• Jesse Adams, Valerie Alipio-Jocson, Katherine Inoyama, Victoria Bartlett, Saira Sandhu, Jemima Oso, John J Barry, David W Loring, and Kimford Meador.
• From Psychiatry and Behavioral Sciences (J.A., V.A.-J., S.S., J.O., J.J.B.) and Neurology and Neurological Sciences (K.I., V.B., K.M.), Stanford University, CA; and Neurology (D.W.L.), Emory University, Atlanta, GA. jadamsmd@uw.edu.
• Neurology. 2017 Jan 31; 88 (5): 470-476.

ObjectiveTo evaluate the potential efficacy of immediate-release methylphenidate (MPH) for treating cognitive deficits in epilepsy.MethodsThis was a double-blind, randomized, single-dose, 3-period crossover study in patients with epilepsy and chronic cognitive complaints comparing the effects of placebo and MPH 10 and 20 mg given 1 week apart. Cognitive outcome was evaluated on the basis of an omnibus z score calculated from performance on the Conners Continuous Performance Test 3 (ability to discriminate between target and nontarget stimuli [d'] and hit reaction time standard deviation), Symbol-Digit Modalities Test, and Medical College of Georgia Paragraph Memory Test. Adverse events and seizure frequency were monitored. An open-label follow-up is reported elsewhere.ResultsThirty-five adult patients with epilepsy participated, of whom 31 finished. Demographics included the following: mean age = 35.3 years (range 20-62 years), 13 men and 18 women, and baseline seizure frequency of 2.8 per month. Epilepsy types were focal (n = 24), generalized (n = 6), or unclassified (n = 1). Mean epilepsy duration was 12.5 years. A statistically significant performance benefit was present at both 10-mg (p = 0.030) and 20-mg (p = 0.034) MPH doses. No seizures were associated with either MPH dose. Adverse effects leading to withdrawal included cognitive "fogginess" (n = 1 on 20 mg), anxiety/agitation (n = 1 on 10 mg), and tachycardia (n = 1). One participant was lost to follow-up after one 20-mg dose without side effect.ConclusionsThis single-dose study suggests that MPH may be effective in ameliorating some cognitive deficits in patients with epilepsy. Additional studies are required.Clinicaltrialsgov IdentifierNCT02178995.Classification Of EvidenceThis study provides Class II evidence that single doses of MPH improve cognitive performance on some measures of attention and processing speed in patients with epilepsy and cognitive complaints.© 2016 American Academy of Neurology.

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