Managing anti‐epileptic drug treatment in adult patients with intellectual disability: a serious conundrum

Doran, Zoë; Shankar, Rohit; Keezer, Mark R; Dale, Colin; McLean, Brendan; Kerr, Michael Patrick; Devapriam, John; Craig, John; Sander, Josemir W.

doi:10.1111/ene.13016

Cited by 47 publications

(66 citation statements)

References 24 publications

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“…15 Considerable challenges remain for clinicians to determine the source of behavioral disorder, whether due to epilepsy, use of medication, a combination of both, or other factors. 16 Practice Points for Etiology…”

Section: Etiologymentioning

confidence: 99%

Behavioral disorder in people with an intellectual disability and epilepsy: A report of the Intellectual Disability Task Force of the Neuropsychiatric Commission of ILAE

et al. 2016

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SummaryThe management and needs of people with intellectual disability (ID) and epilepsy are well evidenced; less so, the comorbidity of behavioral disorder in this population. “Behavioral disorder” is defined as behaviors that are difficult or disruptive, including stereotypes, difficult or disruptive behavior, aggressive behavior toward other people, behaviors that lead to injury to self or others, and destruction of property. These have an important link to emotional disturbance. This report, produced by the Intellectual Disability Task Force of the Neuropsychiatric Commission of the ILAE, aims to provide a brief review of some key areas of concern regarding behavioral disorder among this population and proposes a range of research and clinical practice recommendations generated by task force members. The areas covered in this report were identified by experts in the field as being of specific relevance to the broad epilepsy community when considering behavioral disorder in persons with epilepsy and ID; they are not intended to be exhaustive. The practice recommendations are based on the authors’ review of the limited research in this field combined with their experience supporting this population. These points are not graded but can be seen as expert opinion guiding future research and clinical practice.

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Section: Etiologymentioning

confidence: 99%

Behavioral disorder in people with an intellectual disability and epilepsy: A report of the Intellectual Disability Task Force of the Neuropsychiatric Commission of ILAE

et al. 2016

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“…As Antiepileptic drugs (AEDs) are the mainstay of epilepsy treatment to prevent avoidable harm in this vulnerable group it is important to ascertain the most appropriate and relevant drug therapies for this group. There is currently little evidence to inform on prescribing AEDs in people with epilepsy and ID [17].…”

Section: Introductionmentioning

confidence: 99%

Perampanel in the general population and in people with intellectual disability: Differing responses

Shankar

Henley²,

Wehner³

et al. 2017

Seizure

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“…Intellectual disability and psychiatric comorbidities are both common in people with epilepsy; approximately a quarter of people with epilepsy have intellectual disability 35 and their lifetime prevalence of psychiatric comorbidities is as high as 35%. 36 Unfortunately, this significant population of patients is excluded from participation in randomised, clinical trials of AEDs.…”

Section: Efficacy and Safety Of Perampanel In Special Sub-populationsmentioning

confidence: 99%

“…36 Unfortunately, this significant population of patients is excluded from participation in randomised, clinical trials of AEDs. 35 Thus, there are no current guidelines on AED selection in people with intellectual disability and the real-world evidence is sparse. In addition, in patients with epilepsy and, in particular, in this subpopulation, it is important to understand cognitive impact of AEDs.…”

Section: Efficacy and Safety Of Perampanel In Special Sub-populationsmentioning

confidence: 99%

Reflections on the Use of Perampanel in Epilepsy – Lessons from the Clinic and Real-world Evidence

Trinka¹,

Carreño²

2017

European Neurological Review

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O ptimal epilepsy management includes five important elements: rational treatment selection, efficacy, off-target effects, adherence and interactions and dosing issues. Perampanel (2-[2-oxo-1-phenyl-5-pyridin-2-yl-1,2-dihydropyridin-3-yl]benzonitrile; E2007) is the first potent, selective, orally-active non-competitive alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist approved for the treatment of patients with epilepsy. Results from randomised controlled trials and real-world studies of refractory epilepsy populations treated with perampanel showed effective frequency reduction for both focal-onset seizures (without and with secondary generalisation) and for primary generalised tonic-clonic seizures. Perampanel therapeutic doses have been calculated to only inhibit a fraction of AMPA receptors, thereby to enable sufficient seizure control without substantial impairment of neurological function. Further investigation in special subpopulations of people with epilepsy, including the elderly and people with learning disability or psychiatric comorbidities, is warranted. With an average long half-life of 105 hours, perampanel may be more forgiving in circumstances of suboptimal adherence. Perampanel is not a strong inducer or inhibitor of cytochrome P450 enzymes, and dose adjustment is not always required for the elderly or for those with mild renal impairment.

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Managing anti‐epileptic drug treatment in adult patients with intellectual disability: a serious conundrum

Abstract: There is a significant shortfall in suitably powered studies to provide sufficient evidence for safe prescribing of AEDs to people with ID.

Cited by 47 publications

References 24 publications

Behavioral disorder in people with an intellectual disability and epilepsy: A report of the Intellectual Disability Task Force of the Neuropsychiatric Commission of ILAE

Behavioral disorder in people with an intellectual disability and epilepsy: A report of the Intellectual Disability Task Force of the Neuropsychiatric Commission of ILAE

Perampanel in the general population and in people with intellectual disability: Differing responses

Reflections on the Use of Perampanel in Epilepsy – Lessons from the Clinic and Real-world Evidence

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