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Socanski D, Ogrim G, Duric N. Children with ADHD and EEG abnormalities at baseline assessment, risk of epileptic seizures and maintenance on methylphenidate three years later. Ann Gen Psychiatry 2024; 23:22. [PMID: 38907242 PMCID: PMC11193234 DOI: 10.1186/s12991-024-00510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/14/2024] [Indexed: 06/23/2024] Open
Abstract
PURPOSE This study aimed to assess the incidence of EEG abnormalities (EEG-ab) in children diagnosed with ADHD, investigate the risk of epileptic seizures (SZ) and maintenance on methylphenidate (MPH) over a three-year period. METHODS A total of 517 ADHD children aged 6-14 years were included. Baseline assessments included the identification of EEG-ab, ADHD inattentive subtype (ADHD-I), comorbid epilepsy, the use of antiepileptic drugs (AEDs) and the use of MPH. At the 3-year follow-up, assessments included the presence of EEG-ab, maintenance on MPH, AED usage, SZ risk in cases with EEG-epileptiform abnormalities (EEG-epi-ab), compared with control ADHD cases without EEG-epi-ab matched for age and gender. RESULTS EEG-ab were identified in 273 (52.8%) cases. No statistically significant differences were observed between the EEG-ab and EEG-non-ab groups in terms of age, gender, ADHD-I type or initial use of MPH. EEG non-epileptiform abnormalities (EEG-non-epi-ab) were found in 234 out of 478 (49%) cases without EEG-epi-ab. Notably, EEG-non-epi-ab occurred more frequently in the group of 39 cases with EEG-epi-ab (30/39 (76.9%) vs. 9/39, (21.3%), a subset selected for 3-year follow-up. At 3-year-follow-up no statistically significant difference was found in maintenance on MPH in ADHD cases with and without EEG-epi-ab. Nobody of ADHD cases without comorbid epilepsy or with comorbid epilepsy with achieved SZ freedom developed new SZ. Only 3 children with drug resistant epilepsy experienced SZs, without increase in SZ frequency. The disappearance rate of EEG-epi-ab was higher than that EEG-non-epi-ab (71.8% vs. 33.3%). CONCLUSIONS Children with and without EEG-ab exhibited similar patterns of MPH use (initial use, positive response, and maintenance on MPH). The presence of comorbid epilepsy and EEG-ab, with or without EEG-epi-ab, was not associated with an increased risk of SZ despite the use of MPH.
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Affiliation(s)
- Dobrinko Socanski
- Department of Child and Adolescent Psychiatry, Østfold Hospital Trust, Fredrikstad, Norway.
- Department of Child and Adolescent Psychiatry, Stavanger University Hospital, Stavanger, Norway.
| | - Geir Ogrim
- Neuropsychiatric Team, Åsebråten Clinic, Østfold Hospital Trust, Fredrikstad, Norway
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Nezla Duric
- Department of Child and Adolescent Psychiatry, Fonna Health Trust, Haugesund, Norway
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Gopaul M, Altalib H. Do psychotropic drugs cause seizures? Epilepsy Behav Rep 2024; 27:100679. [PMID: 38881884 PMCID: PMC11179069 DOI: 10.1016/j.ebr.2024.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024] Open
Abstract
Patients with epilepsy often present with concurrent psychiatric disorders, posing unique challenges for healthcare providers. This review explores the intricate relationship between psychiatric comorbidities, epilepsy, and psychotropic medications to inform clinical decision-making. The bidirectional association between epilepsy and psychiatric conditions complicates treatment, with psychiatric symptoms preceding or following seizure onset. The review discusses the seizure risks associated with antidepressants, CNS stimulants, and antipsychotics, shedding light on both historical perspectives and recent empirical evidence. Antidepressants, particularly tricyclic antidepressants (TCAs), are known to pose seizure risks, while newer agents like selective serotonin reuptake inhibitors (SSRIs) exhibit lower incidences and even potential anticonvulsant effects. Contrary to common beliefs, CNS stimulants used in attention-deficit/hyperactivity disorder (ADHD) treatment show efficacy without significantly increasing seizure risk. However, the association between ADHD and seizures warrants careful consideration. Among antipsychotics, clozapine stands out for its heightened seizure risks, especially during titration and at high doses, necessitating close monitoring and individualized approaches. Understanding the nuanced seizure risks associated with different psychotropic medications is crucial for optimizing patient care and minimizing iatrogenic seizures in this vulnerable population. By recognizing the complexities of psychiatric comorbidities in epilepsy and considering the unique challenges they pose, healthcare providers can make informed decisions to enhance patient safety and treatment outcomes. This review offers practical insights to guide clinicians in navigating the intricate landscape of managing psychiatric comorbidities in patients with epilepsy.
