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CNS Drugs

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01.02.2000 | Disease Management

Epidemiology and Treatment of Epilepsy in Patients who are Mentally Retarded

verfasst von: Dr Shoumitro Deb

Erschienen in: CNS Drugs | Ausgabe 2/2000

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Abstract

Epilepsy affects approximately 14 to 24% of patients who are mentally retarded. The prevalence increases in those patients who have associated neurological disorders. The severity of mental retardation also influences prevalence. Approximately 7 to 15% of patients with mild to moderate mental retardation, 45 to 67% of those with severe retardation and about 50 to 82% of patients with profound retardation have a lifetime history of epilepsy. The prevalence of epilepsy also varies according to patients’ age and the aetiology of mental retardation. Both false positive and false negative diagnoses of epilepsy remain possible in patients who are mentally retarded.

Polytherapy with anticonvulsants is a commonly used approach to the treatment of epilepsy in patients with mental retardation. However, a reduction in polytherapy has been shown to improve both seizure frequency and the behavioural profile of these patients. Because of the cognitive and behavioural adverse effects of barbiturates and the effect of phenytoin on the CNS, they are not ideal as drugs of first choice in patients with epilepsy who are mentally retarded. Both valproic acid (sodium valproate) and lamotrigine are favoured for use in these patients because of their broad spectrums of anticonvulsant activity and thus efficacy in different seizure types, effects in Lennox-Gastaut syndrome, and minimal effects on cognition and behaviour. The use of carbamazepine is restricted in certain seizure types but can be chosen for some patients who are mentally retarded because of its mood stabilising properties. Oxcarbazepine has similar properties to those of carbamazepine but with a better tolerability profile. Vigabatrin, felb-amate, gabapentin, topiramate, tiagabine and zonisamide are also useful, particularly as add-on therapy. Serious adverse events, such as visual field defects caused by vigabatrin, and fatal blood dyscrasias and hepatotoxicity associated with felba-mate, will restrict the use of these drugs in this population. Neurosurgical treatment has been proven effective in a number of patients with epilepsy who are mentally retarded.

Sillanpää M, Gram L, Johannessen SI, et al. Epilepsy and mental retardation. Philadelphia (PA): Wrightson Biomedical Publishing Limited, 1999

Kotagal P, Lüders HO. The epilepsies: etiology and prevention.San Diego (CA): Academic Press, 1999

Forsgren I, Edvinsson SO, Blomquist HK, et al. Epilepsy in a population of mentally retarded children and adults. Epilepsy Res 1990; 6(3): 234–48PubMedCrossRef

Goulden KJ, Shinnar S, Koller H, et al. Epilepsy in children with mental retardation; a cohort study. Epilepsia 1991; 32(5): 690–7PubMedCrossRef

McGrother CW, Hauck A, Bhaumik S, et al. Community care for adults with learning disability and their carers: needs andoutcome from the Leicestershire register. J Intellect Disabil Res 1996; 40(2): 183–90PubMedCrossRef

Deb S. Epilepsy and mental retardation. Epilepsie Bull 1997;25: 91–4

Rutter M, Tizard J, Yule W, et al. Research report: Isle of WightStudies, 1964–1974. Psychol Med 1976; 6(3): 313–32PubMedCrossRef

Shepherd C, Hosking G. Epilepsy in school children with intellectual impairment in Sheffield: the size and nature of the problem and its implications in service provision. J Ment Defic Res 1989; 33(Pt 6): 511–4PubMed

Steffenburg U, Hagberg G, Kyllerman M. Characteristics of seizures in a population-based series of mentally retarded children with active epilepsy. Epilepsia 1996; 37: 850–6PubMedCrossRef

10.

Michelucci R, Forti A, Rubboli G, et al. Mental retardation and behavioural disturbances related to epilepsy: a review. Brain Dysfunction 1989; 2(1): 3–9

11.

Suzuki H, Aihara M, Sugai K. Severely retarded children in a defined area of Japan: prevalence rate, associated disabilities and causes. Brain Dev 1991; 23(1): 4–8

12.

