Torres Alcy R, Whitney Jane, Gonzalez-Heydrich Joseph
Department of Neurology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Epilepsy Behav. 2008 Feb;12(2):217-33. doi: 10.1016/j.yebeh.2007.08.001. Epub 2007 Dec 11.
Attention-deficit/hyperactivity disorder (ADHD) in children with epilepsy is a common source of impairment. Based on review of Medline indexed articles, meeting abstracts, and data requested from drug manufacturers, a summary of evidence that might guide treatment and research is presented. Methylphenidate (MPH) has shown high response rates and no increase in seizures in small trials. However, low baseline seizure rates, small numbers of subjects, and short observation periods limit the power of these studies to detect increases in seizure risk. Although longer-term effects of MPH and its effects in children with frequent seizures need to be studied, the evidence available at this time best supports use of MPH for the treatment of ADHD not amenable to changes in antiepileptic drugs or improvements in seizure control. This treatment should be part of a biopsychosocial approach. Other agents show promise. Preclinical, retrospective and open-label studies on amphetamines and atomoxetine support undertaking randomized controlled studies of these agents in patients with ADHD plus epilepsy. In contrast, additional data on guanfacine and modafinil should be gathered before undertaking randomized controlled studies with these agents.
癫痫患儿的注意力缺陷多动障碍（ADHD）是常见的功能损害来源。基于对Medline索引文章、会议摘要以及向药品制造商索取的数据的综述，本文呈现了可能指导治疗和研究的证据总结。在小型试验中，哌甲酯（MPH）显示出高反应率且癫痫发作未增加。然而，低基线癫痫发作率、受试者数量少以及观察期短限制了这些研究检测癫痫发作风险增加的能力。尽管需要研究MPH的长期影响及其对频繁癫痫发作儿童的影响，但目前可得的证据最支持使用MPH治疗对调整抗癫痫药物或改善癫痫控制无效的ADHD。这种治疗应成为生物心理社会方法的一部分。其他药物也显示出前景。关于苯丙胺和托莫西汀的临床前、回顾性及开放标签研究支持对这些药物在ADHD合并癫痫患者中进行随机对照研究。相比之下，在对胍法辛和莫达非尼进行随机对照研究之前，应收集更多数据。
