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Pope J, Truesdale M, Brown M. Risk factors for falls among adults with intellectual disabilities: A narrative review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:274-285. [PMID: 32945091 DOI: 10.1111/jar.12805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/17/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of falls involving people with intellectual disabilities (ID) is high in comparison with the general population. There has been little evidence to date on the contributing risk factors. The objective of this review was to identify risk factors for people with intellectual disabilities. METHOD Literature searches were conducted using electronic databases to explore evidence on the subject, and narrative synthesis was employed to analyse the results. RESULTS Seven risk factors were identified: decreasing physical ability, epilepsy, paretic conditions, impulsiveness, previous falls, incontinence and non-use of assistive equipment. Thematic analysis identified factors across the four concepts: the person, the situation, ongoing and protective factors. CONCLUSION Factors for falls involving people with intellectual disabilities are dynamic and multifactorial. Some are specific to the population; however, further research is required to develop the understanding of the possible reasons. The findings have implications across policy, education, practice and research.
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Affiliation(s)
- John Pope
- Edinburgh Napier University, Edinburgh, UK
| | | | - Michael Brown
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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102
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Peña-Salazar C, López Cuiña M, Chavarría V, Robles Olmo B. [Convulsive status epilepticus as a possible symptom of COVID-19 in a patient with intellectual disability and autistic spectrum disorder]. Neurologia 2020; 35:703-705. [PMID: 35572159 PMCID: PMC7832995 DOI: 10.1016/j.nrl.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/05/2020] [Accepted: 07/19/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- C Peña-Salazar
- Unidad Especializada en Trastornos Psiquiátricos en personas con Discapacidad Intelectual (UHEDI), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Research and Development Unit, Institut de Recerca Sant Joan de Déu, Grupo de Tecnologías Sanitarias y Resultados en Atención Primaria y Salud Mental (PRISMA), Barcelona, España; Consortium for Biomedical Research in Epidemiology & Public Health, CIBER en Epidemiología y Salud Pública (CIBERESP); Servicio de Neurología, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona. España.
| | - M López Cuiña
- Servicio de Neurología, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona. España
| | - V Chavarría
- Research and Development Unit, Institut de Recerca Sant Joan de Déu, Grupo de Tecnologías Sanitarias y Resultados en Atención Primaria y Salud Mental (PRISMA), Barcelona, España; Consortium for Biomedical Research in Epidemiology & Public Health, CIBER en Epidemiología y Salud Pública (CIBERESP)
| | - B Robles Olmo
- Servicio de Neurología, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona. España
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Allard J, Henley W, Snoeijen‐Schouwenaars F, Ool J, Tan I, Jurgen Schelhaas H, Majoie MHJM, Hudson S, McLean B, Shankar R. European perspective of perampanel response in people with Intellectual Disability. Acta Neurol Scand 2020; 142:255-259. [PMID: 32383205 DOI: 10.1111/ane.13261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/21/2020] [Accepted: 05/03/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Epilepsy prevalence is over 20% for those with ID. It is difficult to diagnose and treat and more likely to be treatment resistant. The evidence informing prescribing is sparse, particularly for new drugs such as perampanel (PMP). AIMS OF THE STUDY This study seeks to strengthen the research evidence regarding PMP for people with ID by pooling information from two isolated and separately conducted studies: the UK-based Epilepsy Database Register (Ep-ID) and the data from the Kempenhaeghe clinic in the Netherlands. METHODS A single data set of comparable data was created and analysed under agreement and supervision of a UK statistician. RESULTS Seizure reduction within twelve months was evident in 62% of Dutch and 47% of UK patients. Retention rates were higher for those in the UK (P = .01) and for patients with moderate to profound ID, whilst side effects were more prominent in the Dutch cohort. CONCLUSIONS Comparable rates of seizure reduction are in line with estimates for non-ID patients, adding to the evidence suggesting that PMP has a similar impact on those with ID. Taking a European perspective and sharing data across centres can help strengthen the evidence for prescribing antiepileptic drugs in the ID population.
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Affiliation(s)
- Jon Allard
- Cornwall Partnership NHS Foundation Trust Redruth UK
| | | | | | - Jans Ool
- Department of Residential Care Academic Centre for Epileptology Kempenhaeghe Heeze The Netherlands
| | - In Tan
- Department of Residential Care Academic Centre for Epileptology Kempenhaeghe Heeze The Netherlands
| | | | - Marian H. J. M. Majoie
- School of Mental Health and Neuroscience Maastricht University Medical Center Maastricht The Netherlands
- School of Health Professions Education Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht The Netherlands
- Department of Neurology Academic Centre for Epileptology Kempenhaeghe Heeze The Netherlands
| | - Sharon Hudson
- Cornwall Partnership NHS Foundation Trust Redruth UK
| | | | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust Redruth UK
- University of Exeter Truro UK
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104
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Reliability of the Quality of Life Inventory-Disability Measure in Children with Intellectual Disability. J Dev Behav Pediatr 2020; 41:534-539. [PMID: 32412990 DOI: 10.1097/dbp.0000000000000815] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess responsiveness and reproducibility using the estimates of test-retest reliability for the Quality of Life Inventory-Disability (QI-Disability), accounting for changes in child health and parental stress. METHOD Quality of Life Inventory-Disability was administered twice over a 1-month period to a sample of 55 primary caregivers of children (aged 5-19 years) with intellectual disability. Caregivers also reported their child's physical and mental health and completed a 4-item Perceived Stress Scale to assess parental stress. Fixed-effects linear regression models examined responsiveness of QI-Disability to the reported change in child health and parental stress. Reliability was then assessed using intraclass correlations (ICCs) calculated from QI-Disability scores adjusted for changes in child health and parental stress. RESULTS Five of 7 unadjusted ICC values indicated at least moderate agreement (>0.70), and 2 values indicated fair agreement. After accounting for changes in child health and parental stress, adjusted ICC values showed substantial agreement for the total QI-Disability score and 4 domain scores (adjusted ICC ≥ 0.80). Adjusted ICC scores indicated moderate agreement for the Physical Health domain (adjusted ICC = 0.68) and fair agreement for the Positive Emotions domain (adjusted ICC = 0.58). Improvements in a child's physical health rating were associated with higher total, Physical Health, and Positive Emotion domain scores, whereas improvements in mental health were associated with higher total and Negative Emotions domain scores, indicating better quality of life. Changes in parental stress did not have a statistically significant relationship with quality of life. CONCLUSION Satisfactory test-retest reliability was shown. Preliminary evidence indicates that QI-Disability is responsive to changes in child health, but not to differing levels of parental stress.