Benedetti BD, Dov I, Hauser WA, et al. Frequency of seizures among children with cerebral palsy and mental retardation [abstract]. Dev Med Child Neurol 1986: 28 Suppl. 53: 36

13.

Hauser WA. Risk factors for epilepsy. In: Kotagal P, Lüders HO, editors. The epilepsies: etiology and prevention. San Diego (CA): Academic Press, 1999: 1–11

14.

Stafstorm CE. Mechanisms of epilepsy in mental retardation: insight from Angelman syndrome, Down syndrome and Fragile X syndrome. In: Sillanpää M, Gram L, Johannessen SI, et al., editors. Epilepsy and mental retardation. Philadelphia (PA): Wrightson Biomedical Publishing Limited, 1999: 7–40

15.

Deb S, Ahmed Z. Special conditions leading to mental retardation. In: Gelder MG, Andreasen N, Lopez-Ibor JJ, editors. New Oxford Textbook of Psychiatry. Oxford University Press. In press

16.

Lund J. Epilepsy and psychiatric disorder in the mentally retarded adults. Acta Psychiatr Scand 1985; 72: 557–62PubMedCrossRef

17.

Deb S, Joyce J. Characteristics of epilepsy in a population bases cohort of adults with learning disability. Ir J Psychol Med 1999; 16(1): 5–9

18.

Murphy CC, Trevathan E, Yeargin-Allsopp M. Prevalence of epilepsy and epileptic seizures in 10-year old children: results from the Metropolitan Atlanta Developmental Disability Study. Epilepsia 1995; 36(9): 866–72PubMedCrossRef

19.

Sillanpää M. Medico-social prognosis of children with epilepsy. Epidemiological study and analysis of 245 cases. Acta Paediatr Scand 1973: Suppl. 237: 1–104

20.

Trevathan E, Murphy CC, Yeargin-Allsopp M. Prevalence and descriptive epidemiology of Lennox-Gastaut syndrome among Atlanta children. Epilepsia 1997; 38: 1283–8PubMedCrossRef

21.

Sillanpää M. Definitions and epidemiology. In: Sillanpää M, Gram L, Johannessen SI, et al., editors. Epilepsy and mental retardation. Philadelphia (PA): Wrightson Biomedical Publishing Limited, 1999: 1–6

22.

Dobyns WB, Truwit CL. Lissencephaly and other malformations of cortical development: 1995 update. Neuropediatric 1995; 26: 132–47CrossRef

23.

Li LM, Fish DR, Sisodiya SM, et al. High resolution magnetic resonance imaging in adults with partial or secondary generalised epilepsy attending a tertiary referral unit. J Neurol Neurosurg Psychiatry 1995; 59: 384–7PubMedCrossRef

24.

Deb S. Strutural neuroimaging in mental retardation. Br J Psychiatry 1997; 171:417–9PubMedCrossRef

25.

Cataltepe O, Comair YG. Focal resection in the treatment of neuronal migrational disorders. In: Kotagal P, Lüders HO, editors. The epilepsies: etiology and prevention. San Diego (CA): Academic Press, 1999: 87–92

26.

Holthausen H, Tuxhorn I, Pieper T, et al. Hemispherectomy in the treatment of neuronal migrational disorders. In: Kotagal P, Lüders HO, editors. The epilepsies: etiology and prevention. San Diego (CA): Academic Press, 1999: 93–102

27.

Roberts DW. Corpus callosotomy in the treatment of neuronal migrational disorders. In: Kotagal P, Lüders HO, editors. The epilepsies: etiology and prevention. San Diego (CA): Academic Press, 1999: 103–12

28.

Lehesjoki A-E, Koskiniemi M, Sistonen P, et al. Localisation of a gene for progressive myoclonus epilepsy to chromosome 21q22. Proc Natl Acad Sci U S A 1991; 88: 3696–9PubMedCrossRef

29.

Eubanks JH, Puranam RS, Kleckner N, et al. The gene encoding the glutamate receptor subunit GluR5 is located on human chromosome 21 q21.1–22.1 in the vicinity of the gene for familial amyotrophic lateral sclerosis. Proc Natl Acad Sci U S A 1993; 90(1): 178–82PubMedCrossRef

30.

