Treatment of Seizures in People with Intellectual Disability

ORCID

Abstract

There is a synergistic relationship between epilepsy and intellectual disability (ID), and the approach to managing people with these conditions needs to be holistic. Epilepsy is the main co-morbidity associated with ID, and clinical presentation tends to be complex, associated with higher rates of treatment resistance, multi-morbidity and premature mortality. Despite this relationship, there is limited level 1 evidence to inform treatment choice for this vulnerable population. This review updates the current evidence base for anti-seizure medication (ASM) prescribing for people with ID. Recommendations are made on the basis of evidence and expert clinical opinion and summarised into a Traffic Light System for accessibility. This review builds on work developed through UK’s Royal College of Psychiatrists, Faculty of Intellectual Disability Psychiatry and includes newer pragmatic data from the Cornwall UK Ep-ID Research Register, a national research register for England and Wales that has been in existence for the last 10 years. The Register acts as a source for an in-depth exploration of the evidence base for prescribing ‘newer’ (third generation, specifically post-2004) ASMs. Its findings are discussed and compared. A practical approach to prescribing and choosing ASMs is recommended on the based evidence. This approach considers the drug profile, including adverse effects and clinical characteristics. The review also details newer specialist ASMs restricted to certain epilepsy syndromes, and potential future ASMs that may be available soon. For completeness, we also explore non-pharmacological interventions, including surgeries, to support epilepsy management.

Publication Date

2025-01-03

Publication Title

CNS Drugs

Volume

39

Issue

2

ISSN

1172-7047

Acceptance Date

2024-11-27

Deposit Date

2025-01-04

Embargo Period

2026-01-03

Funding

L.W. has received honoraria from the pharmaceutical companies of UCB and Veriton Pharma to provide talks to peer audiences. M.K. has received honoraria to provide talks to peer audiences and for conference travel from UCB, Eisai and Angelini Pharma. R.S. is the chief investigator of the NIHR adopted national Ep-ID register (which is described in the paper and evidence from it used). 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 RSs\u2019 NHS institution and goes towards the salary of the research co-ordinator and the institution\u2019s project oversight costs. The contributing companies to date include Eisai, UCB, Bial and Jazz Pharmaceuticals (previously GW pharma). In addition to the above, R.S. 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 funding bodies including charities, all outside this work.

First Page

161

Last Page

183

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This item is under embargo until 03 January 2026

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