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105
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Kinney MO, Chester V, Tromans S, Alexander RT, Angus-Leppan H, Bagary M, Cock H, Devapriam J, Hassiotis A, Mula M, Reuber M, Ring H, Roy A, Scheepers M, Shankar R. Epilepsy, anti-seizure medication, intellectual disability and challenging behaviour - Everyone's business, no one's priority. Seizure 2020; 81:111-116. [PMID: 32777744 DOI: 10.1016/j.seizure.2020.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE People with Intellectual Disability (ID) and epilepsy are more likely to experience psychiatric conditions, challenging behaviour (CB), treatment resistance and adverse effects of anti-seizure medications (ASM) than those without. This population receives care from various professionals, depending on local care pathways. This study evaluates the training status, confidence, reported assessment and management practices of different professional groups involved in caring for people with ID, epilepsy and CB. METHODS A cross sectional survey using a questionnaire developed by expert consensus which measured self-reported training status, confidence, and approaches to assessment and management of CB in people with ID and epilepsy was distributed to practitioners involved in epilepsy and/or ID. RESULTS Of the 83 respondents, the majority had either a psychiatry/ID (n = 39), or Neurology/epileptology background (n = 31). Psychiatry/ID and Neurology/epileptology had similar confidence in assessing CB in ID-epilepsy cases, but Psychiatry/ID exhibited higher self-rated confidence in the management of these cases. While assessing and managing CB, Psychiatry/ID appeared more likely to consider mental health aspects, while Neurology/epileptology typically focused on ASM. CONCLUSION Psychiatry/ID and Neurology/epileptology professionals had varying training levels in epilepsy, ID and CB, had differing confidence levels in managing this patient population, and considered different factors when approaching assessment and management. As such, training opportunities in ID should be offered to neurology professionals, and vice versa. Based on the findings, a best practice checklist is presented, which aims to provide clinicians with a structured framework to consider causal explanations for CB in this population.
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Affiliation(s)
- M O Kinney
- Department of Neurology, The Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast, United Kingdom
| | - V Chester
- Department of Psychiatry, Hertfordshire Partnership University NHS Foundation Trust, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - S Tromans
- Department of Health Sciences, University of Leicester, University Road, Leicester, United Kingdom; Department of Intellectual Disability, Leicestershire Partnership NHS Trust, Agnes Unit, Anstey Lane, Leicester, United Kingdom
| | - R T Alexander
- Department of Psychiatry, Hertfordshire Partnership University NHS Foundation Trust, Norwich, United Kingdom; School of Life and Medical Sciences, University of Hertfordshire, United Kingdom
| | - H Angus-Leppan
- Epilepsy Initiative Group, Department of Clinical Neurosciences, Royal Free London NHS Foundation Trust, London, United Kingdom; UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - M Bagary
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
| | - H Cock
- Institute of Molecular and Clinical Sciences, St George's University of London, London, United Kingdom; Atkinson Morley Regional Epilepsy Network, St Georges Epilepsy Group, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Devapriam
- Worcestershire Health & Care NHS Trust, 2 Kings Court, Charles Hastings Way, Worcester, United Kingdom
| | - A Hassiotis
- UCL Division of Psychiatry, London, United Kingdom; Camden & Islington NHS Foundation Trust, St Pancras Way, London, United Kingdom
| | - M Mula
- St George's University Hospital, St George's University of London, United Kingdom
| | - M Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - H Ring
- Cambridge Intellectual and Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - A Roy
- Department of Psychiatry of Intellectual Disability, Coventry and Warwickshire Partnership NHS Trust, United Kingdom
| | - M Scheepers
- Gloucestershire Health & Care NHS Foundation Trust, Leckhamptom Lodge, Charlton Lane, Cheltenham, Gloucestershire, United Kingdom
| | - R Shankar
- Exeter Medical School, Knowledge Spa, Truro, United Kingdom; Cornwall Partnership NHS Foundation Trust, Chy Govenek, Truro, United Kingdom.
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106
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Crozier D, Martin K. Fifteen-minute consultation: Epilepsy in the child with intellectual disabilities-aetiology. Arch Dis Child Educ Pract Ed 2020; 105:204-208. [PMID: 31792041 DOI: 10.1136/archdischild-2019-316975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/16/2019] [Accepted: 11/11/2019] [Indexed: 11/03/2022]
Abstract
Epilepsies are a relatively common group of disorders affecting children and young people. Children with intellectual disabilities have an increased risk of developing an epilepsy, and children with epilepsy are more likely to have difficulties with learning or development than those who do not have an epilepsy. Assessment in this group can be more challenging but is particularly important as it may provide information regarding a potential unifying diagnosis, prognosis and best treatment options.
