Q: Ritalin and epilepsy?

EEG of SeizureWhen faced with co-morbidities in paediatrics, many of us need to take a deep breath. It’s not really that often your off-the-street child has more than one diagnosis, is it? (And currently, you can take a 9:1 bet on the diagnosis being ‘bronchiolitis’.) So, when the question of treating a child with ADHD and epilepsy arises, there’s a pair of problems that are faced:1) guidance that suggests ‘caution’ when treating children with epilepsy with psychostimulants: but if the child’s climbing the walls, the parents are hiding under the tables and the teachers are barring the school gates, how much ‘caution’ is needed?

2) how do we acquire and appraise evidence of adverse effects, or conjunctions of rare occurrences?

These questions are in the process of being assessed by Dr Boyes in Bradford, but thoughts (as always) are welcome.

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  • Deborah Proctor

    My personal experience is that my seizures are supressed by stimulants! I doubt I’m alone. I finally found a wonderful pediatric neurologist explain why most of my grand mal’s were nocturnal. I’m again, not alone here, and really enjoyed his answer, and think more should consider what he said. He explained that a foci firing in a sleeping brain had nothing to override it, because the “awake” system wasn’t activated. He said that’s why I seldom if ever had major seizures while driving or concentrating, as any firing happening during those periods were “intercepted” by the working circuitry. This thought was further supported by the fact that my seizures of all types were exacerbated by “sedating” AEDS. I had over 40 per day when placed on phenobarb, and equally as poor response to primidone etc. Best response at the time was to pediatric doses of meds (I was 20 at the time). I was eventually diagnosed with a dysembryoplastic neuroepithelial tumor, mesial temporal sclerosis, and cortical dysplasia. Bottom line here: Could we begin doing PET or SPEC scans on epilepsy patients and more research into “augmenting” what’s working, rather than “nuking” the entire brain, and quality of life, for these patients by overmedicating them without really evaluating their issues? We have the technology.. just few neurologist trained, or capable, of thinking outside the box!