Abstracts

Twelve to 39% of children with epilepsy have Attention Deficit/Hyperactivity Disorder (ADHD)¹, yet only methylphenidate has controlled data in this population., We reviewed medical records of pediatric patients with ADHD plus epilepsy given atomoxetine (ATM) abstracting diagnoses, clinical course, adverse events, and prospectively entered Clinical Global Impressions scores (CGI). Response at last visit is a CGI-Improvement score of 1 or 2 plus a drop of at least 1 point in CGI-Severity score compared to baseline, and continuation of ATM., Twenty-seven patients (10.1[plusmn]4.2 years, 63% male) were treated with ATM for median 26, range 4-141 weeks. The average daily dose was 35[plusmn]24 mg (median 25, range 10-100mg). For the 22 patients with weights available the dose was 0.9[underline]+[/underline]0.4 (range 0.1-1.6) mg/kg/day. Twenty-four (90%) had been unsuccessfully treated with stimulants prior to ATM.
ADHD was combined subtype in 21 (78%) patients. Twenty-one patients (88%) were diagnosed with a psychiatric disorder in addition to ADHD including mood disorders in 16, anxiety in 8, and psychosis in 6. Six patients had a concomitant antipsychotic when they began treatment with ATM and 11 patients (41%) were treated with an antipsychotic at the last visit on ATM.
Average seizure frequency at baseline was 9[underline]+[/underline]37 per month (median 0, range 0 to 90). Epilepsy etiology was idiopathic ([italic]n[/italic]=18, 67%), cryptogenic ([italic]n[/italic]=8, 30%) or symptomatic ([italic]n[/italic]=1, 4%). Seizure onset was strictly partial ([italic]n[/italic]=4, 15%), generalized ([italic]n[/italic]=9, 33%), or mixed partial and generalized ([italic]n[/italic]=13, 48%).
Twenty-three patients (85%) were on antiepileptic medications (AED) at baseline, and 21 (78%) at the last visit on ATM. Four patients increased and two patients decreased their AED regimens during ATM treatment. There were no serious adverse events and no patients discontinued ATM due to an increase or worsening of seizures.
Seventeen of 27 patients (63%) discontinued ATM. The reasons were: inadequate response ([italic]n[/italic]=7, 23%), increased irritability/activation ([italic]n[/italic]=8, 30%), appetite decrease and tremor ([italic]n[/italic]=1, 4%), or noncompliance ([italic]n[/italic]=1, 4%). Eight patients (30%) met criteria for response. ATM dose, epilepsy type, and comorbid psychiatric disorders did not predict response or discontinuation., The modest response rate (30%) and high discontinuation rate (63%) on ATM could be due to the high percentage of stimulant non-responders in this sample. The absence of serious adverse events or discontinuations for seizure exacerbation indicates that prospective studies should be planned. Limitations of this study include its small sample size, retrospective nature, and lack of randomization and placebo control.
References:Dunn DW, et al. Dev Med Child Neurol. 2003;45(1):50-54.,