Wisniewski KE, French JH, Fernando S et al. Fragile x syndrome: associated neurological abnormalities. Ann Neurol 1985; 18: 665–9PubMedCrossRef

31.

Betts T. Pseudoseizures: seizures that are not epilepsy. Lancet 1990; 336: 163–4PubMedCrossRef

32.

Coulter DL. Epilepsy and mental retardation: an overview. Am J Ment Retard 1993; 98(5): 1–11PubMed

33.

Deb S. Electrophysiological correlates of psychopathology in individuals with mental retardation and epilepsy. J Intellect Disabil Res 1995; 39: 129–35PubMedCrossRef

34.

Alvarez N, Besag F, Iivanianen M. Use of antiepileptic drugs in the treatment of epilepsy in people with intellectual disability. J Intellect Disabil Res 1998; 42 Suppl. 1: 1–15

35.

Deb S, Hunter D. The effect of anticonvulsant medication on the psychopathology of adults with a mental handicap and epilepsy. Hum Psychopharmacol 1992; 7: 129–34CrossRef

36.

Deb S, Joyce J. The use of antiepileptic medication in a population based cohort of adults with learning disability and epilepsy. Int J Psychiatry Clin Pract 1999; 3: 129–33CrossRef

37.

Collacott RA, Dignon A, Hauck A, et al. Clinical and therapeutic monitoring of epilepsy in a mental handicap unit. Br J Psychiatry 1989; 155: 522–5PubMedCrossRef

38.

Pellock JM, Hunt PA. A decade of modern epilepsy therapy in institutionalised mentally retarded patients. Epilepsy Res 1996; 25: 263–8PubMedCrossRef

39.

British National Formulary. No. 38. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain, 1999

40.

Alvarez N. Barbiturates in the treatment of epilepsy in people with intellectual disability. J Intellect Disabil Res 1998; 42 Suppl. 1: 16–23

41.

Iivanianen M. Phenytoin: effective but insidious therapy for epilepsy in people with intellectual disability. J Intellect Disabil Res 1998; 42 Suppl. 1: 24–31

42.

Aldenkamp AP, van Bronswijk K. Cognitive side-effects as an outcome measure in antiepileptic drug treatment: the current debate. In: Sillanpää M, Gram L, Johannessen SI, et al., editors. Epilepsy and mental retardation. Philadelphia (PA): Wrightson Biomedical Publishing Limited, 1999: 135–46

43.

Friis ML. Valproate in the treatment of epilepsy in people with intellectual disability. J Intellect Disabil Res 1998; 42 Suppl. 1:32–5PubMed

44.

Deb S. Mental disorder in adults with mental retardation and epilepsy. Compr Psychiatry 1997; 38(3): 179–84PubMedCrossRef

45.

Weisburg H, Alvarez N. Carbamazepine in the treatment of epilepsy in people with intellectual disability. J Intellect Disabil Res 1998; 42 Suppl. 1: 36–40

46.

Friedman DL, Kastner T, Plummer AT, et al. Adverse behavioral effects in individuals with mental retardation and mood disorders treated with carbamazepine. Am J Mental Retard 1992; 96(5): 541–6

47.

Gaily E, Granstrom M-L, Lliukkonen E. Oxcarbazepine in thetreatment of epilepsy in children and adolescents with intellectualdisability. J Intellect Disabil Res 1998; 42 Suppl. 1:41–5

48.

Besag FMC. Lamotrigine in the treatment of epilepsy in peoplewith intellectual disability. J Intellect Disabil Res 1998; 42 Suppl. 1: 50–6

49.

Dulac O, Kaminska A. Use of lamotrigine in Lennox-Gestaut and related epilepsy syndromes. J Child Neurol 1997; 12 Suppl. l:S23–8PubMedCrossRef

50.

Genton P, Dravet C, Bureau N, et al. Aggravation of severe myoclonic epilepsy of infancy by lamotrigine [abstract]. Epilepsia 1997: 38 Suppl. 3: 32

51.