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Affiliation(s)
- Margaret Gopaul
- Yale Comprehensive Epilepsy Center, Dept. of Neurology, Yale University School of Medicine New Haven, CT, USA
- Veteran Administration (VA) Epilepsy Center of Excellence in West Haven, CT, USA
| | - Hamada Altalib
- Yale Comprehensive Epilepsy Center, Dept. of Neurology, Yale University School of Medicine New Haven, CT, USA
- Veteran Administration (VA) Epilepsy Center of Excellence in West Haven, CT, USA
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Fan HC, Chiang KL, Chang KH, Chen CM, Tsai JD. Epilepsy and Attention Deficit Hyperactivity Disorder: Connection, Chance, and Challenges. Int J Mol Sci 2023; 24:ijms24065270. [PMID: 36982345 PMCID: PMC10049646 DOI: 10.3390/ijms24065270] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
Comorbidities are common in children with epilepsy, with nearly half of the patients having at least one comorbidity. Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder characterized by hyperactivity and inattentiveness level disproportional to the child’s developmental stage. The burden of ADHD in children with epilepsy is high and can adversely affect the patients’ clinical outcomes, psychosocial aspects, and quality of life. Several hypotheses were proposed to explain the high burden of ADHD in childhood epilepsy; the well-established bidirectional connection and shared genetic/non-genetic factors between epilepsy and comorbid ADHD largely rule out the possibility of a chance in this association. Stimulants are effective in children with comorbid ADHD, and the current body of evidence supports their safety within the approved dose. Nonetheless, safety data should be further studied in randomized, double-blinded, placebo-controlled trials. Comorbid ADHD is still under-recognized in clinical practice. Early identification and management of comorbid ADHD are crucial to optimize the prognosis and reduce the risk of adverse long-term neurodevelopmental outcomes. The identification of the shared genetic background of epilepsy and ADHD can open the gate for tailoring treatment options for these patients through precision medicine.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
| | - Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, Taichung 433, Taiwan
- Department of Nutrition, Hungkuang University, Taichung 433, Taiwan
| | - Kuang-Hsi Chang
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
| | - Chuan-Mu Chen
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
- The iEGG and Animal Biotechnology Center, and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
| | - Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
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Pipe A, Ravindran N, Paric A, Patterson B, Van Ameringen M, Ravindran AV. Treatments for child and adolescent attention deficit hyperactivity disorder in low and middle-income countries: A narrative review. Asian J Psychiatr 2022; 76:103232. [PMID: 35987096 DOI: 10.1016/j.ajp.2022.103232] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects approximately 2-7 % of children globally and is associated with a myriad of difficulties that have long-term consequences. Most children and adolescents live in low- and middle-income countries (LMICs), but there are few reports and no consolidation of findings on ADHD treatment outcomes in this population. We conducted a review of ADHD treatment literature for children and adolescents living in LMICs. METHODS Studies were identified using databases (PsychoINFO, Pubmed, MEDLINER, EMBASE, Global Health, Academic Search Complete, Google Scholar). The initial search produced 139 articles. These were filtered for language, title, abstract, and full-text keyword identification to yield a final 20 articles to be included in this review. RESULTS Reports on outcomes of both psychological and pharmacological treatment were relatively sparse, particularly the former, which mostly referred to parent training and multimodal programs in pre-school children. Most evidence exists for the benefit of methylphenidate-IR with a few reports on other agents, including clonidine, atomoxetine, and lisdexamfetamine. Methylphenidate is the most common agent to treat ADHD in youth in LMICs. Younger age, combined subtype, and comorbid oppositional defiant disorder were associated with poorer treatment outcome. CONCLUSION Access to treatment for ADHD is overall limited in LMICs and varied among individual countries. Pharmacological treatments were generally more available than psychological interventions. Several barriers including stigma, cost, and lack of resources were reported to impact treatment acceptance. More research in LMICs is needed to improve and expand mental health services in these regions.
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Affiliation(s)
- Amy Pipe
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario N6A 5C1, Canada.
| | - Nisha Ravindran
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J 1H4 Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8 Canada.
| | - Angela Paric
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J 1H4 Canada.
| | - Beth Patterson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Ontario, L8N 3K7 Canada; MacAnxiety Research Centre, McMaster University, 1057 Main Street West, Hamilton, Ontario, L8S 1B8 Canada.
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Ontario, L8N 3K7 Canada.
| | - Arun V Ravindran
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J 1H4 Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8 Canada.
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Barra ME, Edlow BL, Brophy GM. Pharmacologic Therapies to Promote Recovery of Consciousness. Semin Neurol 2022; 42:335-347. [PMID: 36100228 DOI: 10.1055/s-0042-1755271] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Pharmacologic interventions are commonly used to support rehabilitation efforts of patients with disorders of consciousness (DoC). The 2018 practice guidelines recommend amantadine in adults with traumatic DoC to promote functional recovery, though several other stimulants are used off-label in clinical practice and trials, such as methylphenidate, bromocriptine, levodopa, and zolpidem. Differences in the mechanisms of action, adverse effects, pharmacokinetics, and drug-drug interactions should be considered when selecting the best agent for each individual patient. Overall, pharmacologic stimulants may provide a safe and inexpensive pathway to increased functionality and participation in rehabilitation. This article provides a concise summary of scientific evidence supporting the use of pharmacologic therapies to stimulate recovery of consciousness in patients with DoC.
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Affiliation(s)
- Megan E Barra
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts.,Department of Neurology, Center for Neurotechnology and Neurorecovery (CNTR), Massachusetts General Hospital, Boston, Massachusetts
| | - Brian L Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery (CNTR), Massachusetts General Hospital, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Gretchen M Brophy
- Department of Pharmacotherapy and Outcomes Science and Neurosurgery, Virginia Commonwealth University, Medical College of Virginia, Richmond, Virginia
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Bearden DJ, Shakil S, O'Banion D, Ono KE, Drane DL, Loring DW, Tarquinio DC. Methylphenidate treatment for cognitive symptoms associated with ADHD in a pediatric epilepsy patient following resection of a left frontal cortical dysplasia. Epilepsy Behav Rep 2021; 16:100435. [PMID: 33981985 PMCID: PMC8085698 DOI: 10.1016/j.ebr.2021.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/02/2021] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
ADHD symptoms can emerge or worsen after epilepsy surgery. Methylphenidate use improved cognitive symptoms of ADHD in our patient. Seizure aggravation did not occur following use of a neurostimulant in our patient. Our patient benefitted from a multidisciplinary intervention approach.
We present data on a 10-year-old patient with drug-resistant epilepsy who was treated with methylphenidate for symptoms of attention deficit hyperactivity disorder (ADHD) that developed after she underwent surgical resection of a left frontal cortical dysplasia. . The patient’s parents reported methylphenidate was helpful in improving their child’s reading performance. Based on parents’ report, we examined benefits of methylphenidate on our patient’s cognitive problems in a controlled setting. The patient underwent a neuropsychological evaluation completed in three sessions over a five-day period. Methylphenidate was administered prior to the second testing session only and was associated with improvements in the patient’s attention, executive function, processing speed, and short-term memory performances. In comparison, word-reading performance, a task less susceptible to neurological impairment, was stable over the three sessions. The patient remained seizure-free after surgery and use of methylphenidate did not reduce seizure threshold. These findings support the use of methylphenidate in treating targeted cognitive problems associated with ADHD emerging after epilepsy surgery in children.
