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Methylphenidate for Cognitive Problems in Epilepsy Patients?
In a small study, a single dose helped attention and processing speed.
Patients with epilepsy often complain of cognitive difficulties, which may be due to the underlying brain dysfunction or from the antiepileptic medication. Stimulants might help problems with attention, concentration, and fatigue, but clinicians and patients have raised concerns about the safety of stimulants, despite evidence indicating that they do not increase the risk for seizures. The current researchers conducted a double-blind, randomized, three-arm, cross-over study comparing a single dose of 10-mg methylphenidate, 20-mg methylphenidate, and placebo in 31 patients with epilepsy and chronic cognitive complaints (mean age, 35; 13 men; mean time since epilepsy diagnosis, 12.5 years; focal epilepsy, 24 patients).
Treatments were administered 1 week apart. Both methylphenidate doses were associated with significant benefit for processing speed and attention (but not immediate verbal recall). Patients tolerated the single doses well, although two patients withdrew because of anxiety and one because of self-limited tachycardia.
This study provides us with a few clinically relevant insights. First, the authors review the data on the safety of stimulants in epilepsy and note the lack of evidence that methylphenidate is associated with seizures. Second, a single dose can be beneficial for selected cognitive problems. This study does not answer questions about the efficacy or safety of long-term dosing. However, physicians can administer a single dose to determine if it is tolerated and beneficial. If so, continued treatment would seem reasonable.
Jonathan Silver, MD reviewing Adams J et al. Neurology 2017 Jan 31.
Adams J et al. Methylphenidate, cognition, and epilepsy: A double-blind, placebo-controlled, single-dose study. Neurology 2017 Jan 31; 88:470.
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