Beran RG, Gibson RJ. Aggressive behaviour in intellectually challenged patients with epilepsy treated with lamotrigine. Epilepsia 1998; 39: 280–2PubMedCrossRef

52.

Ylinen A. Antiepileptic efficacy of vigabatrin in people with severe epilepsy and intellectual disability. J Intellect Disabil Res 1998; 42 Suppl 1:46–9PubMed

53.

Ramsay RE, Slater JD. Antiepileptic drugs in clinical development. In: French JA, Dichter MA, Leppik IE, editors. New antiepileptic drug development, preclinical and clinical aspects (Epilepsy Research: Supplement No. 10). Oxford: Elsevier Science Ltd, 1993:45–67

54.

Bhaumik S, Branford D, Duggirala C, et al. A naturalistic study f the use of vigabatrin, lamotrigine and gabapentin in adults with learning disabilities. Seizure 1997; 6: 127–33PubMedCrossRef

55.

Eke T, Talbot JF, Lawden MC. Severe persistent visual field constriction association with vigabatrin. BMJ 1997;314: 180–1PubMedCrossRef

56.

Mikati MA, Chouerir, Khurana DS, et al. Gabapentin in the treatment of refractory partial epilepsy in children with intellectual disability. J Intellect Disabil Res 1998; 42 Suppl. 1: 57–62

57.

Kerr MP. Topiramate; uses in people with an intellectual disability who have epilepsy. J Intellect Disabil Res 1998; 42 Suppl. 1: 74–9

58.

Iinuma K, Minami T, Cho K, et al. Long term effects of Zonisamide in the treatment of epilepsy in children with intellectualdisability. J Intellect Disabil Res 1998;42 Suppl. 1:68–73PubMed

59.

Kälväiinen R. Tiagabine: a new therapeutic option for people with intellectual disability and partial epilepsy. J Intellect Disabil Res 1998; 42 Suppl. 1: 63–7

60.

Leppik JE, Wolff DL. The place of felbamate in the treatment of epilepsy. CNS Drugs 1995; 4(4): 294–301CrossRef

61.

Ben-Menachem E, Henriksen O, Johannessen SI. Diagnosis and treatment of partial seizures. CNS Drugs 1999; 11(1): 23–39CrossRef

62.

Isojärvi JIT, Tokola RA. Benzodiazepine in the treatment ofepilepsy in people with intellectual disability. J Intellect Disabil Res 1998; 42 Suppl. 1: 80–92

63.

Scheepers M, Scheepers B, Clough P. Midazolam via the intranasal route: an effective treatment rescue medication for severe epilepsy in adults with a learning disability. Seizure 1998; 7:509–12PubMedCrossRef

64.

Henriksen O, Bjørnaes H, Røste GK. Epilepsy surgery in mental retardation: the role of surgery. In: Sillanpää M, Gram L, Johannessen SI, et al., editors. Epilepsy and mental retardation. Philadelphia (PA): Wrightson Biomedical Publishing Limited, 1999: 105–13

65.

Brodie MJ, Yuen AWC, and the 105 Study Group. Lamotriginesubstitution study: evidence for synergism with sodium valproate? Epilepsy Res 1997; 26: 423–32PubMedCrossRef

66.

Stephen LJ, Sills GJ, Brodie MJ. Lamotrigine and topiramate v may be a useful combination. Lancet 1998; 351: 958–9PubMed

67.

Deb S, Fraser WI. The use of psychotropic medication in people in people with learning disability: towards rational prescribing. Hum Psychopharmacol 1994; 9: 259–72CrossRef

Titel: Epidemiology and Treatment of Epilepsy in Patients who are Mentally Retarded
verfasst von: Dr Shoumitro Deb
Publikationsdatum: 01.02.2000
Verlag: Springer International Publishing
Erschienen in: CNS Drugs / Ausgabe 2/2000
Print ISSN: 1172-7047
Elektronische ISSN: 1179-1934
DOI: https://doi.org/10.2165/00023210-200013020-00005

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