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Epilepsy Behav. 2018 Sep;86:72-78. doi: 10.1016/j.yebeh.2018.06.028. Epub 2018 Jul 6.

Challenging behavior in adults with epilepsy and intellectual disability: An analysis of epilepsy characteristics.

Author information

1
Department of Residential Care, Kempenhaeghe Epilepsy Center, PO Box 61, 5590AB Heeze, the Netherlands. Electronic address: oolj@kempenhaeghe.nl.
2
Department of Residential Care, Kempenhaeghe Epilepsy Center, PO Box 61, 5590AB Heeze, the Netherlands.
3
Department of Neurology, Academic Center for Epileptology Kempenhaeghe, PO Box 61, 5590AB Heeze, the Netherlands.
4
Department of Behavioral Sciences, Kempenhaeghe Epilepsy Center, PO Box 61, 5590AB Heeze, the Netherlands; Department of Neurology, Maastricht University Medical Center, PO Box 616, 6200MD, Maastricht, the Netherlands; Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium; Department of Electrical Engineering, University of Technology, PO Box 513, Eindhoven, the Netherlands.
5
Department of Behavioral Sciences, Kempenhaeghe Epilepsy Center, PO Box 61, 5590AB Heeze, the Netherlands; Department of Neurology, Maastricht University Medical Center, PO Box 616, 6200MD, Maastricht, the Netherlands; Center of Neurological Learning Disabilities Kempenhaeghe, PO Box 61, 5590AB Heeze, the Netherlands.

Abstract

PURPOSE:

The study aimed to describe the frequency and severity of self-injurious, stereotyped, and aggressive/destructive behavior in adults with both epilepsy and intellectual disability (ID) who reside at a tertiary epilepsy center and to investigate the associations between challenging behavior and epilepsy and ID characteristics.

METHOD:

The frequency and severity of self-injurious, (motoric) stereotyped, and aggressive/destructive behavior among 189 patients was assessed using the Behavior Problem Inventory. Comparisons were made with an adult reference population with ID, based on gender, to determine whether the behavior was clinically deviant. Epilepsy characteristics, including age at onset, epilepsy type, seizure types, seizure frequency, and use of antiepileptic drugs (AEDs), were retrieved from patient files. The level of ID was classified using the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) and an ID domain discrepancy was allocated if there was a substantial difference between two domains of adaptive behavior within a subject.

RESULTS:

Self-injurious behavior was present in 35% of subjects, stereotyped behavior in 60%, and aggressive/destructive behavior in 63%. The behavior exceeded clinical norms in 7%, 18%, and 12%, respectively. Aggression was the behavior evaluated most often as being problematic, despite its reported frequency being the lowest. When adjusting for level of ID and use of psychotropic medication, logistic regression analyses showed that self-injurious behavior was significantly associated with a lower number of AEDs (odds ratio (OR) = 0.4); that stereotyped behavior was significantly associated with a higher number of seizure types (OR = 1.4) and a lower number of AEDs (OR = 0.4); and that aggression was significantly associated with the presence of an ID domain discrepancy (OR = 3.1).

CONCLUSION:

Challenging behavior is a serious issue among adults with epilepsy and ID. Although some of the epilepsy and ID characteristics seemed to contribute independently to these types of challenging behavior, the effects of epilepsy-related characteristics are modest when compared with ID.

KEYWORDS:

Behavioral problems; Developmental disability; Mental health; Seizures

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