Expert Review on the Use of Methylphenidate in Children and Adult With Epilepsy and Attention Deficit Hyperactivity Disorder
5 affiliations
- 1Unidad de Neurología, Hospital Niño Jesús, 28009 Madrid, Spain
- 2Área de Neurología Pediátrica y Neurofisiología. Hospital Sant Joan de Déu. Institut de Recerca Sant Joan de Déu. EpiCARE Coordinator Center, 08950 Barcelona, Spain
- 3Servicio de Pediatría, Hospital Miguel Servet, 50009 Zaragoza, Spain
- 4Unidad de Neuropediatría, Servicio de Pediatría, Hospital Universitario de Navarra, 31008 Pamplona, Spain
- 5Unidad de Neurología Pediátrica, AGC de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
Abstract
Attention deficit hyperactivity disorder (ADHD) is a comorbidity affecting 12%–29% of individuals with epilepsy, significantly impacting learning, psychosocial development, behaviour, and quality of life. Moreover, ADHD and epilepsy share a bidirectional relationship. Although methylphenidate has been proven effective in alleviating ADHD symptoms, its use remains limited in individuals with epilepsy due to outdated concerns—dating back over 20 years—that psychostimulants could increase seizure frequency. This manuscript presents a narrative review of the scientific literature published between January 2000 and May 2026 regarding the use of methylphenidate in patients with epilepsy and ADHD. Based on the available evidence, a panel of paediatric neurologists from five Spanish tertiary hospitals with expertise in epilepsy and neurodevelopmental disorders reached an expert consensus and developed a series of practical recommendations for the assessment and management of these patients. This expert group issued several recommendations, including the proactive screening of ADHD symptoms in all children and adults with epilepsy from the onset of the condition. Current evidence has not consistently demonstrated an increased seizure risk associated with methylphenidate in patients with epilepsy, although available data remain limited for some epilepsy subgroups. Furthermore, undertreatment of ADHD is associated with poorer patient outcomes. Methylphenidate may be considered in children and adults with epilepsy when clinically indicated, following optimization of epilepsy management, associated comorbidities, and behavioural and psychosocial interventions. Treatment decisions should be individualized, particularly in patients with active epilepsy, drug-resistant epilepsy, recent seizure worsening, or developmental and epileptic encephalopathies.
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- Family socioeconomic status and attention-deficit/hyperactivity disorder symptoms in preschool children: a cross-sectional study of 21,366 parent–child dyads in Yan’an, western China
- Changes in parent-rated attention-deficit/hyperactivity disorder symptom scores and sleep parameters during individualized multidisciplinary clinical management in children with comorbid obstructive sleep apnea: a prospective cohort study in Vietnam
BibTeX
@article{insuga2026expert,
title = {{Expert Review on the Use of Methylphenidate in Children and Adult With Epilepsy and Attention Deficit Hyperactivity Disorder}},
author = {Víctor Soto Insuga and María Eugenia Russi and Elena González Alguacil and Javier López Pisón and Sergio Aguilera Albesa and Ignacio Málaga Dieguez and Carmen Fons},
journal = {Revista de Neurología},
year = {2026},
month = oct,
doi = {10.31083/rn52291},
url = {https://doi.org/10.31083/rn52291},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Expert Review on the Use of Methylphenidate in Children and Adult With Epilepsy and Attention Deficit Hyperactivity Disorder
AU - Víctor Soto Insuga
AU - María Eugenia Russi
AU - Elena González Alguacil
AU - Javier López Pisón
AU - Sergio Aguilera Albesa
AU - Ignacio Málaga Dieguez
AU - Carmen Fons
PY - 2026
DA - 2026/10/29
JO - Revista de Neurología
DO - 10.31083/rn52291
UR - https://doi.org/10.31083/rn52291
AB - Attention deficit hyperactivity disorder (ADHD) is a comorbidity affecting 12%–29% of individuals with epilepsy, significantly impacting learning, psychosocial development, behaviour, and quality of life. Moreover, ADHD and epilepsy share a bidirectional relationship. Although methylphenidate has been proven effective in alleviating ADHD symptoms, its use remains limited in individuals with epilepsy due to outdated concerns—dating back over 20 years—that psychostimulants could increase seizure frequency. This manuscript presents a narrative review of the scientific literature published between January 2000 and May 2026 regarding the use of methylphenidate in patients with epilepsy and ADHD. Based on the available evidence, a panel of paediatric neurologists from five Spanish tertiary hospitals with expertise in epilepsy and neurodevelopmental disorders reached an expert consensus and developed a series of practical recommendations for the assessment and management of these patients. This expert group issued several recommendations, including the proactive screening of ADHD symptoms in all children and adults with epilepsy from the onset of the condition. Current evidence has not consistently demonstrated an increased seizure risk associated with methylphenidate in patients with epilepsy, although available data remain limited for some epilepsy subgroups. Furthermore, undertreatment of ADHD is associated with poorer patient outcomes. Methylphenidate may be considered in children and adults with epilepsy when clinically indicated, following optimization of epilepsy management, associated comorbidities, and behavioural and psychosocial interventions. Treatment decisions should be individualized, particularly in patients with active epilepsy, drug-resistant epilepsy, recent seizure worsening, or developmental and epileptic encephalopathies.
SN - 0210-0010
SN - 1576-6578
ER -