increase in monthly seizure count within 3 months of starting MPH.

Key findings: Eighteen (18) patients were identified with refractory epilepsies (14 generalized, 4 focal), IQ <70, and ADHD. Male patients predominated (13:5) and ADHD was diagnosed at a median age of 11.5 years (range 6–18 years). With use of a combination of a behavioral management program and MPH 0.3–1 mg/kg/day, ADHD symptoms improved in 61% of patients (11/18; type A intraclass correlation coefficient of CGI 0.85, 95% confidence interval [CI] 0.69–0.94). Daily MPH dose, epilepsy variables, and psychiatric comorbidity did not relate to treatment response across the sample. MPH adverse effects led to treatment cessation in three patients (dysphoria in two, anxiety in one). There was no statistical evidence for a deterioration of seizure control in this group with the use of MPH.

Significance: Methylphenidate with behavioral management was associated with benefit in the management of ADHD in more than half of a group of children with severe epilepsy and additional cognitive impairments. Eighteen percent had significant side effects but no attributable increase in seizures. Methylphenidate is useful in this group and is likely to be under employed.

Show MeSH
Related in: MedlinePlus