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How to treat my ADHD?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At November 12, 2016
Reviewed AtAugust 1, 2023

Patient's Query

Hi doctor,

I have attention deficit hyperactivity disorder (ADHD). My common symptoms are disturbance of selective attention of auditory and visual input, disorders of visual perception, impaired organization and categorization of verbal material, disturbance of language comprehension, impaired long-term memory, altered personality and affective behavior and handwriting problems. Already, I have tried medicines like, Focalin, Adderall, Strattera, Quillivant, Ritalin, Topiramate, Metadate, Concerta, Vyvanse, Dexedrine and antidepressants like Zoloft, Lamictal and Wellbutrin. They all give me the same effect and worst my symptoms. My brain single photon emission computed tomography (SPECT) indicates left caudate and right temporal hypoperfusion. These findings correlate with the reported symptoms of decreased attention and concentration when the temporal lobe is involved as in focal hypoperfusion. An interictal epileptogenic focus or learning disabilities may be present complicating the ADHD. I have no hope for this. Please help

Hi,

Welcome to icliniq.com. I understand your symptoms and the clinical case scenario. Most of the medicines, which work for ADHD (attention deficit hyperactivity disorder), are not working well for you. Actually, they are worsening you. This is an observation which supports the possibility that we are not dealing with an ADHD alone, but also another co-existing disease, most likely medial temporal lobe subclinical seizures. So, you do not have any classical signs of temporal lobe epilepsy, but you do have T signs of temporal dysfunction. I suggest tablet Trileptal 150 mg (Oxcarbazepine) thrice a day to your prescription. This will control your symptoms because of temporal lobe dysfunction. Consult your specialist doctor, discuss with him or her and take the medicine with consent. You should have a normal complete blood count before starting this medicine and after starting every month you should check complete blood count and sodium level. I need to know your magnetic resonance imaging (MRI) brain report. Also, you need to have one EEG (electroencephalogram) to find out the exact form of abnormal electrical activity in your brain.

Patient's Query

Thank you doctor,

Yes, I have both of them. Can I send it to you?

Hi,

Welcome back to icliniq.com. Yes, sure. Please send it across.

Patient's Query

Hi doctor,

I have attached the reports. Please have a look.

Hi,

Welcome back to icliniq.com. I saw the magnetic resonance imaging (MRI) report (attachment removed to protect patient identity), nothing abnormal reported in it. But, when I look at the date, it was done two years ago. I would like to know, when was the single-photon emission computed tomography (SPECT) scan done? Have your symptoms worsen during last two years? If possible, please let me know the electroencephalogram (EEG) report also. Meanwhile, I would like to add one very important suggestion. I hope by this time you already know that the attention deficit hyperactivity disorder (ADHD) is basically all about neurotransmitter imbalance. Meditation helps a lot to regain the balance of brain chemicals. At least half an hour a day, every day would help you a lot. But, it takes time to show some effect. So, along with medicine I would suggest you to do the meditation and moderate physical exercises also. SPECT, MRI and EEG are basically an attempt to localize any point of abnormal electrical activity in your brain. If we are able to localize, with newer treatments, we can treat such issues surgically.

Patient's Query

Thank you doctor,

Yes, my symptoms have worsened. I do not have a recent magnetic resonance imaging (MRI). I found my electroencephalogram (EEG) report, and is not recent either. Thank you doctor that you found the problem at the first try. Is it really hard to live with this? I am going to meet my doctor to discuss about Trileptal.

Hi,

Welcome back to icliniq.com. Thank you for the appreciation. I saw your electroencephalogram (EEG) (attachment removed to protect patient identity), It is not normal and there is abnormal electrical activity in the form of sharp waves. Please meet your neurologist and tell about the abnormal electrical activity in EEG and medial temporal lobe hypometabolism in single-photon emission computed tomography (SPECT). Neurologist will understand the significance of this finding and prescribe you Trileptal or some other antiepileptic of his choice. Also, he or she may ask you to repeat the whole work up that is EEG, magnetic resonance imaging (MRI) and SPECT to know the current condition.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Hardik Nareshbhai Rajyaguru
Dr. Hardik Nareshbhai Rajyaguru

Neurology

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