Stimulants are the most commonly used medications in the treatment of attention deficit hyperactivity disorder (ADHD), a neurodevelopmental disorder whose symptoms manifest early in childhood. Besides other co-occurring disorders, children with ADHD are often diagnosed with epilepsy. Although there are no guidelines on managing children diagnosed with both ADHD and epilepsy, most clinical drug trials involving stimulants have excluded children with pre-existing epilepsy based on the hypothetical risk that the medication will aggravate seizures.
A team of researchers at the Indiana University (IU) Bloomington investigated if ADHD medication increased the risk of seizures. Results of the study, published in the journal Neurology in February 2018, showed that patients with ADHD had an elevated risk of seizures compared to non-ADHD individuals. However, ADHD medication prescribed for the disorder was linked to a lower risk of seizures among patients, both with and without a past history of epilepsy. The findings disproved current hypotheses linking ADHD medication with a higher risk of seizures.
The researchers also carried out long-term, within-person comparisons and found no link between ADHD medication use and seizures among individuals, both with or without a previous history of seizures. A two-year cumulative association analysis also suggested the same outcome.
The researchers collected data on prescription drug claims of 801,838 patients (aged 5-64, 59.21 percent male) with ADHD, relating to the period 2005-2014. The data was compared to a control group comprising 801,831 people. Two categories of ADHD medications were analyzed: stimulants (including Adderall, Focalin and Dexedrine), and atomoxetine hydrochloride, a non-stimulant drug approved by the Food and Drug Administration (FDA) and sold under the brand name Strattera.
ADHD medication possibly targets shared symptomology
According to the researchers, the findings could be attributed to several possibilities. They hypothesized that ADHD medications could be targeting a shared symptomology which increased the risk of individuals for both ADHD and epileptic seizures. It was also possible that ADHD medicines were helping affected individuals in adhering to their anti-epilepsy drug regimens, or they were helping in alleviating stress.
A previous study evaluated the efficacy and safety of methylphenidate, a stimulant commonly sold under the brand name Ritalin, in treating co-occurring ADHD and severe epilepsy among 22 children (average age: 11 years 2 months). The participants were administered methylphenidate for three months as part of an open-label, non-controlled trial. At the end of the trial, it was found that besides significantly improving symptoms of ADHD, methylphenidate also reduced the severity of seizures.
The authors of the current as well as past study emphasized that although evidence suggested that ADHD medication did not increase the risk of seizures, randomized controlled trials were needed to substantiate the findings. The current study also suffered from additional limitations. Since the researchers investigated data pertaining to individuals with commercial health insurance, it was possible that the findings would not be replicated in other groups. Information on seizures from hospital records and emergency department visits was deemed to be incomplete, and medication usage frequencies could not be determined from data on health insurance claims.
Adolescent ADHD treatment
Estimates regarding the prevalence of ADHD in American children have changed over time, and they can vary depending on the methods used for measurement. According to the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5 percent children have ADHD. It was previously found that nearly 6.4 million children aged 4-17 (11 percent of the age group) had ever received an ADHD diagnosis. Males had a higher likelihood of being diagnosed with ADHD than females. Past research also found a higher ADHD prevalence rate of 20-50 percent in children with epilepsy.
Symptoms of ADHD can be managed with the right treatment. According to the American Academy of Pediatrics (AAP), simultaneous behavioral therapy and medication is effective for children aged 6 and older. For ADHD children aged below 6, behavioral therapy is suggested as a preferred treatment before administering medication. School accommodations and interventions may also be required as a part of the treatment process.
White River Academy is a leading ADHD treatment center for boys in the U.S. It helps teen boys aged 12-17 struggling with ADHD focus on developing life skills that help in altering problematic behavior. Contact our 24/7 helpline or chat online with a trained specialist for more information about the best ADHD residential treatment center for boys.