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Affiliation(s)
- Denise Crozier
- Child Development Centre, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
| | - Katherine Martin
- Child Development Centre, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
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107
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Yu JN, Yue CF, Wang KJ, Chi NN, Li X. Effect of cinnamaldehyde on Cav-1 and Survivin expression in epilepsy: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20459. [PMID: 32501993 PMCID: PMC7306385 DOI: 10.1097/md.0000000000020459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This systematic review aims to assess the effect of cinnamaldehyde on Cav-1 and Survivin expression in epilepsy. METHODS We will search Cochrane Library, PUBMED, EMBASE, CINAHL, Web of Science, Google Scholar, PsycINFO, WANGFANG, VIP, CBM, and CNKI from their inceptions to the March 31, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. RevMan 5.3 software will be used for statistical analysis. RESULTS This systematic review will investigate whether cinnamaldehyde is effective on Cav-1 and Survivin expression in epilepsy. CONCLUSION Its findings will provide helpful evidence for the effect of cinnamaldehyde on Cav-1 and Survivin expression in epilepsy.Systematic review registration: INPLASY202040152.
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Affiliation(s)
| | | | | | | | - Xin Li
- First Ward of Neurology Department, First Affiliated Hospital of Jiamusi University, Jiamusi, China
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108
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Sun JJ, Perera B, Henley W, Ashby S, Shankar R. Seizure and Sudden Unexpected Death in Epilepsy (SUDEP) characteristics in an urban UK intellectual disability service. Seizure 2020; 80:18-23. [PMID: 32485614 DOI: 10.1016/j.seizure.2020.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study identifies epilepsy-related characteristics and SUDEP risk factors in people with epilepsy (PWE) attending an urban community ID service in the UK where managing epilepsy is not part of the service remit, to understand the care provided to this vulnerable population. METHODS An electronic database search in a north London community ID service (catchment population approx. 290,000) identified relevant ID/epilepsy characteristics in PWE to compare those with mild ID to moderate-profound ID. The SUDEP and Seizure Safety Checklist ("Checklist"), was administered to patients and families/carers. Risk management data was compared to similar data from Cornwall UK where PWE are supported within the ID service and the Checklist is used annually. RESULTS One fifth (137/697) of people attending the service had epilepsy. Over 3/4 had moderate-profound ID. Neurodevelopmental disorders were coexistent in 2/3, psychiatric conditions in 1/3 (1/4 of which was psychosis). The mean number of anti-seizure drugs was 1.45 ± 0.98, and 1/4 were taking psychotropic medications. Over a third did not have an epilepsy care plan. None contacted (n = 103) had SUDEP awareness. The median number of Checklist risk factors was seven (IQR 4.5-9). A third had experienced seizures lasting >5 min or status epilepticus. In comparison to the Cornish ID data significant differences were evident in four of seven modifiable risk factors. CONCLUSIONS This real world study highlights the complexity and risks among PWE and ID. The lack of a "joined up" approach can undermine the safety of this vulnerable population. Person-centred risk communication and care plans are easily achievable and essential.
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Affiliation(s)
- James J Sun
- Haringey Learning Disability Partnership, Barnet, Enfield and Haringey Mental Health NHS Trust, London, United Kingdom; Institute of Health Informatics, University College London, London, United Kingdom
| | - Bhathika Perera
- Haringey Learning Disability Partnership, Barnet, Enfield and Haringey Mental Health NHS Trust, London, United Kingdom
| | - William Henley
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - Rohit Shankar
- University of Exeter Medical School, Exeter, United Kingdom; Cornwall Partnership NHS Foundation Trust, United Kingdom.
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109
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McConkey R, Taggart L, DuBois L, Shellard A. Creating Inclusive Health Systems for People With Intellectual Disabilities: An International Study. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020. [DOI: 10.1111/jppi.12341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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110
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Chronic Health Conditions in Aging Individuals with Intellectual Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093126. [PMID: 32365862 PMCID: PMC7246565 DOI: 10.3390/ijerph17093126] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 12/21/2022]
Abstract
Life expectancy of people with intellectual disability (ID) has increased in recent decades. However, there is little evidence of whether these extra years of life are spent in good health. The aim of this study, conducted in Spain, is to obtain information about the prevalence of chronic health conditions in people with ID over the age of 44 and compare it with that of their peers without disability. Twenty health conditions were analyzed in 1040 people with ID and 12,172 people without ID through a study of their prevalence. The findings show that chronic constipation, urinary incontinence, thyroid disorders and obesity are the most prevalent chronic diseases among individuals with ID. In addition, this population group suffers these health conditions more frequently than older adults without ID. Detection and early intervention in these health conditions will improve adequate access to social health services and subsequent treatment of aging adults with ID.
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111
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Kodama M, Higuchi H, Ishii-Maruhama M, Nakano M, Honda-Wakasugi Y, Maeda S, Miyawaki T. Multi-drug therapy for epilepsy influenced bispectral index after a bolus propofol administration without affecting propofol's pharmacokinetics: a prospective cohort study. Sci Rep 2020; 10:1578. [PMID: 32005870 PMCID: PMC6994638 DOI: 10.1038/s41598-020-58460-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/15/2020] [Indexed: 11/30/2022] Open
Abstract
Some previous studies have indicated that valproate (VPA) might change the pharmacokinetics and enhance the effects of propofol. We evaluated whether clinical VPA therapy affected the propofol blood level, the protein-unbound free propofol level, and/or the anesthetic effects of propofol in the clinical setting. The subjects were divided into the control group (not medicated with antiepileptics), the mono-VPA group (medicated with VPA alone), and the poly-VPA group (medicated with VPA, other antiepileptics, and/or psychoactive drugs). General anesthesia was induced via the administration of a single bolus of propofol and a remifentanil infusion, and when the bispectral index (BIS) exceeded 60 sevoflurane was started. There were no significant differences in the total blood propofol level at 5, 10, 15, and 20 min or the protein-unbound free propofol level at 5 min after the intravenous administration of propofol between the 3 groups. However, the minimum BIS was significantly lower and the time until the BIS exceeded 60 was significantly longer in the poly-VPA group. In the multivariate regression analysis, belonging to the poly-VPA group was found to be independently associated with the minimum BIS value and the time until the BIS exceeded 60. Clinical VPA therapy did not influence the pharmacokinetics of propofol. However, multi-drug therapy involving VPA might enhance the anesthetic effects of propofol.
