Epilepsy occurs in more than 30% of persons with mental retardation and up to 50% of those with multiple handicaps living in institutional settings. Treatment of epilepsy in this population presents many unique challenges. Through careful adherence to basic principles of diagnosis, classification, and antiepileptic drug use, as many as 80% of individuals can be successfully managed with one- or two-drug therapy and enjoy positive outcomes in the areas of community integration and increased independence. Rational polypharmacy with the newer anticonvulsant drugs offers additional opportunity for improving outcomes for these individuals, especially with the use of felbamate and lamotrigine, where broad-spectrum efficacy and positive impact on psychosocial functioning is being demonstrated. Further systematic study of new drugs in this population is clearly warranted. ( J Child Neurol 1997;12(Suppl 1):S38-S43).
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References
1.
Hauser WA, Hesdorffer DC: Epilepsy: Frequency, Causes, and Consequences. Baltimore , Epilepsy Foundation of America, 1990.
2.
Marcus JC: Control of epilepsy in a population with mental retardation: Lack of correlation with IQ, neurologic status, and electroencephalogram. Am J Ment Retard1993;98S:47-51.
3.
Singh BK, Towle PO: Antiepileptic drug status in adult outpatients with mental retardation . Am J Ment Retard1993;985:41-46.
4.
Olsson I., Steffenburg S., Gillberg C.: Epilepsy in autism and autistic like conditions: A population-based study . Arch Neurol1988;45: 666-668.
5.
Goulden KJ, Shinnar S., Koller H., et al: Epilepsy in children with mental retardation: A cohort study . Epilepsia, 1991;32:690-697.
6.
Donat JF, Wright FS: Episodic symptoms mistaken for seizures in the neurologically impaired child . Neurology1990;40:156-157.
7.
Manford M., Hart YM, Sander Jwas, et al: The national general practice study of epilepsy: The syndromic classification of the International League Against Epilepsy applied to epilepsy in a general population. Arch Neurol1992;49:801-808.
8.
Mariani E., Ferini-Strombi L., Sala M., et al: Epilepsy in institutionalized patients with encephalopathy: Clinical aspects and nosological considerations. Am J Ment Retard1993;98S:27-33.
9.
Paeschel SM, Louis S., McKnight P.: Seizure disorders in Down's syndrome. Arch Neurol1991;48:318-320.
10.
Steffenburg U., Hagberg G., Kyllerman M.: Characteristics of seizures in a population-based series of mentally retarded children with active epilepsy. Epilepsia1996;37:850-856.
11.
Schmidt D.: Reduction of two-drug therapy in intractable epilepsy. Epilepsia1983;24:368-376.
12.
Bennet HS, Dunlop T., Ziring PR: Reduction of polypharmacy for epilepsy in an institution for the retarded . Dev Med Child Neurol1983;25:735-737.
13.
Coulter DL: Withdrawal of barbiturate anticonvulsant drugs: Prospective controlled study . Am J Ment Retard1988;93:320-327.
14.
Clancy RR, Blubaugh KM, Pippidis M., et al: Antiepileptic drug monotherapy and behavioral disorders in institutionalized mentally retarded children with epilepsy, abstract. Ann Neurol1991; 30:493.
15.
Poindexter AR, Berglund JA, Kolstoe PD: Changes in antiepileptic drug prescribing patterns in large institutions: Preliminary results of a five-year experience . Am J Ment Retard1993 ;98S:34-40.
16.
Bates ER, Wilder BJ, Brown R., et al: Antiepileptic drug reduction program at a center for the developmentally disabled, abstract. Epilepsia1991;32(Suppl 3):3.
17.
Mirza WV, Credeur LJ, Penry JK: Results of antiepileptic drug reduction in patients with multiple handicaps and epilepsy. Drug Invest1993;5:320-326.
18.
Pellock JM, Hunt PA: A decade of modem epilepsy therapy in institutionalized mentally retarded patients. Epilepsy Res1996;25: 263-268.
19.
Dodson WE: Felbamate in the treatment of Lennox-Gastaut syndrome: Results of a 12-month open-label study following a randomized clinical trial. Epilepsia1993;34(Suppl 7):S7-S17.
Litzinger MJ , Duvall B., Little P.: Movement of individuals with complex epilepsy from an institution into the community: Seizure control and functional outcome . Am J Ment Retard1993;98S:52-57.
27.
Fosgren L., Edvensson S., Nystrom L., et al: Influence of epilepsy on mortality in mental retardation: An epidemiologic study. Epilepsia1996;37:956-963.
28.
Derby LE, Tennis P., Jick H.: Sudden unexplained death among subjects with refractory epilepsy. Epilepsia1996;37:931-935.
29.
Nashef L., Fisk DR, Garner S., et al: Sudden death in epilepsy: A study of incidence in a young cohort with epilepsy and learning difficulty. Epilepsia1995;36:1187-1194.
30.
Penry JK, Pellock JM, Ramsay RE, et al: Epilepsy Management in the Multiply Handicapped. Norwalk, CT, K and S Communications, 1991.
31.
Alvarez N.: Discontinuance of antiepileptic medication in patients with developmental disabilities and diagnosis of epilepsy. Am J Ment Retard1989;93:593-599.
32.
Delgado MR, Riela AR, Mills J., et al: Discontinuation of antiepileptic drug treatment after two seizure-free years in children with cerebral palsy. Pediatrics1996;97:192-197.
