Attention-deficit/hyperactivity disorder medication and seizures

Kelsey K. Wiggs, Zheng Chang, Patrick D. Quinn, Kwan Hur, Robert Gibbons, David Dunn, Isabell Brikell, Henrik Larsson, Brian M. D'Onofrio

Research output: Contribution to journalArticle

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Abstract

Objective Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of seizures, but there is uncertainty about whether ADHD medication treatment increases risk among patients with and without preexisting seizures. Methods We followed a sample of 801,838 patients with ADHD who had prescribed drug claims from the Truven Health MarketScan Commercial Claims and Encounters databases to examine whether ADHD medication increases the likelihood of seizures among ADHD patients with and without a history of seizures. First, we assessed overall risk of seizures among patients with ADHD. Second, within-individual concurrent analyses assessed odds of seizure events during months when a patient with ADHD received ADHD medication compared with when the same individual did not, while adjusting for antiepileptic medications. Third, within-individual long-term analyses examined odds of seizure events in relation to the duration of months over the previous 2 years patients received medication. Results Patients with ADHD were at higher odds for any seizure compared with non-ADHD controls (odds ratio [OR] = 2.33, 95% confidence interval [CI] = 2.24-2.42 males; OR = 2.31, 95% CI = 2.22-2.42 females). In adjusted within-individual comparisons, ADHD medication was associated with lower odds of seizures among patients with (OR = 0.71, 95% CI = 0.60-0.85) and without (OR = 0.71, 95% CI = 0.62-0.82) prior seizures. Long-term within-individual comparisons suggested no evidence of an association between medication use and seizures among individuals with (OR = 0.87, 95% CI = 0.59-1.30) and without (OR = 1.01, 95% CI = 0.80-1.28) a seizure history. Conclusions Results reaffirm that patients with ADHD are at higher risk of seizures. However, ADHD medication was associated with lower risk of seizures within individuals while they were dispensed medication, which is not consistent with the hypothesis that ADHD medication increases risk of seizures.

Original languageEnglish (US)
Pages (from-to)e1104-1110
JournalNeurology
Volume90
Issue number13
DOIs
StatePublished - Mar 27 2018

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Attention Deficit Disorder with Hyperactivity
Seizures
Odds Ratio
Confidence Intervals
Anticonvulsants
Uncertainty

ASJC Scopus subject areas

  • Clinical Neurology

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Wiggs, K. K., Chang, Z., Quinn, P. D., Hur, K., Gibbons, R., Dunn, D., ... D'Onofrio, B. M. (2018). Attention-deficit/hyperactivity disorder medication and seizures. Neurology, 90(13), e1104-1110. https://doi.org/10.1212/WNL.0000000000005213

Attention-deficit/hyperactivity disorder medication and seizures. / Wiggs, Kelsey K.; Chang, Zheng; Quinn, Patrick D.; Hur, Kwan; Gibbons, Robert; Dunn, David; Brikell, Isabell; Larsson, Henrik; D'Onofrio, Brian M.

In: Neurology, Vol. 90, No. 13, 27.03.2018, p. e1104-1110.

