Objectives: Amantadine has been used for attention deficit hyperactivity treatment in head injured patients. Its mechanism of action is thought to be as a dopamine agonist. We present two children with ADHD and concomitant epilepsy, whose ADHD symptoms were not improved with conventional stimulant medications but were significantly ameliorated with amantadine.
Methods: Case reports.
Results: Case 1: A 15 year old male with borderline intellectual impairment and left hemispheric focal seizures with secondary generalization was treated with occasional partial seizures continuing. His schoolwork was substantially impaired by symptoms of ADHD and treatment was instituted sequentially with methylphenidate and dextroamphetamine compounds, with continued symptoms and poor tolerance. He was started on 100mg amantadine twice daily with substantial improvement in concentration and school performance with no worsening of seizures. Treatment has continued for 28 months. Case 2: A 12-year-old female with mild mental retardation was evaluated for ADHD at age 5. Because of concerns for staring episodes and confusion, an EEG was obtained which showed generalized spike wave discharges. She was treated primarily with depakote, but other anticonvulsants including lamictal, zonegran and keppra were used as well. Episodes of confusion were improved on these medications, but attentional issues severely impaired her classroom achievement. Conventional stimulant treatment was not beneficial Amantadine 100mg twice daily was used for 4 months with significant improvement in attention, but discontinued because of pedal and palmar edema.
Conclusion: In summary, two patients are described who have epilepsy and associated ADHD. The ADHD was particularly disabling in both cases and standard treatment with stimulants was not beneficial. Amantadine was beneficial in treating symptoms of ADHD with no deleterious effect on seizure control. Further trials in this population may be useful given the significance of the comorbid conditions of epilepsy and ADHD.