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Affiliation(s)
- Donald J. Bearden
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Corresponding author at: Center for Advanced Pediatrics, Children’s Healthcare of Atlanta, 1400 Tullie Rd. NE, Ste. 430, Atlanta, GA 30329, USA.
| | - Sidra Shakil
- Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - David O'Banion
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Developmental Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Kim E. Ono
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel L. Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology University of Washington School of Medicine, Seattle, WA, USA
| | - David W. Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Leeman-Markowski BA, Adams J, Martin SP, Devinsky O, Meador KJ. Methylphenidate for attention problems in epilepsy patients: Safety and efficacy. Epilepsy Behav 2021; 115:107627. [PMID: 33360744 PMCID: PMC7884102 DOI: 10.1016/j.yebeh.2020.107627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of seizures, and children with epilepsy have an increased prevalence of ADHD. Adults with epilepsy often have varying degrees of attentional dysfunction due to multiple factors, including anti-seizure medications, frequent seizures, interictal discharges, underlying lesions, and psychiatric comorbidities. Currently, there are no approved medications for the treatment of epilepsy-related attentional dysfunction. Methylphenidate (MPH) is a stimulant, FDA-approved for the treatment of ADHD, and often used for ADHD in the setting of pediatric epilepsy. Large database and registry studies indicate safety of MPH in children with ADHD and epilepsy, with no significant effect on seizure frequency. Small single-dose and open-label studies suggest efficacy of MPH in adults with epilepsy-related attention deficits. Methylphenidate represents a possible treatment for attentional dysfunction due to epilepsy, but large, randomized, placebo-controlled, double-blinded studies are needed.
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Affiliation(s)
- Beth A Leeman-Markowski
- Research Service, VA New York Harbor Healthcare System, 423 E. 23rd St., New York, NY 10010, United States; Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34th St., New York, NY 10016, United States.
| | - Jesse Adams
- Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305-5723, United States.
| | - Samantha P Martin
- Research Service, VA New York Harbor Healthcare System, 423 E. 23rd St., New York, NY 10010, United States; Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34th St., New York, NY 10016, United States.
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, Department of Neurology, New York University Langone Health, 223 E. 34th St., New York, NY 10016, United States; Department of Neurosurgery, New York University Langone Health, 660 1st Ave. #5, New York, NY 10016, United States; Department of Psychiatry, New York University Langone Health, 550 1st Ave., New York, NY 10016, United States.
| | - Kimford J Meador
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 213 Quarry Road, MC 5979 (room 2856), Palo Alto, CA 94304-5979, United States.
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Abstract
PURPOSE OF REVIEW Attention deficit/hyperactivity disorder (ADHD) is a frequent comorbidity in patients with epilepsy and is associated with important psychosocial and academic consequences. Evidence are now available to guide diagnosis and treatment of patients with both ADHD and epilepsy. RECENT FINDINGS The prevalence of ADHD varies from 12 to 39% in patients with newly diagnosed epilepsy to 70% in drug-resistant epilepsy. The diagnosis of ADHD requires parent-validated and teacher-validated rating scales, based on the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and DSM-V, to confirm the information in the rating scales by interviewing parents and to exclude other causes of symptoms. Treatment with methylphenidate is associated with clinically significant improvement of ADHD symptoms in 60-75% of patients. Recent data reinforce the hypothesis that ADHD medications do not increase risk of seizures, even in patients with epilepsy. Beyond pharmacological management, experts have recommended to include multidisciplinary involvement in transition clinics for patients with both comorbid ADHD and epilepsy. SUMMARY Management of ADHD in patients with epilepsy requires implementation of evidence-based data in clinical practice both for diagnosis and treatment. Currently, there is no specific treatment of ADHD associated with epilepsy and its treatment is based on the usual treatments of ADHD, with reassuring data about their safety in epilepsy.
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Kanner AM, Helmstaedter C, Sadat-Hossieny Z, Meador K. Cognitive disorders in epilepsy I: Clinical experience, real-world evidence and recommendations. Seizure 2020; 83:216-222. [DOI: 10.1016/j.seizure.2020.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 01/14/2023] Open
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Park J, Choi HW, Yum MS, Ko TS, Shon SH, Kim HW. Relationship Between Aggravation of Seizures and Methylphenidate Treatment in Subjects with Attention-Deficit/Hyperactivity Disorder and Epilepsy. J Child Adolesc Psychopharmacol 2018; 28:537-546. [PMID: 30089215 DOI: 10.1089/cap.2017.0070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We aimed to investigate the effectiveness and safety of methylphenidate (MPH), and especially its influence on seizures, in subjects with attention-deficit/hyperactivity disorder (ADHD) and epilepsy through a retrospective chart review of subjects treated with MPH in a clinical setting. We also evaluated factors that could affect seizure aggravation during MPH treatment. METHODS From April 2004 to July 2011, MPH was prescribed to 105 subjects with ADHD and epilepsy. The demographic characteristics, psychiatric and medical history, and electroencephalography (EEG) results were reviewed. Two pediatric neurologists reviewed seizure type, epilepsy diagnosis, changes in seizure frequency, and EEG parameters during MPH treatment. Pediatric neurologists and psychiatrists determined the temporal relationship between seizure aggravation and MPH treatment. RESULTS The mean age of the subjects was 14.8 ± 3.4 years (range: 7-24 years). Sixty-five (61.9%) of the subjects were male. The mean duration of MPH treatment was 22 months (range: 2 weeks to 89 months) and the mean dose of MPH was 0.84 mg/kg/day. MPH was effective in controlling ADHD symptoms in both the seizure aggravation and nonaggravation groups. However, 21 (20%) subjects had aggravated seizures and 32 (32.3%) subjects had worsened EEG findings. Subjects with uncontrolled seizure or anxiety disorders at baseline were more likely to show aggravated seizures. Subjects who had epileptiform discharges, anxiety disorders, or were free of antiepileptic drug use at baseline experienced EEG worsening more frequently. The median duration of MPH treatment was significantly longer in subjects who did not show seizure aggravation than in those who did (p < 0.001). CONCLUSIONS MPH treatment may be related to aggravation of seizures or significant worsening of EEG findings in subjects with ADHD and epilepsy. Thus, clinicians should closely monitor seizure aggravation after MPH administration, especially for high-risk subjects with uncontrolled seizures or anxiety disorders at baseline.
