Antiepileptic drugs, occurrence of seizures and effect of co‐administration of potential seizure threshold‐lowering psychotropic drugs in adults with intellectual disability who have epilepsy

Abstract

Epilepsy is a complex neurological disorder and a common condition among people with intellectual disability (Habibi et al., 2016). It is a spectrum disorder, estimated to encompass >25 different syndromes and seizure types with variation in severity among individuals (Habibi et al., 2016;Jensen, 2011). Estimates of the prevalence of epilepsy vary. In people with intellectual disability, this may be the result of underlying population biases and methods employed (Lhatoo & Sander, 2001;McCarron et al., 2014). The prevalence of epilepsy in people without intellectual disability ranges from 0.6% to 1% (Forsgren et al., 2005;McGrother et al., 2006;Ngugi et al., 2010). In people with intellectual disability, estimates of 14%-44% have been reported (Bowley & Kerr, 2000;McCarron et al., 2014). Prevalence rates of epilepsy have shown a strong relationship with level of intellectual disability, those with the most severe intellectual disability having a high prevalence of epilepsy (53%) and those with mild intellectual disability having a lower prevalence (18.9%;McGrother et al., 2006).

The relationship between antiepileptic drug load and challenging behaviors in older adults with intellectual disability and epilepsy

“…To act as a proxy, the individual was required to know the person with intellectual disability for a minimum of six months. In terms of questions relating to epilepsy and the focus of this study, 20.8% of interviews were self-report only, 48.5% used a proxy interview style, and 30.7% used a combination of self-report and proxy style [29].…”

“…McCarron et al undertook a comparison of demographics, showing the IDS-TILDA sample to be representative of this population group [25]. Level of intellectual disability is associated with intelligence quotient scores [26] -mild (50-69), moderate (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), severe (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) and profound (<20). Case notes for each participant where possible, confirmed the correct classification.…”

“…In successive Waves (2 and 3) of the study, each participant/proxy was asked 'since your last interview, has a doctor ever told you that you have epilepsy?'. Consequently, a variable for prevalence was created [29]. Following reported epilepsy diagnosis confirmation, subsequent questions were asked regarding the reported diagnosis e.g., 'When were you first told by a Doctor that you had epilepsy?'.…”

“…Reported epilepsy diagnosis data were not available for one (0.2%) participant with medication data (Fig. 1) [29].…”

“…At the time of interview, trained interviewers checked all medication data for accuracy. Medications were coded using the World Health Organization Anatomical Therapeutic Chemical Classification (ATC) System by two pharmacists JOC and HA [29]. For Wave 3, medication data were available for 549 (90.1%) participants (Fig.…”