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

Abstract

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.

The relationship between clinical presentation and the nature of care in adults with intellectual disability and epilepsy – national comparative cohort study

“…24 Conversely, there is evidence to suggest that multiple ASM prescribing goes up for PwID with each decade of life. 24 In addition, multiple ASM prescribing is linked also with a higher chance of other psychotropics prescribing including antipsychotics. 24 Seen together, these patterns suggest the possibility of the use of ASMs for management for behavioural concerns particularly in older PwID.…”

“…24 In addition, multiple ASM prescribing is linked also with a higher chance of other psychotropics prescribing including antipsychotics. 24 Seen together, these patterns suggest the possibility of the use of ASMs for management for behavioural concerns particularly in older PwID. 25 Other neurodevelopmental disorders (ASD and ADHD) were more frequently diagnosed in the younger age group.…”

“…A recent review found that the likelihood of prevalence of seizure freedom in PwID for at least 1 year increased with age. 24 Conversely, there is evidence to suggest that multiple ASM prescribing goes up for PwID with each decade of life. 24 In addition, multiple ASM prescribing is linked also with a higher chance of other psychotropics prescribing including antipsychotics.…”

“… 24 Conversely, there is evidence to suggest that multiple ASM prescribing goes up for PwID with each decade of life. 24 In addition, multiple ASM prescribing is linked also with a higher chance of other psychotropics prescribing including antipsychotics. 24 …”

“… 24 In addition, multiple ASM prescribing is linked also with a higher chance of other psychotropics prescribing including antipsychotics. 24 …”