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Affiliation(s)
- Jangho Park
- 1 Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine , Ulsan, Korea
| | - Hae-Won Choi
- 2 Department of Pediatrics, Kangdong Miz Women's Hospital , Seoul, Korea
| | - Mi-Sun Yum
- 3 Department of Pediatric Neurology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Tae-Sung Ko
- 3 Department of Pediatric Neurology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Seung-Hyun Shon
- 4 Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Hyo-Won Kim
- 4 Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
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The Challenge of Pharmacotherapy in Children and Adolescents with Epilepsy-ADHD Comorbidity. Clin Drug Investig 2018; 38:1-8. [PMID: 29071470 DOI: 10.1007/s40261-017-0585-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Epilepsy is common in children and adolescents where its prevalence is 3.2-5.5/1000. About one-third of patients also have attention deficit hyperactivity/impulsivity disorder (ADHD). The possible relationship between epilepsy and ADHD is still unclear, and ADHD symptoms (such as inattention, hyperactivity, behavioral disturbances) are frequently considered as adverse effects of antiepileptic drugs (AEDs). The literature was searched for data on the behavioral effects of AEDs. Phenobarbital is the most frequently reported medication to induce symptoms of ADHD, followed by topiramate and valproic acid. Phenytoin seems to exert modest effects, while for levetiracetam there are contrasting data. Lacosamide induces some beneficial effects on behavior; carbamazepine and lamotrigine exert favorable effects on attention and behavior. Gabapentin and vigabatrin have limited adverse effects on cognition. Oxcarbazepine, rufinamide, and eslicarbazepine do not seem to aggravate or induce ADHD symptoms, whereas perampanel can lead to a high incidence of hostile/aggressive behavior, which increases with higher dosages. Information about the behavioral effects of ethosuximide, zonisamide, tiagabine, pregabalin, stiripentol, and retigabine is still limited. Because ADHD significantly affects the quality of life of epilepsy patients, the clinical management of this neuropsychiatric disorder should be a priority. Methylphenidate is effective most children and adolescents with ADHD symptoms and comorbid epilepsy, without a significant increase of seizure risk, although data are still limited with few controlled trials.
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Liu X, Carney PR, Bussing R, Segal R, Cottler LB, Winterstein AG. Stimulants Do Not Increase the Risk of Seizure-Related Hospitalizations in Children with Epilepsy. J Child Adolesc Psychopharmacol 2018; 28:111-116. [PMID: 29028437 PMCID: PMC5911707 DOI: 10.1089/cap.2017.0110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the safety of stimulants in children with epilepsy. METHODS In a retrospective cohort study based on Medicaid Analytic eXtract billing records from 26 U.S. states from 1999 to 2010, we identified incident stimulant use among children with epilepsy through outpatient encounter claims and pharmacy claims. We established a control group of nonusers and used frequency matching to generate index dates. We followed both cohorts for 12 months and calculated hazard ratios [HRs] of current and former use of stimulants versus no use on the outcome of seizure-related hospitalization using multivariate Cox proportional hazard models. RESULTS We identified 18,166 stimulant users and 54,197 nonusers in children with epilepsy. The incidence of seizure-related hospitalization in current stimulant users, former users, and nonusers was 3.6, 3.5, and 4.3 per 100 patient-years. After adjustment for confounders, we found current and former use of stimulants did not increase seizure-related hospitalizations (HR 0.95, 95% confidence interval [CI]: 0.83, 1.09 and HR 0.99, 95% CI: 0.85, 1.15). Children with cerebral palsy, congenital nervous system anomalies, or intellectual disability did not have significantly higher HRs than those without the already mentioned comorbidities. CONCLUSION This study has not identified any overall increase in the rate of seizure-related hospitalizations with the use of stimulants in children with epilepsy.
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Affiliation(s)
- Xinyue Liu
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Paul R. Carney
- Department of Neurology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Regina Bussing
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Linda B. Cottler
- Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
- Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, Florida
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Adams J, Alipio-Jocson V, Inoyama K, Bartlett V, Sandhu S, Oso J, Barry JJ, Loring DW, Meador KJ. Methylphenidate, cognition, and epilepsy: A 1-month open-label trial. Epilepsia 2017; 58:2124-2132. [DOI: 10.1111/epi.13917] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jesse Adams
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford California U.S.A
| | - Valerie Alipio-Jocson
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford California U.S.A
| | - Katherine Inoyama
- Department of Neurology and Neurological Sciences; Stanford University; Stanford California U.S.A
| | - Victoria Bartlett
- Department of Neurology and Neurological Sciences; Stanford University; Stanford California U.S.A
| | - Saira Sandhu
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford California U.S.A
| | - Jemima Oso
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford California U.S.A
| | - John J. Barry
- Department of Psychiatry and Behavioral Sciences; Stanford University; Stanford California U.S.A
| | - David W. Loring
- Department of Neurology; Emory University; Atlanta Georgia U.S.A
| | - Kimford J. Meador
- Department of Neurology and Neurological Sciences; Stanford University; Stanford California U.S.A
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14
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Kral MC, Lally MD, Boan AD. Effectiveness and Side Effect Profile of Stimulant Medication for the Treatment of Attention-Deficit/Hyperactivity Disorder in Youth with Epilepsy. J Child Adolesc Psychopharmacol 2017; 27:735-740. [PMID: 28383998 DOI: 10.1089/cap.2016.0186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This clinical case series examined the effectiveness and potential side effects associated with stimulant medication for the treatment of attention-deficit/hyperactivity disorder (ADHD) in 20 youth with epilepsy. METHODS Response to stimulant medication was examined through symptom reduction on the Conners-Third Edition: Parent Rating Scale, Short Form [Conner 3-P(S)], which was administered to caregivers before initiation of treatment and following dosage titration to achieve therapeutic efficacy. Stimulant medication side effects were examined with the Side Effect Rating Scale before treatment and following dosage titration. Repeated measures mixed model approach was used to compare symptom reduction and side effects between the two time points. RESULTS Repeated measures ANOVA revealed significant ADHD symptom reduction as measured by the Conner 3-P(S). Review of patient medical records and caregiver report did not reveal seizure exacerbation. Caregivers, in fact, reported fewer side effects following treatment for ADHD compared with baseline. CONCLUSION These results contribute to growing evidence in support of the effectiveness of stimulant medication, without seizure exacerbation or medication side effects, for treatment of ADHD in youth with epilepsy.
