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Journal of Child Neurology
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Attention-Deficit Disorders and Epilepsy in Childhood: Incidence, Causative Relations and Treatment Possibilities

Rami Kaufmann, MD

Department of Child Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel

Hadassa Goldberg-Stern, MD

Epilepsy Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel

Avinoam Shuper, MD

Department of Child Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel, AVINOAMS{at}clalit.org.il

At least 20% of children with epilepsy have clinical attention-deficit hyperactivity disorder (ADHD) compared to 3% to 7% of the general pediatric population. Several mechanisms may account for the high prevalence, such as a common genetic propensity, noradrenergic system dysregulation, subclinical epileptiform discharges, or even seizures, antiepileptic drug effects, and psychosocial factors. At the same time, children with attention-deficit hyperactivity disorder have a higher than normal rate of electroencephalography abnormalities (5.6-30.1% vs. 3.5%). Methylphenidate treatment is equally efficient in children with isolated attention-deficit hyperactivity disorder and in children with attention-deficit hyperactivity disorder and epilepsy (70%-77%). Electroencephalography screening in patients with attention-deficit hyperactivity disorder in the absence of other clinical indications or before starting methylphenidate treatment is not currently indicated. Methylphenidate is considered safe for use in children who are seizure-free. However, the few reports of seizure aggravation in methylphenidate-treated children with uncontrolled epilepsy have raised concern.

Key Words: attention-deficit hyperactivity disorder (ADHD) • epilepsy • methylphenidate

Journal of Child Neurology, Vol. 24, No. 6, 727-733 (2009)
DOI: 10.1177/0883073808330165
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