Tackling increased risks in older adults with intellectual disability and epilepsy: Data from a national multicentre cohort study

Watkins, LV; Henley, William; Sun, James J.; Perera, Bhathika; Angus‐Leppan, Heather; Sawhney, Indermeet; Purandare, Kiran; Eyeoyibo, Mogbeyiteren; Scheepers, Mark; Lines, Geraldine; Winterhalder, Robert; Shankar, Rohit

doi:10.1016/j.seizure.2022.05.022

Cited by 13 publications

(12 citation statements)

References 27 publications

(27 reference statements)

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“…Many PwID with a past history of epilepsy remain seizure free and should be considered for ASM withdrawal. Given the multi-dimensional challenges at the patient, clinician and resource level, 59,60 this remains a poorly engaged topic but requires more research and coproduced engagement to reduce and prevent iatrogenic harm.…”

Section: Discussionmentioning

confidence: 99%

Patterns of antiseizure medications prescribing in people with intellectual disability and epilepsy: A narrative review and analysis

Branford

Sun

Burrows

et al. 2023

Brit J Clinical Pharma

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People with intellectual disabilities (PwID) have a bidirectional relationship with epilepsy. Nearly 25% of PwID have seizures and 30% people with epilepsy are thought to have a significant intellectual impairment. Furthermore, 70% of PwID are thought to have treatment‐resistant epilepsy. In the United Kingdom, antiseizure medications (ASMs) are the second most widely prescribed psychotropic agent for PwID. However, it is unclear what the current evidence and patterns is on current prescribing of ASMs, including when and how a case is made to withdraw them. A narrative review along with an analysis of large‐scale NHS Digital published data (2015–2020) on several aspects of ASM prescribing by general practices for PwID was undertaken. The review results and data analysis are consolidated and presented as 11 themes to provide a comprehensive overview of the study topic. Recent studies estimate that one‐third and one‐fifth of PwID are prescribed ASMs. A history of epilepsy is seen as the primary prescribing reason; however, often it is a legacy, and the indication is no longer clear. The proportion receiving ASMs continues to rise with age. This pattern of use does not correlate well with seizure onset. There are limited data on de‐prescribing ASMs in PwID. The study population heterogenicity, associated polypharmacy, multimorbidity and higher sudden unexpected death in epilepsy risks are outlined. Suggestions are made from available evidence for improving prescribing practices for PwID and seizures, and key areas for further research in this complex clinical area are outlined.

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Section: Discussionmentioning

confidence: 99%

Patterns of antiseizure medications prescribing in people with intellectual disability and epilepsy: A narrative review and analysis

Branford

Sun

Burrows

et al. 2023

Brit J Clinical Pharma

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“…An extension of this issue is the ASM prescribing. Significant concerns are emerging of the use and monitoring of ASMs in people with ID for both seizure and non-seizure management, i.e., for behavioural issues and particularly those over 40 years of age (Watkins et al 2022b;Branford et al 2023a;Branford et al 2023b). This raises concerns of who is monitoring physical health issues such as epilepsy and the associated prescribing in particular, the ASMs in this vulnerable population in a timely, holistic and person centred manner (O'Dwyer et al 2021).…”

Section: Discussionmentioning

confidence: 99%

“…Significant concerns are emerging of the use and monitoring of ASMs in people with ID for both seizure and non‐seizure management, i.e., for behavioural issues and particularly those over 40 years of age (Watkins et al . 2022b; Branford et al . 2023a; Branford et al .…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of people with intellectual disability admitted to hospital with constipation: identifying possible specific high‐risk factors

Laugharne,

Wilcock,

Rees

et al. 2023

J intellect Disabil Res

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BackgroundPeople with intellectual disabilities (ID) die on an average 20 years earlier to the general population. They have higher rates of multimorbidity and polypharmacy. Around 25% of people with ID report chronic constipation. The England Learning Disabilities Mortality Review found that nearly 25% of deaths identified constipation as a long‐term health problem. However, the likely risk factors for constipation related harm are poorly enumerated. We sought to identify possible specific high‐risk factors by examining the clinical characteristics of people with ID admitted to hospital with constipation.MethodsData of people with ID admitted with constipation in two general hospitals covering a population of 1.3 million from 2017 to 2022 were reported using the STROBE guideline for cohort studies. Collected data included age, gender, intellectual disability severity, recorded medication, presenting complaint and co‐morbidities. The medication anticholinergic burden was calculated using the anticholinergic burden scale. Continuous variables were summarised by mean and standard deviation if normally distributed, with categorical variables summarised by the number and percentage in each category.ResultsOf 46 admissions (males 52%), 57% had moderate to profound ID, 37% had epilepsy, 41% prescribed antiseizure medication (ASM) and 45% were on laxatives. Average age was 46 years. The anticholinergic burden score mean was 2.3 and median, one.ConclusionsWe can hypothesise that people with more severe ID, suffering from epilepsy and on ASM may be more at risk of developing severe constipation. Some admissions may be avoided with earlier use of laxatives in the community.

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“…18 Second, PwID on ASMs appear to have high levels of multimorbidity and polypharmacy. 19 In particular, those over 40 years of age are more vulnerable to proportionate increases in polypharmacy and multimorbidity while inversely effected by level of service and care, compared with their younger peers 20 Third, concerns about long-term side-effects relating to issues such as bone and bowel health need considering. 21,22 Who should 'own' the problem?…”

Section: Prescribing Asms For the Management Of Challenging Behaviour...mentioning

confidence: 99%

“…Second, PwID on ASMs appear to have high levels of multimorbidity and polypharmacy. 19 In particular, those over 40 years of age are more vulnerable to proportionate increases in polypharmacy and multimorbidity while inversely effected by level of service and care, compared with their younger peers 20…”

Section: Why Is Addressing Asm Prescribing In Pwid Important?mentioning

confidence: 99%

Antiseizure medications prescribing for behavioural and psychiatric concerns in adults with an intellectual disability living in England

2023

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Summary Antiseizure medications (ASMs) are the second most widely prescribed psychotropic for people with intellectual disabilities in England. Multiple psychotropic prescribing is prevalent in almost half of people with intellectual disabilities on ASMs. This analysis identifies limited evidence of ASM benefit in challenging behaviour management and suggests improvements needed to inform clinical practice.

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Tackling increased risks in older adults with intellectual disability and epilepsy: Data from a national multicentre cohort study

Cited by 13 publications

References 27 publications

Patterns of antiseizure medications prescribing in people with intellectual disability and epilepsy: A narrative review and analysis

Patterns of antiseizure medications prescribing in people with intellectual disability and epilepsy: A narrative review and analysis

Clinical characteristics of people with intellectual disability admitted to hospital with constipation: identifying possible specific high‐risk factors

Antiseizure medications prescribing for behavioural and psychiatric concerns in adults with an intellectual disability living in England

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