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Affiliation(s)
- Matsuri Kodama
- Department of Dental Anesthesiology and Special Care Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hitoshi Higuchi
- Department of Dental Anesthesiology, Okayama University Hospital, Okayama, Japan.
| | - Minako Ishii-Maruhama
- Department of Dental Anesthesiology and Special Care Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mai Nakano
- Department of Dental Anesthesiology and Special Care Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuka Honda-Wakasugi
- Department of Dental Anesthesiology and Special Care Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shigeru Maeda
- Department of Dental Anesthesiology, Okayama University Hospital, Okayama, Japan
| | - Takuya Miyawaki
- Department of Dental Anesthesiology and Special Care Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Abstract
Epilepsy is considered a disease characterized by an underlying predisposition to seizures as well as neurobiologic, cognitive, psychologic, and social consequences. It is the most frequent chronic neurologic condition of childhood, affecting 0.5%-1% of children worldwide. It comprises a variety of disorders with many different etiologies, consequently affecting management and outcome. Although the great majority of children have epilepsies that are self-limited and have a good prognosis, it is nevertheless very well recognized that epileptic activity (be it seizures or interictal discharges) can be particularly deleterious to the developing brain acting as a disruptor to normal developmental function. Indeed, epilepsy and neurocognitive and behavioral disorders very frequently coexist, and it can be challenging to understand if there is causality or if they are all the reflection of the underlying brain disorder. Hence, accurate phenotypic and etiologic diagnosis is of utmost importance as it will not only guide decision making with regard to choice of treatment but also enable management of expectations concerning outcome. The current chapter aims to provide a general overview of the fast evolving and vast field of childhood epilepsy from its definition and epidemiology, to its diagnostic challenges, management, and outcome.
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Affiliation(s)
- Filipa Bastos
- University College London National Institute of Health Research Biomedical Research Centre, Great Ormond Street Institute of Child Health, and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; Centre Hospitalier Universitaire de Lausanne, Child Neurology and Neurorehabilitation Unit, University of Lausanne, Lausanne, Switzerland
| | - J Helen Cross
- University College London National Institute of Health Research Biomedical Research Centre, Great Ormond Street Institute of Child Health, and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
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Reppermund S, Srasuebkul P, Dean K, Trollor JN. Factors associated with death in people with intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:420-429. [DOI: 10.1111/jar.12684] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 10/09/2019] [Accepted: 10/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Simone Reppermund
- Department of Developmental Disability Neuropsychiatry School of Psychiatry UNSW Sydney Sydney NSW Australia
- Centre for Healthy Brain Ageing School of Psychiatry UNSW Sydney Sydney NSW Australia
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry School of Psychiatry UNSW Sydney Sydney NSW Australia
| | - Kimberlie Dean
- School of Psychiatry UNSW Sydney Sydney NSW Australia
- Justice Health & Forensic Mental Health Network Sydney NSW Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry School of Psychiatry UNSW Sydney Sydney NSW Australia
- Centre for Healthy Brain Ageing School of Psychiatry UNSW Sydney Sydney NSW Australia
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Larkin C, O'Brien D, Maheshwari D. Anaesthesia for epilepsy surgery. BJA Educ 2019; 19:383-389. [PMID: 33456862 PMCID: PMC7807957 DOI: 10.1016/j.bjae.2019.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 11/28/2022] Open
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115
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Watkins L, O'Dwyer M, Kerr M, Scheepers M, Courtenay K, Shankar R. Quality improvement in the management of people with epilepsy and intellectual disability: the development of clinical guidance. Expert Opin Pharmacother 2019; 21:173-181. [PMID: 31790280 DOI: 10.1080/14656566.2019.1695780] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: This clinical guidance looks at the specific concerns of delivery of medical treatment for people with epilepsy and intellectual disability (ID). People with ID have not been included in licensing drug trials of AEDs. However, this population has an over-representation of seizure comorbidity, treatment resistance, and polypharmacy while also being vulnerable to not having their views considered.Areas covered: This review summarizes the current most robust evidence available for the use of licensed AEDs in people with epilepsy and ID. The article provides practical evidence-based clinical information to help prescribers choose the most appropriate AED from the drugs discussed. The article highlights other important individualized factors to consider before initiating or changing antiepileptic medication.Expert opinion: A 'traffic light' coding system is applied to commonly used AEDs based on the level of evidence and expert clinical experience. Managing epilepsy in the ID population requires specialist care. Treatment plans need to be holistic and tailored to accommodate an individual's comorbidities, concurrent medications, general health, social and environmental status. There is a need for large quality trial data to assess the most suitable AEDs on seizure control and quality of life in this population with complex needs.
