ORCID
- Lance Watkins: 0000-0002-0447-5906
- Rohit Shankar: 0000-0002-1183-6933
Abstract
IntroductionPeople with Intellectual Disabilities (PwID) are twenty times more likely than general population to have epilepsy. Guidance for prescribing antiseizure medication (ASM) to PwID is driven by trials excluding them. Levetiracetam (LEV) is a first-line ASM in the UK. Concerns exist regarding LEV's behavioural and psychological adverse effects, particularly in PwID. There is no high-quality evidence comparing effectiveness and adverse effects in PwID to those without, prescribed LEV.MethodsPooled casenote data for patients prescribed LEV (2000–2020) at 18 UK NHS Trusts were analysed. Demographics, starting and maximum dose, adverse effects, dropouts and seizure frequency between ID (mild vs. moderate-profound (M/P)) and general population for a 12-month period were compared. Descriptive analysis, Mann-Whitney, Fisher's exact and logistic regression methods were employed.Results173 PwID (mild 53 M/P 120) were compared to 200 without ID. Mean start and maximum dose were similar across all groups. PwID (Mild & M/P) were less likely to withdraw from treatment (P = 0.036). No difference was found between ID and non-ID or between ID groups (Mild vs M/P) in LEV's efficacy i.e. >50 % seizure reduction. Significant association emerged between ID severity and psychiatric adverse effects (P = 0.035). More irritability (14.2 %) and aggression (10.8 %) were reported in M/P PwID.ConclusionPwID and epilepsy have high rates of premature mortality, comorbidities, treatment resistance and polypharmacy but remain poorly researched for ASM use. This is the largest studied cohort of PwID trialled on LEV compared to general population controls. Findings support prescribing of LEV for PwID as a first-line ASM.
Publication Date
2024-05-16
Publication Title
Seizure: European Journal of Epilepsy
Volume
120
ISSN
1059-1311
Acceptance Date
2024-05-15
Deposit Date
2024-06-24
Funding
RS has received institutional and research support from LivaNova, UCB, Eisai, Veriton Pharma, Bial, Angelini, UnEEG and Jazz/GW pharma outside the submitted work. He holds grants from NIHR AI, SBRI and other funding bodies all outside this work. No other author has any declared conflict of interest related to this paper. Data Collection Centres were supported by the UK National Institute of Health (NIHR portfolio 31484 ).
Additional Links
https://linkinghub.elsevier.com/retrieve/pii/S1059131124001419, https://www.scopus.com/pages/publications/85196312857
Keywords
Antiseizure medication, Intellectual disabilities, Learning disability, Developmental disorder, Neurodevelopment, Seizures
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
First Page
25
Last Page
32
Recommended Citation
Allard, J., Sellers, A., Henley, W., Mclean, B., Parrett, M., Rajakulendran, S., Watkins, L., Maguire, M., Ellawela, S., Tittensor, P., Bransgrove, J., Sen, A., Mohanraj, R., Bagary, M., Ram, S., Vernon, N., Baldwin, S., Gill, J., & Shankar, R. (2024) 'Efficacy and tolerability of levetiracetam in people with and without intellectual disabilities: A naturalistic case control study', Seizure: European Journal of Epilepsy, 120, pp. 25-32. Retrieved from https://pearl.plymouth.ac.uk/pms-research/1131
