Gucuyener 2003.

Methods	A cohort study assessing methylphenidate use amongst patients with ADHD and concomitant active seizures or EEG abnormalities
Participants	Number of participants screened: not stated Number of participants included: 119 (57 with epilepsy, 62 with abnormal EEG but no seizure activity) Number of participants followed up: 119 Number of withdrawals: 0 Diagnosis of ADHD: DSM‐IV (subtype: not stated) Age: mean 9.3, range 6‐16 years old IQ: mean 92.3, range 79‐112 Sex: 98 males, 21 females Methylpenidate‐naïve: not stated Ethnicity: not stated Country: Turkey Comorbidity: epilepsy (47.9%) Comedication: antiepilepsy medication for those with epilepsy Sociodemographics: not stated Inclusion criteria Diagnosis of ADHD according to DSM‐IV criteria between June 1997 and June 2000 Diagnosis of epilepsy or EEG abnormalities without defined seizure
Interventions	Methylphenidate dosage: 0.3‐1 mg/kg Administration schedule: initially once daily in the morning before school and titrated to twice a day (drug free on holidays) Duration of intervention: 12 months Treatment compliance: not stated
Outcomes	Serious adverse events: Seizure frequency, observer rated at 3 months intervals EEG findings, observer rated at 3 months intervals No seizures were observed in any of the patients with ADHD and EEG abnormalities In the ADHD with seizures group, 1 patient's seizure type, generalised tonic clonic, changed to a complex partial seizure, but the number of seizures did not increase Only 5 patients had an increased seizure frequency in the ADHD with seizures group and none of the patients in the ADHD with EEG abnormalities group The number of abnormal EEGs with nonepileptic activity was decreased significantly at the end of the study in both groups (P = 0.05) Adverse events: Drug‐related side effects
Notes	Sample calculation: no Ethics approval: not stated Funding/vested interests: not stated Key conclusions of the study authors: methylphenidate had a beneficial effect on EEG. Seizure frequency did not change from baseline. The side effects of methylphenidate were mild and transient. Methylphenidate is safe and effective in children with ADHD and concomitant active seizures or EEG abnormalities.The present data indicate that methylphenidate is a safe and effective agent in children with ADHD and active seizures of EEG abnormalities. Coadministration of methylphenidate and antiepilepsy drugs improves attention without any adverse effects on seizure threshold or EEG findings. We suggest that physicians give the combined medication to patients with ADHD and active seizures or abnormal EEG findings with close monitoring Comments from the study authors: EEG findings did not deteriorate when patients were on methylphenidate. There was a beneficial effect of methylphenidate of both EEG and seizure frequency. We observed these patients for only 1 year, and 57 epileptic patients were having active seizures. Therefore, the improvement in EEG and seizure frequency might not be completely attributable to maturation Comments from the review authors: all participants were on concomitant antiepilepsy medication Exclusion of methylphenidate non‐responders/children who have previously experienced adverse events on methylphenidate: not stated