Treating Attention-Deficit/Hyperactivity Disorder in Children with Epilepsy: Proceed with Caution or with Confidence?

Abstract

Purpose: Attention-deficit/hyperactivity disorder (ADHD) is among the most common comorbidities of epilepsy. Children with epilepsy are at increased risk of cognitive and behavioral problems that can impair school performance and peer relationships, particularly when ADHD is also pres-ent. Effective treatment of ADHD symptoms can improve these outcomes, but clinicians often hesitate to prescribe stimulants because of the perceived risk of seizure exacerbation. Although seizure frequency during methylphenidate treatment has been studied in children with epilepsy and ADHD, seizure frequency following exposure to other stimulants, nonstimulants, or combined therapy has received less attention. Methods: In a retrospective review of a population-based cohort of children with epilepsy, we examined seizure rates before and after treatment of ADHD with stimulants, nonstimulants, or combined stimulant and nonstimulant therapy. Results: Seizure frequency did not increase after ADHD treatment initiation, regardless of seizure type, seizure severity, or medication class. Conclusion: These findings support clinicians’ use of all medication therapies for ADHD in patients with epilepsy.