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Affiliation(s)
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Republic of Ireland
| | - Michael Kerr
- Department of Psychological Medicine & Clinical Neuroscience, Cardiff University, Cardiff, UK.,Vice Chair - SUDEP Action, Wantage, UK
| | | | | | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, UK.,Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
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Li J, Gao K, Cai S, Liu Y, Wang Y, Huang S, Zha J, Hu W, Yu S, Yang Z, Xie H, Yan H, Wang J, Wu Y, Jiang Y. Germline de novo variants in CSNK2B in Chinese patients with epilepsy. Sci Rep 2019; 9:17909. [PMID: 31784560 PMCID: PMC6884442 DOI: 10.1038/s41598-019-53484-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 10/16/2019] [Indexed: 01/16/2023] Open
Abstract
CSNK2B, which encodes the beta subunit of casein kinase II (CK2), plays an important role in neuron morphology and synaptic transmission. Variants in CSNK2B associated with epilepsy and/or intellectual disability (ID)/developmental delay (DD) have been reported in five cases only. Among the 816 probands suspected hereditary epilepsy whose initial report of trio-based whole exome sequencing (WES) were negative, 10 de novo pathogenic or likely pathogenic variants of CSNK2B in nine probands were identified after reanalysis of their raw Trio-WES data. Six of the nine epileptic patients had ID/DD. The age of seizure onset of these nine patients with CSNK2B variants ranged from 2–12 months. Eight patients had age of seizure onset of less than 6 months. The epilepsy of most probands (8/9) was generalized tonic-clonic seizure and clustered (6/9). Most patients had normal electroencephalogram (5/9) and brain magnetic resonance image (7/9) results. Most patients (7/9) had easy-to-control seizures. Levetiracetam was the most commonly used drug in seizure-free patients (5/7). The variants detected in five patients (5/9, 55.6%) were located in the zinc-binding domain. In summary, our research provided evidence that variants in CSNK2B are associated with epilepsy with or without ID/DD. CSNK2B-related epilepsy is relatively easy to be controlled. The zinc-binding domain appears to be the hotspot region for mutation.
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Affiliation(s)
- Jinliang Li
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Kai Gao
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Shuying Cai
- Department of Pediatric Neurology Rehabilitation, Maternal and Child Health Care of Xiamen, Xiamen, Fujian, 361003, China
| | - Yin Liu
- Department of Pediatric Neurology, Tangshan Maternal and Child Health Hospital, Tangshan, Hebei, 063000, China
| | - Yuzhen Wang
- Department of Pediatric Neurology, Tangshan Maternal and Child Health Hospital, Tangshan, Hebei, 063000, China
| | - Shaoping Huang
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, 710004, China
| | - Jian Zha
- Department of Pediatric Neurology, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, 330006, China
| | - Wenjing Hu
- Second Department of Neurology, Hunan Province Children's Hospital, Changsha, Hunan, 410007, China
| | - Shujie Yu
- Department of Pediatric Neurology, Harbin Children's Hospital, Harbin, Heilongjiang, 150010, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Han Xie
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Huifang Yan
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Jingmin Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Ye Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Yuwu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China.
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Sappok T, Diefenbacher A, Winterholler M. The Medical Care of People With Intellectual Disability. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:809-816. [PMID: 31888794 PMCID: PMC6947689 DOI: 10.3238/arztebl.2019.0809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 05/22/2019] [Accepted: 09/13/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND An estimated 1.5 million persons in Germany are intellectually disabled. Persons with intellectual disability (ID) are especially vulnerable to somatic and mental illnesses. METHODS This review is based on pertinent literature retrieved by selective searches in PubMed and the Cochrane Library. RESULTS Genetic abnormalities are a frequent cause of diseases that affect multiple organs and need interdisciplinary treatment. A number of somatic diseases are more common in persons with ID than in the general population, including epilepsy (30-50% in persons with severe or very severe ID, vs. 0.5% in the general popu- lation) and dementia (five times more common than in the general population). Patients with Down syndrome are 20 times more likely than the general population to develop acute lymphoblastic leukemia. Some mental illnesses, too, are more common in persons with ID, e.g., autism spectrum disorders (7.5-15% vs. 1% in the general population). The history and the findings of the physical and psychiatric examination are assessed in accordance with the biopsychosocial model of disease, and in the light of the patient's mental developmental age. Structured instruments for behavioral evaluation and diagnosis are an important additional component of the diagnostic assessment. A holistic approach is required that takes multiple life areas into account and involves the patient's familial and social environment, while obeying the rules of simple language. Psychotherapeutic and psychosocial measures must be adapted to the patient's cognitive abilities and mental developmental age. CONCLUSION Intellectually disabled persons can be treated in a multimodal, multiprofessional approach. As of early 2019, there were 38 medical centers for adults with intellectual disability or severe multiple disabilities in Germany (Medizinische Behandlungszentren für Erwachsene mit geistiger Behinderung oder schweren Mehrfachbehinderungen, MZEB), where they can be cared for with due attention to their special needs.
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Affiliation(s)
- Tanja Sappok
- Berlin Treatment Center for adults with intellectual disabilities (ID) and mental disorders, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin
| | - Albert Diefenbacher
- Department of Psychiatry, Psychotherapy and Psychosomaticsk, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin
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Ghasemi-Dehno A, Jand A, Abasi-Moghadam M, Sadegh M, Mousavi-Hasanzadeh M, Palizvan MR. Mild foot electrical stimulation is comparable with phenytoin in inhibiting pentylenetetrazol-induced kindling in rats. J Physiol Sci 2019; 69:1071-1076. [PMID: 31691158 PMCID: PMC10717911 DOI: 10.1007/s12576-019-00726-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 10/28/2019] [Indexed: 01/18/2023]
Abstract
Increasing evidence demonstrates that electric stimulation has anticonvulsant effects. The present study was undertaken to investigate the effects of mild foot electrical stimulation (MFES) on the development of pentylenetetrazol (PTZ) kindling and compare its effectiveness with the more commonly used treatment, phenytoin. Kindling was induced in rats by repeated injections (every 24 h) of PTZ (37.5 mg/kg). The rats were subjected to either MFES (0.2 mA in intensity for a 160 ms duration with a 160 ms interval for 20 min) or phenytoin (30 mg/kg) before PTZ injections. Following this treatment, rats received MFES every other day for 10 days or 26 days after establishment of PTZ kindling. The data showed that MFES significantly inhibited development of chemical kindling induced by PTZ in rats (p = 0.001, as compared to PTZ-treated animals). This inhibitory effect is comparable with the effect of 30 mg/kg doses of phenytoin (P = 0.99, as compared to phenytoin group). However, 10 days or 26 days durations of MFES had no effect on established kindled seizures (P = 0.58 as compared to PTZ-treated animals). Our data demonstrate that although MFES significantly inhibited the development of chemical kindling, this experimental paradigm had no effect on established kindled seizures.
