Expert Review on the Use of Methylphenidate in Children and Adult With Epilepsy and Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a comorbidity affecting 12%–29% of individuals with epilepsy, significantly impacting learning, psychosocial development, behaviour, and quality of life. Moreover, ADHD and epilepsy share a bidirectional relationship. Although methylphenidate has been proven effective in alleviating ADHD symptoms, its use remains limited in individuals with epilepsy due to outdated concerns—dating back over 20 years—that psychostimulants could increase seizure frequency. This manuscript presents a narrative review of the scientific literature published between January 2000 and May 2026 regarding the use of methylphenidate in patients with epilepsy and ADHD. Based on the available evidence, a panel of paediatric neurologists from five Spanish tertiary hospitals with expertise in epilepsy and neurodevelopmental disorders reached an expert consensus and developed a series of practical recommendations for the assessment and management of these patients. This expert group issued several recommendations, including the proactive screening of ADHD symptoms in all children and adults with epilepsy from the onset of the condition. Current evidence has not consistently demonstrated an increased seizure risk associated with methylphenidate in patients with epilepsy, although available data remain limited for some epilepsy subgroups. Furthermore, undertreatment of ADHD is associated with poorer patient outcomes. Methylphenidate may be considered in children and adults with epilepsy when clinically indicated, following optimization of epilepsy management, associated comorbidities, and behavioural and psychosocial interventions. Treatment decisions should be individualized, particularly in patients with active epilepsy, drug-resistant epilepsy, recent seizure worsening, or developmental and epileptic encephalopathies.