One doctor notes that no ADHD medication has been adequately studied in a patient with co-occurring epilepsy. Methylphenidate (MPH) is the most studied for these co-occurring conditions. MPH has shown good short-term effectiveness. He proposes a dosing regimen of immediate-release MPH and OROS-MPH, since these preparations have been the most studied in children with seizures. Another doctor advises that it is essential to obtain detailed information about the development of ADHD in relation to the onset, course, and treatment of epilepsy before making a decision about what drugs to prescribe and in what dosages. A stimulant is recommended as a first-line treatment for ADHD. A long-acting MPH preparation is also recommended. A third doctor notes that several open-label trials suggest that stimulant medication may be a first-line therapy for children with ADHD and epilepsy. Further, most studies have found no increase in seizure frequency after the addition of MPH in children with well-controlled epilepsy. Four other doctors are in agreement that given the patient's currently well-controlled seizures, his ADHD and oppositional defiant disorder should be treated according to current practice guidelines. First-line pharmacotherapy in this case would be psychostimulants. Given the patient's comorbid oppositional defiant disorder, an extended-release MPH is recommended. All of the doctors recommend monitoring patient reactions to the drugs and their dosages, followed by indicated modifications. 15 references