The comorbidity of seizures, epilepsy, and attentiondeficit-hyperactivity disorder (ADHD) prompted the examination of whether atomoxetine use for ADHD is associated with an increased risk of seizures. Seizures and seizure-related symptoms were reviewed from two independent Eli Lilly and Company databases: the atomoxetine clinical trials database and the atomoxetine postmarketing spontaneous adverse event database. Review of clinical trial data indicated that the crude incidence rates of seizure adverse events were between 0.1 and 0.2%, and were not significantly different between atomoxetine, placebo, and methylphenidate. Only 2% of the postmarketing spontaneous reports of seizure events were classified as having no clear contributing or confounding factors, and the reporting rate (8 per 100 000 patients exposed) was within the expected range of population-based incidence. Although children with ADHD are increasingly recognized as being at an elevated risk for seizures, treatment of ADHD symptoms with atomoxetine does not appear to elevate this risk further. The shared vulnerability between ADHD and seizure activity should be taken into account when making treatment decisions for populations of children with epilepsy and children with ADHD.Both epilepsy and attention-deficit-hyperactivity disorder (ADHD) are fairly common childhood illnesses. Between 0.5 and 1% of children experience a single, non-recurrent, unprovoked, convulsive episode, and the annual incidence of epilepsy in children is estimated to be between 50 and 100 per 100 000. 1,2 Childhood estimates of ADHD prevalence range between 3 and 5%. 3 Based on these population background rates, the comorbidity of seizures and ADHD is greater than expected. 4 Among a sample of 175 pediatric patients with epilepsy, 24% met criteria for ADHD, predominantly inattentive type, 11% for ADHD combined type, and 2% for predominantly hyperactive-impulsive type. 5 Conversely, children diagnosed with ADHD have been found to have an elevated risk for electroencephalogram (EEG) abnormalities, as well as subsequent seizures. In a sample of 347 children with ADHD, EEG abnormalities were present in 6.1% of the children, which was significantly greater than the population prevalence rate of 3.5%. 6 Similarly, in a population-based case-control study, a history of ADHD was 2.5 times more common among children with a new diagnosis of seizure than among a sex-and age-matched control group of individuals who had not experienced a seizure. 7 Given this shared vulnerability between seizures and ADHD, the selection of treatment agents requires careful consideration. Several antiepileptic drugs are known to cause behavioral activity that can exacerbate underlying ADHD symptoms. 8 Similarly, stimulant medications used to treat ADHD have been cautioned as possibly lowering the seizure threshold; this risk is routinely cited as part of the drug reference information. 9 Among patients with epilepsy, concerns have been raised that stimulant medications may exacerbate epilepsy, although no ...