Expert: Dr Billy Levin - 9/28/2010

Question
Hi Dr

Can you please advise me as to what would happen if a child (young adult) is diagnosed with ADHD and also has seizures (used to be mild seizures but the day before yesterday, it turned into a full blown epileptic seizure - first time ever)!  My child is now 18, has not been on any medication for the last +- 2 yrs as we found that the Epilem brought on her seizures more regularly - don't recall the dosage she was on before unfortunately.  About 3 - 4 yrs ago she was diagnosed as having ADHD.  She used Ritalin but this medication made her very aggressive so she stopped using it (it got so bad that she physically attacked me). She stopped using the Ritalin.  Currently no medication is being used, however, the fact that she has now had such a seizure is of grave concern and I know that you will recommend medical attention in this case which I am attending to.  I guess my question is whether there could be a correlation between the seizures and the ADHD and also what medication would work for both of these as I believe that some of the ADHD medication could aggravate the seizures and vice versa. Could you please air your opion to this?

Answer
It is possible to have both ADHD and Epilepsy. Ritalin if used alone will provoke the Epilesy. However both must be treated. First control the Epilepsy totally then very slowly start a therapeutic trial on Ritalin increasing the dose to optimal. Otherwise  Strattera may be used istead of Ritalin. Aggression on Ritalin is usually caused by wrong dose and not the Ritalin itself. Titrating to an optimal dose is essential. Epilim on its own will make ADHD worse.