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Affiliation(s)
- Arefe Ghasemi-Dehno
- Department of Physiology, Faculty of Medicine, Arak University of Medical Sciences, Khonin Shahr Street, Sardasht, Arak, 38481-7-6941, Iran
| | - Abolfazl Jand
- Department of Physiology, Faculty of Medicine, Arak University of Medical Sciences, Khonin Shahr Street, Sardasht, Arak, 38481-7-6941, Iran
| | - Monir Abasi-Moghadam
- Department of Physiology, Faculty of Medicine, Arak University of Medical Sciences, Khonin Shahr Street, Sardasht, Arak, 38481-7-6941, Iran
| | - Mehdi Sadegh
- Department of Physiology, Faculty of Medicine, Arak University of Medical Sciences, Khonin Shahr Street, Sardasht, Arak, 38481-7-6941, Iran
| | - Morteza Mousavi-Hasanzadeh
- Department of Physiology, Faculty of Medicine, Arak University of Medical Sciences, Khonin Shahr Street, Sardasht, Arak, 38481-7-6941, Iran
| | - Mohammad Reza Palizvan
- Department of Physiology, Faculty of Medicine, Arak University of Medical Sciences, Khonin Shahr Street, Sardasht, Arak, 38481-7-6941, Iran.
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Balogh R, Leonard H, Bourke J, Brameld K, Downs J, Hansen M, Glasson E, Lin E, Lloyd M, Lunsky Y, O'Donnell M, Shooshtari S, Wong K, Krahn G. Data Linkage: Canadian and Australian Perspectives on a Valuable Methodology for Intellectual and Developmental Disability Research. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:439-462. [PMID: 31568733 DOI: 10.1352/1934-9556-57.5.439] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Data linkage holds great promise for generating new information about people with intellectual and developmental disabilities (IDD) as a population, yet few centers have developed the infrastructure to utilize this methodology. Two examples, from Canada and Australia, describe their efforts in building data linkage capabilities, and how linked databases can be used to identify persons with IDD and used for population-based research. The value of data linkage is illustrated through new estimates of prevalence of IDD; health service utilization patterns; associations with sociodemographic characteristics, and with physical and mental health conditions (e.g., chronic diseases, injury, fertility, and depression); and findings on equity in medical treatments. Examples are provided of findings used for governmental policy and program planning.
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Affiliation(s)
- Robert Balogh
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Helen Leonard
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Jenny Bourke
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Kate Brameld
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Jenny Downs
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Michele Hansen
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Emma Glasson
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Elizabeth Lin
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Meghann Lloyd
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Yona Lunsky
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Melissa O'Donnell
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Shahin Shooshtari
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Kingsley Wong
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
| | - Gloria Krahn
- Robert Balogh, Ontario Tech University, Oshawa, Ontario, Canada; Helen Leonard and Jenny Bourke, Telethon Kids Institute, The University of Western Australia, Perth; Kate Brameld, Curtin University, Perth, Western Australia; Jenny Downs, Michele Hansen, and Emma Glasson, Telethon Kids Institute, The University of Western Australia, Perth; Elizabeth Lin, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Meghann Lloyd, Ontario Tech University, Oshawa, Ontario, Canada; Yona Lunsky, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Melissa O'Donnell, Telethon Kids Institute, The University of Western Australia, Perth; Shahin Shooshtari, University of Manitoba, Winnipeg, Manitoba, Canada; Kingsley Wong, Telethon Kids Institute, The University of Western Australia, Perth; and Gloria Krahn, Oregon State University, Corvallis
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Watkins LV, Pickrell WO, Kerr MP. Treatment of psychiatric comorbidities in patients with epilepsy and intellectual disabilities: Is there a role for the neurologist? Epilepsy Behav 2019; 98:322-327. [PMID: 30598258 DOI: 10.1016/j.yebeh.2018.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 01/03/2023]
Abstract
This paper will explore the nature of psychiatric co-morbidities in people with an intellectual disability (ID) who have epilepsy. The complexity of clinical presentations and associated co-morbidities require thorough assessment utilising both neurological and psychiatric skills. The neurologist plays a central role in the management of epilepsy in people with ID and therefore requires basic competencies in the assessment of neuropsychiatric co-morbidities. This is key to liaison with other specialist services to ensure individuals receive holistic person-centred care. This article is part of the Special Issue "Obstacles of Treatment of Psychiatric Comorbidities in Epilepsy".
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Affiliation(s)
| | - William Owen Pickrell
- Neurology and Molecular Neuroscience, Swansea University Medical School, Swansea University, Swansea, UK
| | - Michael Patrick Kerr
- Institute of psychological medicine and clinical neuroscience, Cardiff University, UK
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121
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Snoeijen‐Schouwenaars FM, van Ool JS, Tan IY, Aldenkamp AP, Schelhaas HJ, Hendriksen JGM. Mood, anxiety, and perceived quality of life in adults with epilepsy and intellectual disability. Acta Neurol Scand 2019; 139:519-525. [PMID: 30820944 DOI: 10.1111/ane.13085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Depression and anxiety symptoms are common among patients with epilepsy, but are relatively under-researched in patients with both epilepsy and intellectual disability (ID). The aim was to investigate whether epilepsy and ID characteristics are associated with mood, anxiety, and quality of life. MATERIALS AND METHODS Adult patients with epilepsy and ID who rely on tertiary epilepsy care were included (N = 189). Mood, anxiety, and quality of life were assessed by standardized questionnaires. Epilepsy and ID characteristics were retrieved from patient charts or determined by psychometric instruments. RESULTS Elevated levels of depressive and anxiety symptoms were present in 21.7% and 12.7%, respectively. Anxiety was significantly associated with a focal epilepsy type and ID domain discrepancy (substantial difference between two domains of adaptive behavior), but was negatively related to seizure frequency and drug load of mood-stabilizing antiepileptic drugs. Depressive symptoms were not significantly related to epilepsy characteristics, but a severe ID and ID domain discrepancy was associated with more depressive symptoms. Quality of life was significantly worse in those with multiple seizure types and ID domain discrepancy. CONCLUSION Whereas anxiety and quality of life are associated with individual epilepsy characteristics, this could not be confirmed for depressive symptoms in patients with epilepsy and ID, despite its high prevalence.
