Impacto do metilfenidato sobre a frequência e a gravidade das crises epilépticas em crianças com o transtorno de déficit de atenção e hiperatividade (TDAH) associado a epilepsias de difícil controle

• Ano de defesa: 2010
• Autor(a) principal: Santos, Kléber Cavalcante
• Orientador(a): Palmini, André Luis Fernandes
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre
• Palavras-chave em Português: MEDICINA; NEUROCIÊNCIA; HIPERATIVIDADE; EPILEPSIA - TERAPIA; ANTICONVULSIVOS; CRIANÇAS; ADOLESCENTES
• Link de acesso: http://hdl.handle.net/10923/4446

Objective- The aim of the study was to evaluate the effectiveness and safety of MPH in children and teenagers with epilepsy, active seizures associated with ADHD. Methods - 22 out of 75 children at average age of (11,4± 3,7) receiving antiepileptic drugs, being attended at tertiary center, serving severe epilepsy, met our criteria for study of one seizure in the last three months. The ADHD diagnosis was performed through a clinical interview according to the criteria from DSM-IV, Kiddie-SADS and SNAP-IV. During the initial three months of the study the children with ADHD and active seizures were treated only with AED. For the remaining 3 months the treatment with MPH was initiated and adjusted to therapeutic doses. The safety of the AED treatment combined with MPH was determined by changes in seizure severity and frequency when compared to the baseline of MPH therapy. Hague Seizure Severity Scale (HASS) and Barkley scale were utilized to evaluate the respective changes on severity and side effects on MPH. Clinical improvement of ADHD symptoms were measured with clinical criteria and SNAP-IV scores. Results ― The analysis of the group demonstrated improvement on the seizure frequency and no side effects on the seizure severity. Low doses of MPH 0,35 mg/kg (± 0,17) were effective against ADHD symptoms with mild adverse effects and safe use in children with active epilepsy. Conclusion ― Low doses of MPH were effective on the treatment of ADHD symptoms, presenting good tolerability and safety in regard to patients with active epilepsy. A crossover double-blind design including exclusively subjects with refractory and frequent seizures could maximize power, confirm the MPH results on the seizure frequency reduction and severity and address a higher patient heterogeneity and recruitment difficulties.