Neuropsychiatric Symptoms of Epilepsy

13 Attention, Executive Function, and Attention Deficit Hyperactivity Disorder
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Table 13.2 Treatment of
attention problems with
people with epilepsy
Treatment of attention problems with
people with epilepsy
1. Optimize seizure control
2. Review antiepileptic drugs for
adverse effect on attention
3. Review history for possible learning
disability, assess and treat if needed
4. Start methylphenidate if evidence of
ADHD
5. If no effect or adverse effect from
MPH, switch to atomoxetine
6. If no effect or adverse effect from
atomoxetine, consider alpha-2 agonist
7. If no effect or adverse effect,
consider amphetamine or low dose
tricyclic antidepressant
threshold, and the data to support this concern are limited. Several studies assessed
the effect of methylphenidate on symptoms of ADHD in children with reasonably
well-controlled seizures. Feldman et al. [ 102 ] and Gross-Tsur et al. [ 103 ] gave children
with ADHD and well-controlled epilepsy methylphenidate 0.3–0.6 mg/kg/day
and found improvement in attention with no adverse effect on seizure control.
Gucuyener et al. [ 70 ] treated 57 children with ADHD and epilepsy with methylphenidate
0.3–1 mg/kg/day and found no change in mean seizure frequency during the
12-month trial. Two recent studies evaluated response to methylphenidate in patients
with more severe, persistent seizures. Fosi et al. [ 104 ], in a study of 18 patients, 6–18
years of age with intractable seizures, intellectual disability, and ADHD, found that
61 % responded favorably to methylphenidate 0.3–1 mg/kg/day, with no worsening
of seizures. Santos et al. [ 105 ] assessed response to methylphenidate up to 1 mg/kg/
day in 22 patients with severe seizures. They found that 73 % had significant
improvement in symptoms of ADHD and also noted a reduction in seizure severity.
There is much less data on amphetamine to treat ADHD in children with epilepsy. In
one retrospective study of 36 patients less than 18 years of age with epilepsy, the response
to amphetamine in 17 patients was compared to methylphenidate in 19 patients [ 106 ].
There was a significant difference in improvement of ADHD symptoms with 63 % of
patients on methylphenidate improved versus 24 % on amphetamine. Seizure-related
factors and cognitive status did not predict response to stimulant. An increase in seizure
frequency was seen in one patient on amphetamine and one on methylphenidate.
Gonzalez-Heydrich et al. [ 107 ] performed a placebo-controlled trial of methylphenidate
OROS in 33 patients 6–18 years of age with epilepsy. Patients received
18, 36, or 54 mg of methylphenidate or placebo for 1 week and were monitored for
seizures and for response of symptoms of ADHD using the CGI-ADHDimprovement
scale. At each dose, patients receiving methylphenidate OROS showed
a greater decrease in ADHD symptoms than those receiving placebo. The percent of
patients improving was higher on 54 mg than on 18 or 36 mg, but there was a trend
for increase in seizure number at the higher dose of methylphenidate.