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Affiliation(s)
| | - Jans S. van Ool
- Department of Residential Care Kempenhaeghe Epilepsy Center Heeze The Netherlands
| | - In Y. Tan
- Department of Residential Care Kempenhaeghe Epilepsy Center Heeze The Netherlands
| | - Albert P. Aldenkamp
- Department of Behavioral Sciences Kempenhaeghe Epilepsy Center Heeze The Netherlands
- Department of Neurology Maastricht University Medical Center Maastricht The Netherlands
- Department of Neurology Ghent University Hospital Ghent Belgium
- Department of Electrical Engineering University of Technology Eindhoven The Netherlands
| | - Helenius J. Schelhaas
- Department of Neurology Academic Center for Epileptology Kempenhaeghe Heeze The Netherlands
| | - Jos G. M. Hendriksen
- Department of Behavioral Sciences Kempenhaeghe Epilepsy Center Heeze The Netherlands
- Department of Neurology Maastricht University Medical Center Maastricht The Netherlands
- Center of Neurological Learning Disabilities Kempenhaeghe Heeze The Netherlands
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Böhm J, Diefenbacher A, Heinrich M, Sappok T. [Autism spectrum disorders in adults with intellectual disabilities : Frequencies and characteristics]. DER NERVENARZT 2019; 90:490-496. [PMID: 30377732 DOI: 10.1007/s00115-018-0635-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Collation of frequencies and clinical characteristics of autism spectrum disorders (ASD) in persons with intellectual disability (ID). METHODS Cross-sectional analysis of a clinical psychiatric sample of 710 adults with ID and mental disorders. RESULTS The frequency of ASD in an adult sample with ID was 19%. The occurrence of ASD was associated with a higher severity of ID, male gender (in mild to moderate ID), anticonvulsive therapy and reduced employment rates in workshops. CONCLUSION The ASD are a frequent clinical diagnosis in adults with ID.
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Affiliation(s)
- Julia Böhm
- Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Ev. Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Deutschland.
- Zentrum für Seelische Gesundheit, Fakultät für Erziehungswissenschaft und Psychologie, Freie Universität Berlin, Berlin, Deutschland.
| | - Albert Diefenbacher
- Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Ev. Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Deutschland
| | - Manuel Heinrich
- AB Klinisch-Psychologische Intervention, Fakultät für Erziehungswissenschaft und Psychologie, Freie Universität Berlin, Berlin, Deutschland
| | - Tanja Sappok
- Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Ev. Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10365, Berlin, Deutschland
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Li X, Yang H, Yan J, Wang X, Li X, Yuan Y. Low-Intensity Pulsed Ultrasound Stimulation Modulates the Nonlinear Dynamics of Local Field Potentials in Temporal Lobe Epilepsy. Front Neurosci 2019; 13:287. [PMID: 31001072 PMCID: PMC6454000 DOI: 10.3389/fnins.2019.00287] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/11/2019] [Indexed: 12/31/2022] Open
Abstract
Low-intensity pulsed ultrasound stimulation (LIPUS) can inhibit seizures associated with temporal lobe epilepsy (TLE), which is the most common epileptic syndrome in adults and accounts for more than half of the cases of intractable epilepsy. Electroencephalography (EEG) signal analysis is an important method for studying epilepsy. The nonlinear dynamics of epileptic EEG signals can be used as biomarkers for the prediction and diagnosis of epilepsy. However, how ultrasound modulates the nonlinear dynamic characteristics of EEG signals in TLE is still unclear. Here, we used low-intensity pulsed ultrasound to stimulate the CA3 region of kainite (KA)-induced TLE mice, simultaneously recorded local field potentials (LFP) in the stimulation regions before, during, and after LIPUS. The nonlinear characteristics, including complexity, approximate entropy of different frequency bands, and Lyapunov exponent of the LFP, were calculated. Compared with the control group, the experimental group showed that LIPUS inhibited TLE seizure and the complexity, approximate entropy of the delta (0.5–4 Hz) and theta (4–8 Hz) frequency bands, and Lyapunov exponent of the LFP significantly increased in response to ultrasound stimulation. The values before ultrasound stimulation were higher ∼1.87 (complexity), ∼1.39 (approximate entropy of delta frequency bands), ∼1.13 (approximate entropy of theta frequency bands) and ∼1.46 times (Lyapunov exponent) than that after ultrasound stimulation (p < 0.05). The above results demonstrated that LIPUS can alter nonlinear dynamic characteristics and provide a basis for the application of ultrasound stimulation in the treatment of epilepsy.