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Affiliation(s)
- Mary C Kral
- 1 Department of Pediatrics, Medical University of South Carolina , Charleston, South Carolina
| | - Michelle D Lally
- 1 Department of Pediatrics, Medical University of South Carolina , Charleston, South Carolina
| | - Andrea D Boan
- 1 Department of Pediatrics, Medical University of South Carolina , Charleston, South Carolina.,2 Department of Public Health Sciences, Medical University of South Carolina , Charleston, South Carolina
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15
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Kalil Neto F, Nunes ML. Evaluation of sleep organization in patients with attention deficit hyperactivity disorder (ADHD) and ADHD as a comorbidity of epilepsy. Sleep Med 2017; 33:91-96. [DOI: 10.1016/j.sleep.2016.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/16/2016] [Accepted: 08/29/2016] [Indexed: 11/29/2022]
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16
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Groenman AP, Schweren LJS, Dietrich A, Hoekstra PJ. An update on the safety of psychostimulants for the treatment of attention-deficit/hyperactivity disorder. Expert Opin Drug Saf 2017; 16:455-464. [PMID: 28277842 DOI: 10.1080/14740338.2017.1301928] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Methylphenidate is the first-line pharmacological treatment of attention-deficit/hyperactivity disorder (ADHD). Although methylphenidate has a well-established evidence base for treating ADHD, its long-term benefits are unclear. Areas covered: Physical adverse effects, psychiatric adverse events and brain development Expert opinion: Some physical adverse events have been described (e.g. sleep disturbances, growth reduction, loss of appetite), although most are of transient nature. Psychiatric adverse events seem more related to the diagnosis ADHD itself, and not stimulant treatment. Concluding, short-to-mid-term use (i.e., up to 2 years) stimulants are relatively safe, but much less is known about longer-term efficacy and safety of these drugs.
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Affiliation(s)
- Annabeth P Groenman
- a Department of Child and Adolescent Psychiatry , University of Groningen, University Medical Center Groningen , Groningen , Netherlands
| | | | - Andrea Dietrich
- a Department of Child and Adolescent Psychiatry , University of Groningen, University Medical Center Groningen , Groningen , Netherlands
| | - Pieter J Hoekstra
- a Department of Child and Adolescent Psychiatry , University of Groningen, University Medical Center Groningen , Groningen , Netherlands
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17
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Adams J, Alipio-Jocson V, Inoyama K, Bartlett V, Sandhu S, Oso J, Barry JJ, Loring DW, Meador K. Methylphenidate, cognition, and epilepsy: A double-blind, placebo-controlled, single-dose study. Neurology 2016; 88:470-476. [PMID: 28031390 DOI: 10.1212/wnl.0000000000003564] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/28/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the potential efficacy of immediate-release methylphenidate (MPH) for treating cognitive deficits in epilepsy. METHODS This was a double-blind, randomized, single-dose, 3-period crossover study in patients with epilepsy and chronic cognitive complaints comparing the effects of placebo and MPH 10 and 20 mg given 1 week apart. Cognitive outcome was evaluated on the basis of an omnibus z score calculated from performance on the Conners Continuous Performance Test 3 (ability to discriminate between target and nontarget stimuli [d'] and hit reaction time standard deviation), Symbol-Digit Modalities Test, and Medical College of Georgia Paragraph Memory Test. Adverse events and seizure frequency were monitored. An open-label follow-up is reported elsewhere. RESULTS Thirty-five adult patients with epilepsy participated, of whom 31 finished. Demographics included the following: mean age = 35.3 years (range 20-62 years), 13 men and 18 women, and baseline seizure frequency of 2.8 per month. Epilepsy types were focal (n = 24), generalized (n = 6), or unclassified (n = 1). Mean epilepsy duration was 12.5 years. A statistically significant performance benefit was present at both 10-mg (p = 0.030) and 20-mg (p = 0.034) MPH doses. No seizures were associated with either MPH dose. Adverse effects leading to withdrawal included cognitive "fogginess" (n = 1 on 20 mg), anxiety/agitation (n = 1 on 10 mg), and tachycardia (n = 1). One participant was lost to follow-up after one 20-mg dose without side effect. CONCLUSIONS This single-dose study suggests that MPH may be effective in ameliorating some cognitive deficits in patients with epilepsy. Additional studies are required. CLINICALTRIALSGOV IDENTIFIER NCT02178995. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that single doses of MPH improve cognitive performance on some measures of attention and processing speed in patients with epilepsy and cognitive complaints.
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Affiliation(s)
- Jesse Adams
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA.
| | - Valerie Alipio-Jocson
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - Katherine Inoyama
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - Victoria Bartlett
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - Saira Sandhu
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - Jemima Oso
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - John J Barry
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - David W Loring
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
| | - Kimford Meador
- From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA
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18
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Abstract
Dravet syndrome (DS) is an intractable pediatric epilepsy syndrome, starting in early childhood. This disorder typically manifests with febrile status epilepticus, and progresses to a multifocal epilepsy with febrile and non-febrile seizures with encephalopathy. Most cases are due to a mutation in the SCN1A gene. This article reviews treatments for DS, with an emphasis on pharmacotherapy. While many medications are used in treating the seizures associated with DS, these patients typically have medically refractory epilepsy, and polytherapy is often required. First-line agents include valproate and clobazam, although there are supportive data for topiramate, levetiracetam, stiripentol and the ketogenic diet. Other agents such as fenfluramine are promising therapies for Dravet syndrome. Sodium channel-blocking anticonvulsants such as carbamazepine and lamotrigine are generally contraindicated in this syndrome. Nonpharmacologic therapies (such as neurostimulation or surgery) are understudied in DS. Because DS is a global encephalopathy, pharmacologic treatment of non-epileptic manifestations of the disease is often necessary. Attention-deficit hyperactivity disorder is often encountered in patients with DS, and psychostimulants can be helpful for this indication. Other psychoactive drugs are less studied in this context. Extrapyramidal and gait disorders are often encountered in DS as well. While DS is a severe epileptic encephalopathy with a high (up to 15 %) mortality rate in childhood, careful pharmacologic management can improve these patients' clinical picture and quality of life.
