Lens opacities in children using methylphenidate hydrochloride

PURPOSE

To assess clinical findings of eye examination in children having attention deficit hyperactivity disorder (ADHD) administered with methylphenidate hydrochloride.

METHODS

Fifty-seven consecutive patients diagnosed of ADHD and administered with oral methylphenidate hydrochloride treatment for at least one year were involved in this study (Group 1). Sixty healthy subjects (Group 2) having demographic features similar to group 1 were involved as a control group. All patients underwent detailed ophthalmological examination.

RESULTS

One hundred and seventeen consecutive subjects with a mean age of 11.2 ± 2.4 years (7-18 years) were enrolled. Fifty-seven consecutive patient (32 males, 25 females) under oral methylphenidate hydrochloride treatment (Group 1) and 60 healthy control subjects (30 males, 30 females) (Group 2)) were recruited for this prospective study. The mean methylphenidate hydrochloride dosage was 0.9 ± 0.1 mg/kg/day and the mean duration of methylphenidate hydrochloride usage was for 2.73 ± 0.73 years (1-7 years). High intraocular pressure was not observed in any of the patients in our study. We detected lens opacities in five eyes of five patients in group 1 (p = 0.019). The patient with the highest degree of cataract formation had been using MPH for 84 months and this patient's cataract score was P4.

CONCLUSION

Long-term use of methylphenidate may cause lens opacities. In particular, patients who have been using methylphenidate for more than two years should go for regular eye examination.

Effects of attention-deficit/hyperactivity disorder on child abuse and neglect

It is known that children with mental and developmental problems are at risk of abuse and neglect. Attention-deficit/hyperactivity disorder is one of the most frequent neurodevelopmental disorders in children and adolescents. The purpose of this study is to examine whether children diagnosed with ADHD are under more risk in terms of child abuse and neglect compared to controls. In this case-control study, 104 children, who applied to Child and Adolescent Psychiatry Unit of Bursa Yuksek Ihtisas Training and Research Hospital between January and June 2015, were diagnosed with ADHD, and had no other psychiatric comorbidity except for disruptive behavior disorders, and 104 healthy children were compared. Abuse Assessment Questionnaire was applied to children after approval of the families was received. It was determined that the children diagnosed with ADHD were exposed to more physical (96.2%) and emotional abuse (87.5%) in a statistically significant way compared to controls (46.2%; 34.6%), they were exposed to physical and emotional neglect (5.8%) at a lower rate compared to healthy children (24.0%), and there was no difference between them and healthy children in terms of witnessing family violence (56.7%; 47.1%) and being exposed to sexual abuse (5.8%; 1.9%). The children diagnosed with ADHD were exposed to physical and emotional abuse at a higher rate; further studies should emphasize the role of parents in this topic and how parental education and treatment programs change the results.

Antiepileptic treatment in a child with Landau Kleffner syndrome: a case report

INTRODUCTION

Landau-Kleffner Syndrome is a rare childhood disorder characterized by acquired aphasia and epileptiform EEG abnormalities. Hyperactivity and attention problems are common in LKS, and symptoms of Autism Spectrum Disorders (ASDs) may also coexist. Many different treatments have been used for LKS, with varying rates of success. In particular, the effects of antiepileptic drug treatment on acquisition of language have been inconsistent. To the best of our knowledge the literature does not include any reports on the effect of antiepileptic drug treatment on ASD symptoms in patients with LKS. Herein we report a boy with LKS whose ASD symptoms markedly improved in response to antiepileptic treatment.

CASE

A boy aged 3 years 10 months presented to the department of child and adolescent psychiatry due to lack of social interaction, decreased eye contact, stereotypic hand movements, and language regression. The patient was diagnosed as LKS and valproic acid (VAL) treatment was started. The patient was followed-up regularly and after 3 months of treatment with VAL substantial improvement was observed in problematic behaviors, and language and social skills.

DISCUSSION

In the presented LKS case rapid improvement in autism symptoms was observed in response to antiepileptic drug treatment. The patient's reacquisition of speech and rapid improvement in social skills with antiepileptic treatment are important findings. It may be possible to effectively treat ASD symptoms in patients with LKS with early diagnosis and appropriate antiepileptic treatment.