Abstracts

Rationale: Attention deficit hyperactivity disorder (ADHD) affects 12-39% of children with epilepsy. Stimulants are considered first line treatment for ADHD symptoms. However, stimulants may reduce the seizure threshold and can be contraindicated for patients with epilepsy. The FDA approved medical food, Vayarin, is a phosphatidylserine-omega-3 that is EPA enriched and is intended to reduce ADHD symptoms. The effects on patients with epilepsy and ADHD were studied to determine whether Vayarin can be used to treat ADHD without exacerbating seizures.Methods: Texas Child Neurology s electronic health records (EHR) retrospectively identified 35 patients diagnosed with both epilepsy and ADHD who have been prescribed Vayarin. Vayarin therapy in these selected patients had a duration of at least 3 months. Seizure classification, concurrent antiepileptic drugs (AEDs) and effect on ADHD symptoms were evaluated via EHR review. Of the 35 patients, 13 were taking stimulant medication, 3 were taking non-stimulant medication, and 19 were not taking any ADHD medication. Follow-up phone interviews supplemented information in the EHR. Seizure frequency and ADHD symptom changes were quantified.Results: Thirty-five patients with epilepsy and ADHD were on Vayarin for at least 3 months. 15 females and 20 males included in the study had ages ranging from 3 to 22 years; mean age, 11 years. Nineteen patients were diagnosed with localized epilepsy. For patients with partial seizures while using Vayarin, 6 had a reduction in seizure frequency and 1 had an increase in seizure frequency. Two patients had variable seizure frequency during the treatment. Ten patients had stable seizure control while taking Vayarin and were seizure-free before the addition of Vayarin. Six patients were diagnosed with generalized epilepsy with nonconvulsive seizures. While using Vayarin, 2 of these patients had reduction of seizure frequency. Four patients had stable seizure control and were seizure-free before the addition of Vayarin. Seven patients were diagnosed with generalized epilepsy with convulsive seizures. One patient had an increase in seizure frequency. The other 6 were stable. Five of the 6 stable patients were seizure-free prior to the addition of Vayarin. Two patients were diagnosed with generalized epilepsy with both convulsive and nonconvulsive seizures. Both had stable seizure control and had been seizure-free. 34 of the 35 patients (97%) with epilepsy showed improvement in ADHD symptoms and are continuing to take Vayarin with their other medication. Side effects of decreased appetite and moodiness occurred in 4 patients. One patient had these effects after the addition of Vayarin, while 3 patients had these side effects after the addition of Vayarin and other treatment modifications. Conclusions: Vayarin did not adversely affect baseline seizure frequency. Patients (97%) had decreased symptoms of their ADHD. Vayarin was shown to be a safe and viable method of lessening the effects of ADHD in children with epilepsy. No significant side effects were reported.