Treatment of epilepsy in the multiply handicapped

Abstract

The medical management of epilepsy in the multi‐handicapped patient requires careful evaluation, classification, and pharmacologic treatment. It is estimated that 20–40% of patients with mental retardation and cerebral palsy have epilepsy. This review reports the clinical trial data and personal experience related to the use of newer AEDs in the chronic management of epilepsy syndromes in children and adults, as well as information available on the treatment of seizures in individuals with mental retardation and associated handicaps. Furthermore, clusters of seizures, prolonged seizures and status epilepticus are more commonly seen in the multiply handicapped and mentally retarded population and require special attention. The new antiepileptic drugs felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, vigabatrin and zonisamide show specific advantage in some multiply handicapped patients, be it for seizure control or medication tolerance. Furthermore, new modalities of treatment for prolonged seizures allow better efficacy both outside of hospital and within hospital facilities. The treatment of epilepsy in multi‐handicapped and retarded adults and children has significantly advanced in the past few years, and much of this improvement can be attributed to improved knowledge and monitoring of new antiepileptic drugs. Conventional anticonvulsants remain first line therapy for most clinicians, but newer AEDs must broaden the therapeutic option and do allow improved therapy for some multiply handicapped patients. MRDD Research Reviews 2000;6:309–323. © 2000 Wiley‐Liss, Inc.

Topiramate in Patients with Learning Disability and Refractory Epilepsy

“…There are few outcome data to guide the pharmacotherapy of epilepsy in these patients (6). The scope has now widened, however, with the introduction of a range of new AEDs over the last decade (7).…”

Management of Epilepsy in Mentally Retarded Children Using the Newer Antiepileptic Drugs, Vagus Nerve Stimulation, and Surgery

“…Thirteen of 34 identified cases were fatalities. 2 Additional reports suggest that it mayt be useful in infantile spasms as well, producing complete resolution in several patients. 11 However, felbamate might be safer in children than adults because there have been no reported cases of aplastic anemia in children < 13 years old.…”

A comparison of antiepileptic drug therapy in patients with severe intellectual disability and patients with normal intellect

“…A Cochrane Review of pharmacological interventions for epilepsy in patients with ID concluded that in general, antiepileptic drugs (AEDs) with proven efficacy in the general epilepsy population will also be effective in patients with ID and will have similar adverse effect profiles [3]. Numerous studies have concluded that the newer AEDs improve seizure control and/or have acceptable safety profiles in patients with epilepsy and ID (newer AEDs as a group [4][5][6], lamotrigine [7][8][9], levetiracetam [10][11][12], topiramate [13][14][15][16], gabapentin [17,18], pregabalin [19,20], vigabatrin [21][22][23], tiagabine [24], felbamate [25,26] and oxcarbazepine [5,27,28]). Furthermore, the newer AEDs may have fewer adverse effects and pharmacokinetic interactions with other drugs [6].…”