Epilepsy and Intellectual Disabilities (eBook)

Foreword 7
Preface 9
Acknowledgment 11
Contents 13
Contributors 15
Section I Clinical Issues 18
Introduction 19
Access to Care 20
Getting the Diagnosis Right 20
Treatment Issues 20
Psychosocial Issues 20
Delivering a Package of Care 21
Epilepsy: A General Overview 23
Introduction 23
Definitions 23
Classification of Seizures 24
Classification of Epilepsy 27
Causes of Epilepsy 27
Epidemiology 28
Differential Diagnosis of Epilepsy 29
Management 37
Special Client Groups 39
Conclusion 42
References 42
Epidemiology of Epilepsy in Persons with Intellectual Disabilities 45
Introduction 45
Definitions and Variations 45
Overall Incidence and Prevalence of Epilepsy in the ID Population 47
A Note on Mortality 48
A Note on Concomitant Psychiatric Disorder 49
Some Syndromes of Developmental Disability Related to Epilepsy 49
Some Epilepsy Syndromes Related to ID 54
Conclusions: Looking to the Future 54
References 55
Diagnosis of Epilepsy in Persons with Intellectual Disabilities 59
Introduction 59
The Patient™s Medical History 59
Diagnostic Evaluation: Aims and Questions to be Answered 63
Summary/Conclusion 72
References 73
The Differential Diagnosis of Epilepsy 77
Introduction 77
Classification of Nonepileptic Seizures and Events 79
Conclusion 95
References 95
Section II Treatment Issues 99
Management of Acute Seizures in Persons with Intellectual Disabilities 101
Introduction 101
The First Seizure 101
Subsequent Seizures/Seizure Exacerbations in Established Epilepsy 102
Loss of Skills Related to Frequent Daytime Seizures 104
Nonconvulsive Status Epilepticus 104
Loss of Skills Related to Nocturnal Seizures 105
Electrical Status Epilepticus of Slow Wave Sleep 105
Treatment of (Convulsive) Status Epilepticus 106
Conclusion 111
References 111
The Use of Antiepileptic Medication in Adults with Intellectual Disabilities 113
Introduction 113
Evaluating the Impact of Seizures 113
When to Start Treatment 114
Choosing Medication 115
Managing Medication 117
Adverse Effects 118
Paradoxical Worsening of Seizures 119
Substituting and Adding Anticonvulsants 119
Drug Monitoring 120
Withdrawing Medication 121
Individual Medications 121
Specific Evidence for Antiepileptic Drugs in People with ID 121
Evaluating Outcome 122
Conclusion 123
References 123
Vagus Nerve Stimulation Therapy: An Intellectual Disabilities Perspective 125
Introduction 125
Background 125
The VNS Therapy System™ 126
Clinical Efficacy of VNS Therapy 129
Children 130
Intellectual Disability Population 131
VNS in Specific Learning-Disabled Persons 131
Adverse Effects and Safety 136
VNS Therapy and Neurological Investigations 138
Other Benefits of VNS Therapy 140
Conclusion 140
References 141
Resective Surgery for Patients with Epilepsy and Intellectual Disabilities 145
Introduction 145
Should a Low IQ Be a Contraindication to Epilepsy Surgery? 146
Special Consideration for Presurgical Evaluation in People with LD 148
Pathologies Associated with ID That May Benefit from Resective Surgery 150
Hemispherectomy 157
Evaluating the Outcome of Resective Epilepsy Surgery in Patients with ID 160
Conclusion 161
References 161
Section III Psychosocial Issues 169
Psychopathology in People with Epilepsy and Intellectual Disabilities 171
Introduction 171
Psychopathology in Intellectual Disability 171
Psychopathology in Epilepsy in General Population 173
Developmental Issues 173
Personality 174
Anxiety Disorders 174
Mood Disorders 175
Psychotic Phenomena 176
Psychiatric Symptomatology in TLE Patients 177
Forced Normalization 178
Psychopathology and Epilepsy in ID Population 178
Rates of Psychopathology in People with ID and Epilepsy 180
Psychiatric Disorders in People with ID and Epilepsy 180
The Nature of the Combination of Psychopathology and Epilepsy in People with ID 187
Conclusion 193
References 194
Associated Physical Problems of Epilepsy in Intellectual Disabilities 197
Introduction 197
Injuries: Overview 198
Burns 198
Drownings 200
Fractures 201
Head and Soft Tissue Injuries 202
Mortality and Sudden Unexpected Death for People With Epilepsy 203
Use of Nonpsychiatric Hospital Services 204
Conclusion 204
References 205
Epilepsy and Cognition 209
Introduction 209
Attention and Concentration 210
Memory 211
Executive Functions 212
Academic Function 213
Other Cognitive Functions 215
Intractable Epilepsy Syndromes of Childhood 215
Antiepileptic Drugs 216
Other Influences on Cognition 218
Conclusion 219
References 219
Nursing and Community Aspects of Epilepsy in Intellectual Disabilities 225
Introduction 225
Health Care Provision for People with Intellectual Disabilities 226
Evidence for Change 227
Epilepsy Management in Primary Care 228
The Epilepsy Specialist Nurse 230
Nurse-Led Epilepsy Clinics 230
Specific Components of the Specialist Epilepsy Nurse™s Role 232
People with Intellectual Disabilities and Assessing Risks in Epilepsy 233
Consent 233
Women and Epilepsy 234
Contraception 234
Pregnancy 235
Menstruation and Catamenial Epilepsy 235
Genetics 235
Conclusion 235
References 236
Epilogue – Is This as Good as it Gets? 241
Index 243