Efficacy and Safety of Methylphenidate for ADHD with Tics

Abstract

Neurology| May 01 2002 Efficacy and Safety of Methylphenidate for ADHD with Tics AAP Grand Rounds (2002) 7 (5): 49–50. https://doi.org/10.1542/gr.7-5-49 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Efficacy and Safety of Methylphenidate for ADHD with Tics. AAP Grand Rounds May 2002; 7 (5): 49–50. https://doi.org/10.1542/gr.7-5-49 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: adult attention deficit hyperactivity disorder, attention-deficit/hyperactivity disorder, methylphenidate, tic disorder Source: Kurlan R, The Tourette Syndrome Study Group. Treatment of ADHD in children with tics: a randomized controlled trial. Neurology. 2002;58:527–536. The efficacy of methylphenidate (MPH) and clonidine (CLON), alone and in combination, in 136 children with attention deficit hyperactivity disorder (ADHD) and chronic tic disorder was evaluated in a multicenter, randomized, double-blind clinical trial and reported by the Tourette Syndrome Study Group from the University of Rochester, Rochester, New York. Patients aged 7–14 years were assigned to 1 of 4 groups receiving MPH alone (average dose, 27.5 mg/d, 37 children), CLON alone (.25 mg/d, 34), CLON plus MPH combined (.28 mg/d + 26.1 mg/d, 33), or placebo (32). The 16-week trial consisted of CLON/placebo dose titration (weeks 1–4), MPH/placebo dose titration (weeks 5–8), and maintenance therapy (weeks 9–16). Several rating scales were employed at baseline, including Parent and Teacher Conners Questionnaires for ADHD, and site investigator, teacher, and parent scales for tic severity and frequency. Using the Conners Abbreviated Symptom Questionnaire (Teacher) as the ADHD primary outcome measure, compared to placebo, 60% and 80% of the CLON- and MPH-treated patients, respectively, were improved (P<.002 and P<.003). The greatest improvement (85%) occurred in the combined CLON plus MPH-treated patients (P<.0001). Impulsivity and hyperactivity were controlled most effectively by CLON, and inattention responded best to MPH. Tic disorder, assessed by the parent/teacher Global Tic Rating and Self Report Scales, worsened in 20% of MPH-treated subjects (either MPH alone or in combination with CLON, limiting dosage increase in 35% for MPH alone); 26% of those receiving CLON alone; and 22% of the placebo group. A lessening of tic severity, as measured by the investigator-completed Yale Global Scale, occurred in all active treatment groups (CLON plus MPH, CLON alone, MPH alone, in that order), when compared with placebo. Sedation was reported in 48% (moderate-severe in 28%) of CLON-treated patients, both alone and in combination with MPH, compared with 14% for MPH alone and 6% for placebo. Cardiac toxicity, necessitating withdrawal from the study, was observed in 1 subject who developed ECG evidence of isorhythmic dissociation while receiving CLON alone. Patients receiving MPH alone had the lowest rate of side effects. ADHD is frequently associated with tics/Tourette syndrome (TS), occurring in 50% of TS patients, and often causing more disability than the tics.1 Neurobiologically, the 2 disorders appear to be independent,2 but etiologically, the precipitation or exacerbation of tics in patients with ADHD is often attributed to treatment with central nervous system stimulants.3,4 Tics seen during MPH treatment are dose-related, occurring mainly with larger doses. Despite the evidence linking TS to MPH, recent studies have tended to minimize the risk and causal relationship.5 In the present placebo-controlled study and report, the authors conclude that their findings fail to support recommendations to avoid MPH in children with ADHD and co-morbid tic disorder. Symptoms of ADHD are benefited by MPH to the same degree as that generally observed in subjects... You do not currently have access to this content.