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19
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Rheims S, Herbillon V, Villeneuve N, Auvin S, Napuri S, Cances C, Berquin P, Castelneau P, Nguyen The Tich S, Villega F, Isnard H, Nabbout R, Gaillard S, Mercier C, Kassai B, Arzimanoglou A. ADHD in childhood epilepsy: Clinical determinants of severity and of the response to methylphenidate. Epilepsia 2016; 57:1069-77. [PMID: 27237724 DOI: 10.1111/epi.13420] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is commonly observed in children with epilepsy. However, factors associated with the development of ADHD and which might help to guide its therapeutic management, remain an issue of debate. METHODS We conducted a multicenter prospective observational study that included children, aged 6-16 years, with both epilepsy and ADHD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. After inclusion, patients entered a 12-16 week follow-up period during which they were either treated with methylphenidate or they did not receive specific ADHD treatment. ADHD was evaluated with the ADHD Rating Scale-IV. RESULTS One hundred sixty-seven patients were included, of which 91 were seizure-free during the preinclusion baseline period. At inclusion, the ADHD Rating Scale-IV total score was 30.4 ± (standard deviation) 9.2, the inattentive subscore was 17.3 ± 4.4, and the hyperactive subscore was 13.2 ± 6.6. We did not detect any difference of ADHD Rating Scale-IV scores across patients' age or gender, age at epilepsy onset, epilepsy syndrome, seizure frequency, or number of ongoing antiepileptic drugs. Methylphenidate was initiated in 61 patients, including 55 in whom a follow-up evaluation was available. At the last follow-up, 41 patients (75%) treated with methylphenidate and 39 (42%) of those who did not received ADHD therapy demonstrated ≥25% decrease of ADHD Rating Scale-IV total score (p < 0.001). Response to methylphenidate was greater in girls but was not influenced by any epilepsy-related variables. SIGNIFICANCE We did not detect any epilepsy-related factor associated with the severity of ADHD. Twenty-five percent of patients did not respond to methylphenidate. A better understanding of the pathologic process that underlies ADHD development in childhood epilepsy might be required to improve therapeutic strategies.
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Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and Epileptology and Epilepsy Institute (IDEE), Hospices Civils de Lyon and Lyon 1 University, Lyon, France.,Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France
| | - Vania Herbillon
- Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.,Epilepsy, Sleep and Pediatric Neurophysiology Department, Hospices Civils de Lyon, Lyon, France
| | | | - Stéphane Auvin
- AP-HP, Department of Pediatric Neurology, Robert Debré Hospital, Paris, France
| | - Silvia Napuri
- Department of Pediatric Neurology, Rennes University Hospital, Rennes, France
| | - Claude Cances
- Department of Pediatric Neurology, Children Hospital, Toulouse, France
| | - Patrick Berquin
- Department of Pediatric Neurology, INSERM U1105 CURS, Amiens, France
| | - Pierre Castelneau
- Department of Pediatric Neurology, University Hospital of Tours, Tours, France
| | | | - Frédéric Villega
- Department of Pediatric Neurology, University Hospital of Bordeaux, Bordeaux, France
| | | | - Rima Nabbout
- Pediatric Neurology Department, Reference Center for Rare Epilepsies, Necker Hospital, Paris, France
| | - Ségolène Gaillard
- Department of Clinical Pharmacology, EPICIME-CIC 1407 Inserm, Hospices Civils de Lyon, Lyon, France
| | | | - Behrouz Kassai
- Department of Clinical Pharmacology, EPICIME-CIC 1407 Inserm, Hospices Civils de Lyon, Lyon, France
| | - Alexis Arzimanoglou
- Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.,Epilepsy, Sleep and Pediatric Neurophysiology Department, Hospices Civils de Lyon, Lyon, France
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20
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Abstract
The quality of life of children with epilepsy is a function of seizures and associated cognitive and behavioral comorbidities. Current treatments are not successful at stopping seizures in approximately 30% of patients despite the introduction of multiple new antiepileptic drugs over the last decade. In addition, modification of seizures has only a modest impact on the comorbidities. Therefore, novel approaches to identify therapeutic targets that improve seizures and comorbidities are urgently required. The potential of network science as applied to genetic, local neural network, and global brain data is reviewed. Several examples of possible new therapeutic approaches defined using novel network tools are highlighted. Further study to translate the findings into clinical practice is now required.
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Affiliation(s)
- Rod C Scott
- Department of Neurological Sciences, University of Vermont, Burlington, VT, USA; Neurosciences Unit, UCL Institute of Child Health, London, UK
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21
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Maneeton B, Maneeton N, Likhitsathian S, Suttajit S, Narkpongphun A, Srisurapanont M, Woottiluk P. Comparative efficacy, acceptability, and tolerability of lisdexamfetamine in child and adolescent ADHD: a meta-analysis of randomized, controlled trials. Drug Des Devel Ther 2015; 9:1927-36. [PMID: 25897203 PMCID: PMC4389815 DOI: 10.2147/dddt.s79071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Several studies have shown that lisdexamfetamine (LDX) is efficacious in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Objectives Aims of this study were to systematically review the efficacy, acceptability, and tolerability of LDX in child and adolescent ADHD. Any randomized controlled trials (RCTs) of LDX versus placebo carried out in children and adolescents with ADHD were included. Data sources The searches of the SCOPUS, MEDLINE, CINAHL and Cochrane Controlled Trials Register were performed in September 2014. Additional searches in the ClinicalTrials. gov and EU Clinical Trials Register database were conducted. Study eligibility criteria, participants, and interventions This review included all RCTs of LDX versus placebo which were carried out in children and adolescents up to 18 years old. Additionally, the included studies must have reported the final outcomes of: i) severity of ADHD symptoms with standardized scales, ii) rates of improvement, iii) rates of discontinuation. To be more thorough, the languages of such RCTs were not limited. Study appraisal and synthesis methods The abstracts from databases were inspected and the full text versions of relevant trials were examined and extracted for important outcomes. The efficacious measurements included either the pooled mean end-point or changed scores of ADHD rating scales, and the rate of improvement. Acceptability and tolerability were measured by the pooled overall discontinuation rate and the pooled discontinuation rate due to adverse events, respectively. A random effect model technique was utilized to synthesize the mean differences (either standardized mean differences or weighted mean differences) and relative risks (RRs) with 95% confidence intervals (CIs). Results A total of 1,016 children and adolescents with ADHD were included. The dosage of LDX was 30 to 70 mg/day. The pooled mean change scores of LDX-treated group was significantly greater than that of the placebo (weighted mean difference [95% CI] of −15.20 [−19.95, −10.46], I2=94%). The pooled improvement rate of the LDX-treated group was also significantly higher than that of the placebo (RR [95% CI] of 0.34 [0.24, 0.47], I2=80%). The pooled overall discontinuation rate between the two groups was not significantly different (RR [95% CI] of 0.78 [0.46, 1.31], I2=63%). Similarly, the pooled discontinuation rate due to adverse events between the two groups showed no significant difference (RR [95% CI] of 1.99 [0.70, 5.64], I2=0%). Limitations The number of included studies was limited (five RCTs). Conclusion According to the present review, LDX was effective and well-tolerated in the treatment of child and adolescent ADHD. Unfortunately, the acceptability of LDX was not better than the placebo. Since the number of included studies was limited, the outcome from this review should be carefully interpreted and considered as preliminary. Further studies, therefore, should be conducted to confirm these findings. Implication of key findings Lisdexamfetamine is an efficacious stimulant for treating child and adolescent ADHD.
