Mcafee AT, Holdridge KC, Johannes CB, Hornbuckle K, Walker AM. The effect of pharmacotherapy for attention deficit hyperactivity disorder on risk of seizures in pediatric patients as assessed in an insurance claims database. Curr Drug Saf. 2008 May 1;3(2):123-31.

Purpose: To estimate the rate of new-onset seizure in ADHD patients in relation to ADHD pharmacotherapy. Methods: A retrospective cohort study of 34,727 patients, ages 6 to 17, with at least two insurance claims bearing ADHD diagnoses during 2003 in the UnitedHealthcare database. Incidence of seizure was calculated for observation time during treatment with atomoxetine and stimulants/bupropion. Results: Seizure incidence among ADHD patients was 4.5/1,000 person-years (p-y; 95% confidence interval 3.7 – 5.5). ADHD patients who received any ADHD medication had an incidence of 3.8/1,000 p-y (3.0 – 4.8) compared to 8.7 (5.8 –12.4) for patients who did not receive any ADHD medication. The relative risk (RR) for current vs non-use of atomoxetine was 1.1 (0.6 – 2.1). For stimulants and bupropion, the RR for current vs non-use was 0.8 (0.6 – 1.3). Elevated seizure risks were found in association with central nervous system (CNS) disease (OR 3.9, 1.2 – 10.9), CNS medications (OR 2.2, 1.3 – 3.6), metabolic disease (OR 2.9, 1.1 – 6.8), and psychiatric disease risk factors (OR 1.7, 1.1 – 2.6). Conclusions: In this study, there was no statistically significant association between use of atomoxetine or stimulants and seizure risk in children ages 6 to 17 years with ADHD and without prior seizure disorder.

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