ORCID

Abstract

Introduction: There is increased focus on the negative impact of the overprescribing of medication, specifically psychotropic medication, including anti-seizure medications (ASM), in people with Intellectual Disability (ID). This is particularly important for the older adult population, where multi-morbidity and polypharmacy are more common. ASMs are associated with psychiatric and behavioral adverse effects. Furthermore, there is growing awareness of the anticholinergic burden for older adults with epilepsy and ID and the relationship with behaviors that challenge (BtC). Areas covered: This review defines the older adult population and outlines the relationship between epilepsy and ID. BtC is outlined in the context of the population and the relationship with ASMs. The evidence base to guide prescribing and de-prescribing for newer ASMs is also presented, including pragmatic data. Expert opinion: Polypharmacy, particularly psychotropics, are a mortality risk factor for older adults with epilepsy and ID. Therefore, any BtC requires a holistic assessment with a multi-disciplinary approach. This includes specific consideration of all prescribed medicines in the context of polypharmacy. There should be routine reviews, at least annually, for those aged 40 years and over particularly focused on anticholinergic burden and/or polypharmacy.

Publication Date

2024-08-19

Publication Title

Expert Review of Neurotherapeutics

Volume

24

Issue

11

ISSN

1473-7175

Acceptance Date

2024-08-13

Deposit Date

2024-08-21

Embargo Period

2025-08-19

Funding

R Shankar is the chief Investigator of the NIHR adopted national Ep-ID register which is described in the paper. The Register is supported and monitored by the National Institute of Health Research UK. The funding for each molecule examined by the Register is via an Investigator Initiated Support grant from each of the molecule\u2019s parent company. The funding is to R Shankar\u2019s NHS institution and goes toward the salary of the research co-ordinator and the institution\u2019s project oversight costs. The contributing companies till date include Eisai, UCB, Bial, Jazz Pharma (previously GW Pharma). In addition to the above, R Shankar has received institutional research, travel support and/or honorarium for talks and expert advisory boards from LivaNova, UCB, Eisai, Veriton Pharma, Bial, Angelini, UnEEG and Jazz/GW pharma outside the submitted work. He holds or has held competitive grants from various national grant bodies including Innovate, Economic and Social Research Council (ESRC), Engineering and Physical Sciences Research Council (ESPRC), National Institute of Health Research (NIHR), NHS Small Business Research Initiative (SBRI) and other agencies i.e. NHS England and the Baily Thomas Fund all outside this work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Keywords

Epilepsy, developmental disability, intellectual disability, older adults, seizures

First Page

1097

Last Page

1105

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