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Methylphenidate, cognition, and epilepsy: A 1‐month open‐label trial
Author(s) -
Adams Jesse,
AlipioJocson Valerie,
Inoyama Katherine,
Bartlett Victoria,
Sandhu Saira,
Oso Jemima,
Barry John J.,
Loring David W.,
Meador Kimford J.
Publication year - 2017
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13917
Subject(s) - methylphenidate , epilepsy , anxiety , beck depression inventory , placebo , psychology , stimulant , apathy , beck anxiety inventory , depression (economics) , psychiatry , medicine , anesthesia , cognition , attention deficit hyperactivity disorder , alternative medicine , pathology , economics , macroeconomics
Summary Objective Cognitive difficulties are common in epilepsy. Beyond reducing seizures and adjusting antiepileptic medications, no well‐validated treatment exists in adults. Methylphenidate is used effectively in children with epilepsy and attention‐deficit/hyperactivity disorder, but its effects in adults have not been systematically evaluated. We hypothesized that methylphenidate can safely improve cognition in adults with epilepsy. We detail here the open‐label follow‐up to a double‐blind, placebo‐controlled, single‐dose study. Methods Thirty epilepsy patients entered a 1‐month open‐label methylphenidate trial after a double‐blind phase. Doses were titrated according to clinical practice and patient tolerance, ranging 20–40 mg/day. Primary measures included: Conners’ Continuous Performance Test (CPT), Symbol–Digit Modalities Test ( SDMT ), and Medical College of Georgia Memory Test ( MCG ). Secondary measures were: Beck Depression Inventory, 2nd Edition ( BDI ‐ II ), Beck Anxiety Inventory, Apathy Evaluation Scale ( AES ), Stimulant Side‐Effect Checklist, Adverse Events Profile, Quality of Life in Epilepsy‐89 ( QOLIE ‐89), and seizure frequency. Fourteen healthy, nonmedicated controls were tested concurrently. Results Twenty‐eight participants with epilepsy (13 men/15 women) completed the trial. Withdrawals occurred due to anxiety (n = 1) and fatigue (n = 1). Mean age was 36.4 years (range = 20–60). Epilepsy types were: focal (n = 21), generalized (n = 6), or unclassified (n = 1). Mean epilepsy duration was 12.3 years. Mean baseline seizure frequency was 2.8/month. There were significant improvements on methylphenidate for SDMT , MCG , CPT (the ability to discriminate between targets and nontargets [d′] hits, hit reaction time standard deviation, omissions, and commissions), and QOLIE subscales (energy/fatigue, attention/concentration, memory, and language; paired t tests; p ≤ 0.002). BDI ‐ II and additional subscales also improved, at a lower level of statistical significance. Effect sizes were moderate to large. Comparisons with untreated controls (n = 14) revealed greater improvement for epilepsy patients on omissions and commissions, with improvement trends on d′ and hits. Seizure frequency did not increase with methylphenidate treatment (2.8/month vs. 2.4/month). Significance Methylphenidate may be an effective and safe option for improving cognition and quality of life in epilepsy. Larger and longer double‐blind, placebo‐controlled clinical trials are needed.