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Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet].

Pharmacological interventions for epilepsy in people with intellectual disabilities

This version published: 2011; Review content assessed as up-to-date: February 14, 2011.

Plain language summary

This review confirms that in the majority of cases where intellectually disabled populations participated in trials of antiepileptic drugs (AEDs), moderate reductions in seizure frequency and occasional seizure freedom were obtained. Concern about side effects is likely to influence clinical decision‐making. Where side effects were experienced they appeared similar to those seen in people without intellectual disabilities. An area of key concern is the possibility of behaviour disorders induced by antiepileptic drugs. The majority of studies identified in this review lack or do not use reliable measures for behaviour. However, the studies that do measure behaviour show little obvious impact. In summary, this review broadly supports the use of antiepileptic drugs to reduce seizure frequency in patients with refractory epilepsy and intellectual disability. Side effects seem to be the same as in the general population. Behavioural side effects leading to discontinuation of the treatment are rare.

Abstract

Background: The development of epilepsy in a person with intellectual disabilities is common. Seizures in intellectually disabled people are often complex and refractory to treatment and antiepileptic medication may have a profound effect upon behaviour in this patient group.

This is an updated version of a Cochrane Review published in Issue 3, 2007.

Objectives: The aim of our study was to assess the data available from randomised controlled trials of antiepileptic drug interventions in people with epilepsy and intellectual disabilities.

Search methods: For the original review we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE (1948 to December 2010), PsycINFO (1806 to January 2011) and EMBASE (1980 to April 2005). For the current update we conducted searches of the same databases in January 2011.

Selection criteria: Randomised and quasi‐randomised controlled trials (RCTs) of pharmacological interventions for people with epilepsy and a learning disability.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We assessed epilepsy/seizure, behavioural and cognitive outcomes, as well as quality of life and adverse effects.

Main results: Data were heterogenous and a descriptive analysis is presented. In the majority of cases where antiepileptic drugs (AEDs) were trialled in this population, moderate reductions in seizure frequency and occasional seizure freedom were obtained. In general, it seems reasonable to say that AEDs proven effective in the general epilepsy population are also effective in refractory epilepsy in people with intellectual disability. It is not possible to comment on relative efficacy between medications, making clinical decisions difficult.

The quality of the studies does not aid clinicians greatly with respect to side effects. In general, in trial settings patients continued on treatment in the majority of cases, and placebo groups often experienced fewer side effects. Where side effects were experienced they appeared similar to those seen in non‐intellectual disability studies.

The majority of studies had a lack of or used non‐reliable measures of behavioural exacerbation. However, where measured, little obvious impact on behaviour was seen in terms of behaviour disorder.

Authors' conclusions: This review broadly supports the use of AEDs to reduce seizure frequency in people with refractory epilepsy and intellectual disability. The evidence suggests that side effects are similar to those in the general population and that behavioural side effects leading to discontinuation are rare, but that other effects are under‐researched.

Editorial Group: Cochrane Epilepsy Group.

Publication status: New search for studies and content updated (no change to conclusions).

Citation: Beavis J, Kerr M, Marson AG, Dojcinov I. Pharmacological interventions for epilepsy in people with intellectual disabilities. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD005399. DOI: 10.1002/14651858.CD005399.pub2. Link to Cochrane Library. [PubMed: 17636795]

Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

PMID: 17636795

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