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Affiliation(s)
- Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Sirijit Suttajit
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Assawin Narkpongphun
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pakapan Woottiluk
- Psychiatric Nursing Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
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22
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Socanski D, Aurlien D, Herigstad A, Thomsen PH, Larsen TK. Attention deficit/hyperactivity disorder and interictal epileptiform discharges: It is safe to use methylphenidate? Seizure 2015; 25:80-3. [DOI: 10.1016/j.seizure.2015.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/05/2014] [Accepted: 01/03/2015] [Indexed: 11/26/2022] Open
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Sinita E, Coghill D. The use of stimulant medications for non-core aspects of ADHD and in other disorders. Neuropharmacology 2014; 87:161-72. [PMID: 24951855 DOI: 10.1016/j.neuropharm.2014.06.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/02/2014] [Accepted: 06/11/2014] [Indexed: 11/26/2022]
Abstract
Psychostimulants play a central role in the management of ADHD. Here we review the evidence pertaining to the use of methylphenidate, dexamphetamine and related amphetamine salts, the prodrug lisdexamfetamine and modafinil for the management of comorbid ADHD and non-ADHD indications. There is a growing consensus that stimulant medications are helpful at improving the emotional dysregulation and lability, and oppositional and conduct symptoms that are often associated with ADHD. There is some evidence that psychostimulants may improve outcomes in those with treatment resistant depression, reduce negative symptoms and improve cognitive performance in schizophrenia, and that methylphenidate may reduce binge eating in those with bulimia nervosa. In general medicine, whilst the evidence is at times contradictory, psychostimulants have been shown in some studies to be effective treatments for chronic fatigue and narcolepsy, and to improve outcomes post stroke, post head injury, in dementia and various cancers. It seems likely that these effects often result from a combination of, reduction in fatigue, improvements in concentration and cognitive functioning and a lifting of mood which may be a direct or indirect consequence of the medication. Further studies seem warranted and these should focus on efficacy, effectiveness and long term safety. This article is part of the Special Issue entitled 'CNS Stimulants'.
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Affiliation(s)
- Eugenia Sinita
- Department of Research and Development, National Centre of Mental Health, Clinical Psychiatric Hospital, Chisinau, Republic of Moldova
| | - David Coghill
- Division of Neuroscience, University of Dundee, Dundee, UK.
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24
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Saute R, Dabbs K, Jones JE, Jackson DC, Seidenberg M, Hermann BP. Brain morphology in children with epilepsy and ADHD. PLoS One 2014; 9:e95269. [PMID: 24760032 PMCID: PMC3997349 DOI: 10.1371/journal.pone.0095269] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 03/26/2014] [Indexed: 11/18/2022] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is a common comorbidity of childhood epilepsy, but the neuroanatomical correlates of ADHD in epilepsy have yet to be comprehensively characterized. Methods Children with new and recent-onset epilepsy with (n = 18) and without (n = 36) ADHD, and healthy controls (n = 46) underwent high resolution MRI. Measures of cortical morphology (thickness, area, volume, curvature) and subcortical and cerebellar volumes were compared between the groups using the program FreeSurfer 5.1. Results Compared to the control group, children with epilepsy and ADHD exhibited diffuse bilateral thinning in the frontal, parietal and temporal lobes, with volume reductions in the brainstem and subcortical structures (bilateral caudate, left thalamus, right hippocampus). There were very few group differences across measures of cortical volume, area or curvature. Conclusions Children with epilepsy and comorbid ADHD exhibited a pattern of bilateral and widespread decreased cortical thickness as well as decreased volume of subcortical structures and brainstem. These anatomic abnormalities were evident early in the course of epilepsy suggesting the presence of antecedent neurodevelopmental changes, the course of which remains to be determined.
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Affiliation(s)
- Ricardo Saute
- Faculty of Medicine, Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Jana E. Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Daren C. Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Michael Seidenberg
- Department of Psychology, Rosalind Franklin University of Science and Medicine, North Chicago, Illinois, United States of America
| | - Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
- * E-mail:
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25
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Ramos-Quiroga JA, Corominas-Roso M, Palomar G, Gomez-Barros N, Ribases M, Sanchez-Mora C, Bosch R, Nogueira M, Corrales M, Valero S, Casas M. Changes in the serum levels of brain-derived neurotrophic factor in adults with attention deficit hyperactivity disorder after treatment with atomoxetine. Psychopharmacology (Berl) 2014; 231:1389-95. [PMID: 24202115 DOI: 10.1007/s00213-013-3343-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 10/09/2013] [Indexed: 12/25/2022]
Abstract
RATIONALE Atomoxetine (ATX) is a non-stimulant drug approved for the treatment of attention deficit hyperactivity disorder (ADHD). Although animal models have provided evidence that brain-derived neurotrophic factor (BDNF) is involved in the effects of ATX in the brain, there are no studies of BDNF in ADHD patients undergoing treatment with ATX. OBJECTIVES The aim of this study was to evaluate the possible changes in serum levels of BDNF in adults treated with ATX and its relationship with clinical improvement. METHODS A total of 54 adults with ADHD (age 33.43 ± 8.99 years) without any medical or psychiatric comorbidities were treated with ATX for 3 months; 35 of them completed the protocol. The clinical data for ADHD diagnosis, including Conners' ADHD Rating Scale and blood samples, were collected at baseline (V1) and at the end of the treatment (V2). RESULTS Adults with ADHD who completed ATX treatment for 3 months showed a significant improvement in their clinical symptoms. No significant differences were found in BDNF levels before and after treatment with ATX in the whole group of patients (p = 0.15). The inattentive subgroup of ATX responders showed a decrease of serum BDNF after 3 months of ATX treatment (p = 0.05) not present in the combined subtype (p = 0.82). CONCLUSIONS These results suggest that BDNF is not directly involved in the neurobiological mechanisms of ATX-induced improvement of clinical symptoms of ADHD. The differences between the combined and inattentive subtypes in serum BDNF changes suggest selective ATX-induced effects in the function of brain circuitry.
