Intellectual Disability and Epilepsy

Shankar, Rohit; Watkins, Lance; Brown, Stephen

doi:10.1007/978-3-319-90083-4_10

Cited by 3 publications

(4 citation statements)

References 68 publications

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“…In general, it is important to be aware of the wide range of other physical health conditions that can mimic seizure activity. Potential differential diagnoses include cardiac syncope, sleep disorders, and metabolic disturbances [65].…”

Section: Diagnostic Challengementioning

confidence: 99%

Epilepsy in adults with neurodevelopmental disability ‐ what every neurologist should know

Watkins¹,

Linehan²,

Brandt³

et al. 2022

Epileptic Disorders

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This seminar in epileptology addresses Learning Objective 6.1.4 of the International League against Epilepsy Curriculum: Demonstrate the ability to recognize and manage the special needs of persons with epilepsy (and Neurodevelopmental Disorders [NDDs]). The review identifies the essential competencies for neurologists working with people with epilepsy and NDDs, and these competencies are discussed alongside clinical examples. Furthermore, the seminar explores the opportunities offered by integrated service provision between neurology and services for NDD. The epileptic encephalopathies are not a subject of this seminar paper as they are circumscribed by other ILAE learning objectives. This seminar frames the complexity of seizures in association with NDD with a focus on major NDDs; intellectual disability, autism spectrum disorder, and attention deficit hyperactivity disorder. The evidence presented considers epidemiology, co-morbidities, risk factors, mortality, and the diagnostic and treatment challenges. People with NDDs and epilepsy have higher rates of physical and psychiatric co-morbidity, polypharmacy, neuropsychiatric side effects of drugs, and premature mortality including sudden unexpected death in epilepsy. There is a limited Level 1 evidence base to guide assessment and treatment for seizures in adults with NDDs. Therefore, throughout this seminar, the evidence presented for associations and treatment should be observed in context along with its limitations. The evidence for pharmacological treatment of seizures in association with NDDs is presented alongside expert commentary and guidance. There is Level 2 evidence to support treatment with some of the newer anti-seizure medications including brivaracetam, lacosamide, eslicarbazepine acetate, and perampanel as second-line choices. Seizures with a co-morbid NDD should be considered as a collective complex clinical presentation and not discrete conditions. This seminar was co-designed, co-produced and co-authored by an expert by experience and includes case studies and a video to highlight what can go wrong and how it can be avoided.

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Section: Diagnostic Challengementioning

confidence: 99%

Epilepsy in adults with neurodevelopmental disability ‐ what every neurologist should know

Watkins¹,

Linehan²,

Brandt³

et al. 2022

Epileptic Disorders

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“…Rohit Shankar , 1,2 Bhathika Perera, 3 Rhys H Thomas 4,5 In 1997, the neurologist Rajendra Kale stated in the British Medical Journal 'The history of epilepsy can be summarised as 4000 years of ignorance, superstition, and stigma followed by 100 years of knowledge, superstition, and stigma'. Epilepsy remains an orphan disorder, in so much that it remains ostracised from the family of neurodevelopmental disorders (NDDs).…”

Section: Epilepsy An Orphan Disorder Within the Neurodevelopmental Fa...mentioning

confidence: 99%

“…Significantly higher epilepsy prevalence is observed in ID (22.5%), ASD (20%) and ADHD (15%) than the population prevalence (0.8%). [1][2][3] Prevalence data are not sufficient to explain the variation in care outcomes between people with NDD, with and without epilepsy. We conclude that this driven by ignorance, lack of evidence and indifference.…”

Section: Epilepsy An Orphan Disorder Within the Neurodevelopmental Fa...mentioning

confidence: 99%

Epilepsy, an orphan disorder within the neurodevelopmental family

Shankar

Perera

Thomas

2020

J Neurol Neurosurg Psychiatry

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“…Diagnosing epilepsy and seizure type can be difficult in this population, and both false-positive (stereotypy, cardiac syncope, non-epileptic attack disorder may all mimic epileptic seizure) and false-negative (difficulty diagnosing absence, focal seizures) diagnoses are possible 6 . Also, these people are more prone to die from sudden unexpected death in epilepsy (SUDEP) 7 , 8 …”

Section: Special Issues Relating To Epilepsy In Adults With Intellectual Disabilitiesmentioning

confidence: 99%

Association between epilepsy and challenging behaviour in adults with intellectual disabilities: systematic review and meta-analysis

Brizard¹,

Limbu

2020

BJPsych open

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Background Previous systematic reviews showed no significant association between epilepsy and challenging behaviours in adults with intellectual disabilities. Aims To identify whether there is an association between epilepsy and challenging behaviour in adults with intellectual disabilities by carrying out a systematic review of published data. PROSPERO registration number: CRD42020178092. Method We searched five databases and hand-searched six journals. Two authors independently screened titles, abstracts and full articles using a standardised eligibility checklist. Several meta-analyses were carried out. Results The narrative analysis of data from 34 included articles (14 168 adults with intellectual disabilities, 4781 of whom also had epilepsy) showed no significant association between epilepsy and challenging behaviour. Meta-analysis was possible on data from 16 controlled studies. This showed no significant intergroup difference but after sensitivity analysis meta-analysis of 10 studies showed a significantly higher rate of overall challenging behaviour in the epilepsy group (effect size: 0.16) compared with the non-epilepsy group. Aggression and self-injurious behaviour both showed a statistically significant higher rate in the epilepsy group, with very small effect sizes (0.16 and 0.28 respectively). No significant intergroup difference was observed in the rate of stereotypy. Conclusions The findings are contradictory and must be interpreted with caution because of the difficulty in pooling data from varied studies, which is likely to introduce confounding. Where significant differences were found, effect sizes are small and may not be clinically significant, and there are major methodological flaws in the included studies, which should be addressed in future large-scale properly controlled studies.

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Intellectual Disability and Epilepsy

Cited by 3 publications

References 68 publications

Epilepsy in adults with neurodevelopmental disability ‐ what every neurologist should know

Epilepsy in adults with neurodevelopmental disability ‐ what every neurologist should know

Epilepsy, an orphan disorder within the neurodevelopmental family

Association between epilepsy and challenging behaviour in adults with intellectual disabilities: systematic review and meta-analysis

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