Do stimulants (like ritalin) change seizure frequency or severity in children with ADHD and epilepsy?

Developmental Medicine and Child NeurologyDev Med Child Neurol 2013; 55(7)

The impact of methylphenidate on seizure frequency and severity in children with attention-deficit-hyperactivity disorder and difficult-to-treat epilepsies.

Kleber Santos, Andre Palmini, Ana L Radziuk, Rosana Roteart, Fernanda Bastos, Linda Booij, Brisa S Fernandes

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AIM:

Difficult-to-treat epilepsies and attention-deficit-hyperactivity disorder (ADHD) often co-occur. Because of concerns about the use of stimulants in children with this comorbidity, the impact of ADHD treatment on seizure frequency and severity is not known. This pilot study evaluated the safety and efficacy of methylphenidate in this population.

METHOD:

After a 3 month period in which antiepileptic drugs were adjusted, 22 patients recruited from a specialist outpatient clinic for severe epilepsy (16 males, six females; mean age 11y 2mo, SD 3y 2mo) received methylphenidate for 3 months in an open label, non-controlled trial; four with generalized or multifocal (symptomatic/cryptogenic) epilepsy, one with generalized (idiopathic) epilepsy, 17 with partial (symptomatic/cryptogenic) epilepsy; five with partial seizures only, 17 with primarily or secondarily generalized seizures). Epilepsy, ADHD symptoms, and side effects were assessed using the Swanson, Nolan, and Pelham Questionnaire, the Child Behavior Checklist, the Hague Seizure Severity Scale, and the Side Effects Rating Scale.

RESULTS:

Methylphenidate significantly improved ADHD. After 3 months of treatment, 73% of patients no longer had clinically significant symptoms. Methylphenidate also reduced seizure severity (9-point median decrease on the Hague Seizure Severity Scale). Seizure frequency increased in four out of 22 patients, but only one patient withdrew from the study for this reason. Most patients experienced no major side effects.

INTERPRETATION:

These data are among the first showing that low doses of methylphenidate are safe and effective to treat ADHD symptoms in patients with difficult-to-treat epilepsies. Randomized controlled trials are needed to replicate the findings.

Do over-the-counter cold medications affect seizures?

This is a common question and here is some content and a link to epilepsy.com. JR

Do over-the-counter (OTC) drugs affect seizures?

Potential concern for increasing seizures -  diphenhydramine, the active ingredient in medications like Benadryl, which is used for colds, allergies, and to promote sleep. If you have epilepsy, you should talk to your doctor before you use it.

You should also talk to your doctor before you start using any herbal medicines. Just because they come from nature does not necessarily mean they are safe for you to use.

Other common medicines (even aspirin in some cases) can increase the unwanted side effects of your seizure medicines or increase seizures by changing the level of medication in your blood.

 Check the information elsewhere on this site concerning individual seizure medicines.

What OTC medications are considered safe for use by people with epilepsy?

• Medications for runny and stuffed noses containing pseudoephedrine or phenylephrine appear to be relatively safe, but there are reports of seizures caused by these drugs too.
• For aches and pains, acetaminophen (such as Tylenol, Panadol, Excedrin Aspirin Free) is probably the safest medication.
• Aspirin also appears safe, but it should not be given to children.

http://www.epilepsy.com/epilepsy/provoke_otc?print=true#