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

Abstract

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.

Association between epilepsy and psychiatric disorders in adults with intellectual disabilities: systematic review and meta-analysis

“…We have already published a systematic review with meta-analysis specifically on the relationship between epilepsy and problem behaviour in adults with intellectual disabilities. 16 As there is currently no published systematic review and meta-analysis available specifically on the association between psychiatric disorders and epilepsy in adults with intellectual disabilities, we have carried out a systematic review and meta-analysis on studies that explored this relationship. We have concentrated on studies of adults with intellectual disabilities only, as the issues concerning children with intellectual disabilities are different from those of adults.…”

“…This review focuses on data on psychiatric disorders and does not present data on problem behaviour, as a separate systematic review has been published recently on the association between epilepsy and challenging (problem) behaviour in adults with intellectual disabilities. 16 Ethical approval was not required for this study because no individual patient-related data were collected or analysed.…”

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

“…Systematic reviews examining epilepsy as a possible marker [5] for challenging behaviors in people with intellectual disability have yielded inconclusive results [2,5,9,10], with some studies showing an increased prevalence in people with epilepsy and additional factors such as seizures of greater frequency and/or severity, medication side effects, and generalized EEG activity [10]. A metaanalysis of studies of adults with intellectual disability showed a significantly higher rate of challenging behaviors in the epilepsy group compared with the non-epilepsy group, and a significantly higher rate of aggression and SIB in the epilepsy group [9]. However, the authors suggested that the effects may not be clinically significant because of small effect sizes [9].…”

“…A metaanalysis of studies of adults with intellectual disability showed a significantly higher rate of challenging behaviors in the epilepsy group compared with the non-epilepsy group, and a significantly higher rate of aggression and SIB in the epilepsy group [9]. However, the authors suggested that the effects may not be clinically significant because of small effect sizes [9].…”

“…However, lamotrigine has been reported to cause aggression in people with intellectual disability [17]. Other AEDs associated with a higher risk of precipitating challenging behaviors in people with intellectual disability include clobazam, clonazepam, levetiracetam, phenobarbital, perampanel, topiramate, tiagabine, vigabatrin, and zonisamide [9].…”