Research output: Contribution to journalArticle

Wiggs, KK, Chang, Z, Quinn, PD, Hur, K, Gibbons, R, Dunn, D, Brikell, I, Larsson, H & D'Onofrio, BM 2018, 'Attention-deficit/hyperactivity disorder medication and seizures', Neurology, vol. 90, no. 13, pp. e1104-1110. https://doi.org/10.1212/WNL.0000000000005213
Wiggs KK, Chang Z, Quinn PD, Hur K, Gibbons R, Dunn D et al. Attention-deficit/hyperactivity disorder medication and seizures. Neurology. 2018 Mar 27;90(13):e1104-1110. https://doi.org/10.1212/WNL.0000000000005213
Wiggs, Kelsey K. ; Chang, Zheng ; Quinn, Patrick D. ; Hur, Kwan ; Gibbons, Robert ; Dunn, David ; Brikell, Isabell ; Larsson, Henrik ; D'Onofrio, Brian M. / Attention-deficit/hyperactivity disorder medication and seizures. In: Neurology. 2018 ; Vol. 90, No. 13. pp. e1104-1110.
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abstract = "Objective Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of seizures, but there is uncertainty about whether ADHD medication treatment increases risk among patients with and without preexisting seizures. Methods We followed a sample of 801,838 patients with ADHD who had prescribed drug claims from the Truven Health MarketScan Commercial Claims and Encounters databases to examine whether ADHD medication increases the likelihood of seizures among ADHD patients with and without a history of seizures. First, we assessed overall risk of seizures among patients with ADHD. Second, within-individual concurrent analyses assessed odds of seizure events during months when a patient with ADHD received ADHD medication compared with when the same individual did not, while adjusting for antiepileptic medications. Third, within-individual long-term analyses examined odds of seizure events in relation to the duration of months over the previous 2 years patients received medication. Results Patients with ADHD were at higher odds for any seizure compared with non-ADHD controls (odds ratio [OR] = 2.33, 95{\%} confidence interval [CI] = 2.24-2.42 males; OR = 2.31, 95{\%} CI = 2.22-2.42 females). In adjusted within-individual comparisons, ADHD medication was associated with lower odds of seizures among patients with (OR = 0.71, 95{\%} CI = 0.60-0.85) and without (OR = 0.71, 95{\%} CI = 0.62-0.82) prior seizures. Long-term within-individual comparisons suggested no evidence of an association between medication use and seizures among individuals with (OR = 0.87, 95{\%} CI = 0.59-1.30) and without (OR = 1.01, 95{\%} CI = 0.80-1.28) a seizure history. Conclusions Results reaffirm that patients with ADHD are at higher risk of seizures. However, ADHD medication was associated with lower risk of seizures within individuals while they were dispensed medication, which is not consistent with the hypothesis that ADHD medication increases risk of seizures.",
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N2 - Objective Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of seizures, but there is uncertainty about whether ADHD medication treatment increases risk among patients with and without preexisting seizures. Methods We followed a sample of 801,838 patients with ADHD who had prescribed drug claims from the Truven Health MarketScan Commercial Claims and Encounters databases to examine whether ADHD medication increases the likelihood of seizures among ADHD patients with and without a history of seizures. First, we assessed overall risk of seizures among patients with ADHD. Second, within-individual concurrent analyses assessed odds of seizure events during months when a patient with ADHD received ADHD medication compared with when the same individual did not, while adjusting for antiepileptic medications. Third, within-individual long-term analyses examined odds of seizure events in relation to the duration of months over the previous 2 years patients received medication. Results Patients with ADHD were at higher odds for any seizure compared with non-ADHD controls (odds ratio [OR] = 2.33, 95% confidence interval [CI] = 2.24-2.42 males; OR = 2.31, 95% CI = 2.22-2.42 females). In adjusted within-individual comparisons, ADHD medication was associated with lower odds of seizures among patients with (OR = 0.71, 95% CI = 0.60-0.85) and without (OR = 0.71, 95% CI = 0.62-0.82) prior seizures. Long-term within-individual comparisons suggested no evidence of an association between medication use and seizures among individuals with (OR = 0.87, 95% CI = 0.59-1.30) and without (OR = 1.01, 95% CI = 0.80-1.28) a seizure history. Conclusions Results reaffirm that patients with ADHD are at higher risk of seizures. However, ADHD medication was associated with lower risk of seizures within individuals while they were dispensed medication, which is not consistent with the hypothesis that ADHD medication increases risk of seizures.

AB - Objective Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of seizures, but there is uncertainty about whether ADHD medication treatment increases risk among patients with and without preexisting seizures. Methods We followed a sample of 801,838 patients with ADHD who had prescribed drug claims from the Truven Health MarketScan Commercial Claims and Encounters databases to examine whether ADHD medication increases the likelihood of seizures among ADHD patients with and without a history of seizures. First, we assessed overall risk of seizures among patients with ADHD. Second, within-individual concurrent analyses assessed odds of seizure events during months when a patient with ADHD received ADHD medication compared with when the same individual did not, while adjusting for antiepileptic medications. Third, within-individual long-term analyses examined odds of seizure events in relation to the duration of months over the previous 2 years patients received medication. Results Patients with ADHD were at higher odds for any seizure compared with non-ADHD controls (odds ratio [OR] = 2.33, 95% confidence interval [CI] = 2.24-2.42 males; OR = 2.31, 95% CI = 2.22-2.42 females). In adjusted within-individual comparisons, ADHD medication was associated with lower odds of seizures among patients with (OR = 0.71, 95% CI = 0.60-0.85) and without (OR = 0.71, 95% CI = 0.62-0.82) prior seizures. Long-term within-individual comparisons suggested no evidence of an association between medication use and seizures among individuals with (OR = 0.87, 95% CI = 0.59-1.30) and without (OR = 1.01, 95% CI = 0.80-1.28) a seizure history. Conclusions Results reaffirm that patients with ADHD are at higher risk of seizures. However, ADHD medication was associated with lower risk of seizures within individuals while they were dispensed medication, which is not consistent with the hypothesis that ADHD medication increases risk of seizures.

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