Dear Editor:
In the article, “Adult ADHD: Diagnosis, Differential Diagnosis, and Medication Management” [Gentile, et al. Psychiatry 2006 2006;3(8):24–30], on page 28 the authors state that seizure history is a relative contraindication to the use of stimulants.
I would like to mention that many clinical trials have shown no increase in risk of seizures for patients on stimulants, especially when used in therapeutic doses. Gucuyener, et al.,1 compared 57 patients with active seizures and 62 patients with abnormal EEG and found no increase in seizures with use of stimulants. Gross-Tsur, et al.,2 had a similar conclusion about minimal risk, if any, of seizures from use of stimulants.
We must remember that ADHD commonly is a coexisting condition in children and adolescents with seizure disorder, and many times the ADHD is their most imminent concern. These patients should not be denied a trial of stimulants based on inconsistent literature regarding relative contraindications. Likewise, we should carefully monitor stimulant use in all patients, especially the younger ones, because any accidental or intentional overdose or nontherapeutic dose can result in serious complications, including seizures. Another important thing to remember is that certain stimulants can interact with antiseizure medications. For example, methylphenidate can increase the phenytoin level while carbamazepine can decrease the methylphenidate level.
With regards,
Tanvir Singh, MD
Assistant Professor, Department of Psychiatry, Medical University of Ohio, Toledo, Ohio
References
- 1.Gucuyener K, Erdemoglu AK, Senol S, et al. Use of methylphenidate for attention deficit hyperactivity disorder in patients with epilepsy or electroencephalographic abnormalities. J Child Neurol. 2003;18:109–12. doi: 10.1177/08830738030180020601. [DOI] [PubMed] [Google Scholar]
- 2.Gross-Tsur V, Manor O, Vander Meere J, et al. Epilepsy and attention deficit hyperactivity disorder: Is methulphenidate safe and effective? J Pediatr. 1997;130:670–4. doi: 10.1016/s0022-3476(97)70258-0. [DOI] [PubMed] [Google Scholar]