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Affiliation(s)
- Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Escola d'Infermeria building 5th floor, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Catalonia, Spain
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26
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Fosi T, Lax-Pericall MT, Scott RC, Neville BG, Aylett SE. Methylphenidate treatment of attention deficit hyperactivity disorder in young people with learning disability and difficult-to-treat epilepsy: evidence of clinical benefit. Epilepsia 2014; 54:2071-81. [PMID: 24304474 PMCID: PMC4209117 DOI: 10.1111/epi.12399] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/29/2022]
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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Affiliation(s)
- Tangunu Fosi
- The National Centre for Young People with Epilepsy (NCYPE)Surrey, United Kingdom
- Great Ormond Street Hospital for Children NHS TrustLondon, United Kingdom
- Neurosciences Unit, UCL Institute of Child HealthLondon, United Kingdom
- Address correspondence to Tangunu Fosi, Neurosciences Unit (Wolfson Centre), UCL Institute of Child Health, 4/5 Long Yard, London WC1N 3LU, U.K. E-mail:
| | - Maria T Lax-Pericall
- The National Centre for Young People with Epilepsy (NCYPE)Surrey, United Kingdom
- South London and Maudsley NHS Mental Health TrustLondon, United Kingdom
| | - Rod C Scott
- The National Centre for Young People with Epilepsy (NCYPE)Surrey, United Kingdom
- Great Ormond Street Hospital for Children NHS TrustLondon, United Kingdom
- Neurosciences Unit, UCL Institute of Child HealthLondon, United Kingdom
| | - Brian G Neville
- The National Centre for Young People with Epilepsy (NCYPE)Surrey, United Kingdom
- Great Ormond Street Hospital for Children NHS TrustLondon, United Kingdom
- Neurosciences Unit, UCL Institute of Child HealthLondon, United Kingdom
| | - Sarah E Aylett
- The National Centre for Young People with Epilepsy (NCYPE)Surrey, United Kingdom
- Great Ormond Street Hospital for Children NHS TrustLondon, United Kingdom
- Neurosciences Unit, UCL Institute of Child HealthLondon, United Kingdom
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The diagnosis and treatment of attention deficit hyperactivity disorder in patients with epilepsy. Curr Neurol Neurosci Rep 2013; 13:351. [PMID: 23636930 DOI: 10.1007/s11910-013-0351-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Attention deficit/hyperactivity disorder (AD/HD) can cause significant impairment in psychosocial and scholastic achievement. AD/HD should be appropriately managed even if patients have comorbid epilepsy. The diagnosis and treatment of AD/HD in patients with epilepsy presents several challenges. Differentiating independent problems in attention from frequent epileptic seizures is the first step in evaluating these individuals. Once this is accomplished the formal independent diagnosis of AD/HD can be pursued. Data from non-epileptic AD/HD populations should be applied with caution to patients with epilepsy. Once attention deficit disorder has been diagnosed formally, choices in treatment can create other problems as some pharmacological treatments for AD/HD pose a risk of exacerbating seizures. This article serves as a review for the diagnosis and treatment of AD/HD spectrum disorders in patients with epilepsy.
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Santos K, Palmini A, Radziuk AL, Rotert R, Bastos F, Booij L, Fernandes BS. The impact of methylphenidate on seizure frequency and severity in children with attention-deficit-hyperactivity disorder and difficult-to-treat epilepsies. Dev Med Child Neurol 2013; 55:654-60. [PMID: 23480530 DOI: 10.1111/dmcn.12121] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2012] [Indexed: 11/27/2022]
Abstract
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 11 y 2 mo, SD 3 y 2 mo) 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.
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Affiliation(s)
- Kleber Santos
- Severe Epilepsies Outpatient Clinic, Neurology Service, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
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Cortese S, Holtmann M, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Dittmann RW, Graham J, Taylor E, Sergeant J. Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents. J Child Psychol Psychiatry 2013; 54:227-46. [PMID: 23294014 DOI: 10.1111/jcpp.12036] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medication is an important element of therapeutic strategies for ADHD. While medications for ADHD are generally well-tolerated, there are common, although less severe, as well as rare but severe adverse events AEs during treatment with ADHD drugs. The aim of this review is to provide evidence- and expert-based guidance concerning the management of (AEs) with medications for ADHD. METHODS For ease of use by practitioners and clinicians, the article is organized in a simple question and answer format regarding the prevalence and management of the most common AEs. Answers were based on empirical evidence from studies (preferably meta-analyses or systematic reviews) retrieved in PubMed, Ovid, EMBASE and Web of Knowledge through 30 June 2012. When no empirical evidence was available, expert consensus of the members of the European ADHD Guidelines Group is provided. The evidence-level of the management recommendations was based on the SIGN grading system. RESULTS The review covers monitoring and management strategies of loss of appetite and growth delay, cardiovascular risks, sleep disturbance, tics, substance misuse/abuse, seizures, suicidal thoughts/behaviours and psychotic symptoms. CONCLUSION Most AEs during treatment with drugs for ADHD are manageable and most of the times it is not necessary to stop medication, so that patients with ADHD may continue to benefit from the effectiveness of pharmacological treatment.
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Affiliation(s)
- Samuele Cortese
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center of the NYU Langone Medical Center, New York, NY, USA.
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31
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Millichap JG. Efficacy and Safety of Methylphenidate for ADHD and Uncontrolled Seizures. Pediatr Neurol Briefs 2011. [DOI: 10.15844/pedneurbriefs-25-8-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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