Ictal aggression in severely mentally handicapped people

Abstract

Objective: To study the relationship between epilepsy and aggression in a population of severely mentally handicapped people. Methods: Comparing epilepsy and aggression variables in people with epilepsy without aggression, people with aggression without epilepsy, and people with both. The epilepsy variables were: seizure frequency, classification, anticonvulsant drugs, therapeutic drug monitoring, and neuroleptic drugs. Aggression variables were: frequency, direction, type, and neuroleptic drugs. Results: Prevalence of aggressive behaviour was similar in people with and without epilepsy (36%). Partial seizures were less prevalent in people with epilepsy and aggression. People with epilepsy were more likely to manifest unprovoked aggression directed against property. Conclusion: Some episodes of aggressive behaviour in people with epilepsy may be ictal in origin.

Epilepsy and challenging behaviour in adults with intellectual disability: A systematic review

“…This highlights the importance of achieving optimum seizure control. There is limited evidence that generalised seizures may be related to higher rates of challenging behaviour (Andrews et al, 1999;Creaby et al, 1993;Deb & Hunter, 1991). It is important to note where epilepsy subgroups were studied, the sample size was often small and thus caution needs to be applied in interpreting the results.…”

“…No significant difference in presence, frequency or severity of ADP was found (S. A. Creaby, Warner, Jamil, & Jawad, 1993;Deb et al, 2001;Lundqvist, 2013;McGrother et al, 2006;Smith & Matson, 2010a;Tyrer et al, 2006), however, Creaby et al (1993) further analysed different types of ADP as reported by carers and in case notes and while no overall difference on frequency of ADP was found, they did observe EP to be significantly more likely to show unprovoked aggression, and aggression directed against objects.…”

“…Five studies considered seizure frequency as a potential marker for challenging behaviour. While no association between overall challenging behaviour (Deb & Joyce, 1999; C. Espie et al, 2003;Turkistani, 2004), ADP (Creaby et al, 1993) or aggressive behaviour (Mendez et al, 1993) and seizure frequency was seen, inappropriate speech (Chung & Cassidy, 2001), anti-social behaviour and social dysfunction (C. A. Espie et al, 1989) were correlated.…”

“…Two studies considered seizure type in participants with ADB with conflicting results, one did not find an association with aggressive behaviour (Mendez et al, 1993), while the other found EP with ADB to be significantly more likely to have generalised seizures than EP without ADB (Creaby et al, 1993).…”

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

“…Challenging behaviour is defined using a variety of methods in different studies. Five studies 49,[54][55][56][57] collected data retrospectively from participants' case notes and did not use any validated measures. One study 47 collected information on challenging behaviour from parents' and carers' reports and one study 51 used its own questionnaire, for which no validation data are provided.…”