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Affiliation(s)
- Xin Li
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Huifang Yang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Jiaqing Yan
- College of Electrical and Control Engineering, North China University of Technology, Beijing, China
| | - Xingran Wang
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience, Beijing Normal University, Beijing, China
| | - Yi Yuan
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
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Wong K, Leonard H, Pearson G, Glasson EJ, Forbes D, Ravikumara M, Jacoby P, Bourke J, Srasuebkul P, Trollor J, Wilson A, Nagarajan L, Downs J. Epidemiology of gastrostomy insertion for children and adolescents with intellectual disability. Eur J Pediatr 2019; 178:351-361. [PMID: 30554367 DOI: 10.1007/s00431-018-3304-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 12/12/2022]
Abstract
The largest group of recipients of pediatric gastrostomy have neurological impairment with intellectual disability (ID). This study investigated trends in first gastrostomy insertion according to markers of disadvantage and ID etiology. Linked administrative and health data collected over a 32-year study period (1983-2014) for children with ID born between 1983 and 2009 in Western Australia were examined. The annual incidence rate change over calendar year was calculated for all children and according to socioeconomic status, geographical remoteness, and Aboriginality. The most likely causes of ID were identified using available diagnosis codes in the linked data set. Of 11,729 children with ID, 325 (2.8%) received a first gastrostomy within the study period. The incidence rate was highest in the 0-2 age group and there was an increasing incidence trend with calendar time for each age group under 6 years of age. This rate change was greatest in children from the lowest socioeconomic status quintile, who lived in regional/remote areas or who were Aboriginal. The two largest identified groups of ID were genetically caused syndromes (15.1%) and neonatal encephalopathy (14.8%).Conclusion: Gastrostomy is increasingly used in multiple neurological conditions associated with ID, with no apparent accessibility barriers in terms of socioeconomic status, remoteness, or Aboriginality. What is Known: • The use of gastrostomy insertion in pediatrics is increasing and the most common recipients during childhood have neurological impairment, most of whom also have intellectual disability (ID). What is New: • Nearly 3% of children with ID had gastrostomy insertion performed, with the highest incidence in children under 3 years of age. • Gastrostomy use across different social groups was equitable in the Australian setting.
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Affiliation(s)
- Kingsley Wong
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Helen Leonard
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Glenn Pearson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Emma J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - David Forbes
- Medical School, The University of Western Australia, Perth, Australia
- Department of Health, Government of Western Australia, Perth, Australia
| | - Madhur Ravikumara
- Department of Gastroenterology, Perth Children's Hospital, Perth, Australia
| | - Peter Jacoby
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Jenny Bourke
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - Andrew Wilson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
- Department of Respiratory Medicine, Perth Children's Hospital, Perth, Australia
- School of Paediatrics, The University of Western Australia, Perth, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Lakshmi Nagarajan
- Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Perth, Australia
| | - Jenny Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia.
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
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125
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Wang L, Long X, Aarts RM, van Dijk JP, Arends JB. EEG-based seizure detection in patients with intellectual disability: Which EEG and clinical factors are important? Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2018.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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126
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Watkins L, Cock H, Angus-Leppan H, Morley K, Wilcock M, Shankar R. Valproate MHRA Guidance: Limitations and Opportunities. Front Neurol 2019; 10:139. [PMID: 30842753 PMCID: PMC6391862 DOI: 10.3389/fneur.2019.00139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/04/2019] [Indexed: 11/13/2022] Open
Abstract
Recent publication of the Medicines and Healthcare products Regulatory Agency (MHRA) in the United Kingdom has strengthened the regulatory measures for valproate medicines. It highlights the importance of making women of childbearing age with epilepsy aware of the teratogenic risks of valproate and encourages the withdrawal of it from those currently prescribed. While a significant directive, it raises concerns of not having considered the impact on special populations such as women with Intellectual Disability (ID). While it is important that women with ID are not excluded from such safety initiatives, due caution needs to be taken on a case by case basis preferably, to ensure their best interests are central to the decision making. Many women with moderate to profound ID cannot have informed consented sexual relationships not to mention cognitive incapability to make informed choices on medication suitability. These women are at potential risk of having their epilepsy control undermined due to the MHRA directives. Around 30% of people with moderate to profound ID have seizures of which 60% are considered treatment resistant. In this vulnerable population changes to medication without clear clinical and social insights could lead to increased harm levels. This paper enumerates the challenges of application of the new directive to these special populations and proposes a pathway based on individual cognitive ability to provide informed consent to facilitate the continuation or removal of valproate. It is important not to lose sight of individual circumstances and the importance of working collaboratively toward providing person center care.
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Affiliation(s)
- Lance Watkins
- Mental Health and Learning Disability Delivery Unit, Llwyneryr Unit, Neath Port Talbot CLDT, Abertawe Bro Morgannwyg University Health Board, Swansea, United Kingdom
| | - Hannah Cock
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Trust, London, United Kingdom.,Institute of Medical and Biomedical Education, St George's University of London, London, United Kingdom
| | - Heather Angus-Leppan
- Epilepsy Initiative Group, Royal Free London, London, United Kingdom.,University College, London, United Kingdom.,Centre for Research in Public Health and Community Care, University of Hertfordshire, London, United Kingdom
| | - Kim Morley
- Department of Obstetrics and Gynaecology, Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Winchester, United Kingdom
| | - Mike Wilcock
- Royal Cornwall Hospitals Trust, Truro, United Kingdom
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro, United Kingdom.,Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, United Kingdom
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127
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Hove O, Biringer E, Havik OE, Assmus J, Braatveit KJ, Holm SEH, Hermann M. Prevalence of drug use among adults with intellectual disabilities compared with drug use in the general population. Pharmacoepidemiol Drug Saf 2019; 28:337-344. [DOI: 10.1002/pds.4741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Oddbjørn Hove
- Department of Research and Innovation; Helse Fonna HF; Haugesund Norway
| | - Eva Biringer
- Department of Research and Innovation; Helse Fonna HF; Haugesund Norway
| | - Odd E. Havik
- Department of Clinical Psychology; University of Bergen; Bergen Norway
| | - Jörg Assmus
- Center for Clinical Research; Haukeland University Hospital; Bergen Norway
| | | | | | - Monica Hermann
- Department of Health and Caring Sciences; Western University of Applied Sciences; Bergen Norway
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128
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Tschamper MK, Jakobsen R. Parents’ experiences of videoconference as a tool for multidisciplinary information exchange for children with epilepsy and disability. J Clin Nurs 2019; 28:1506-1516. [DOI: 10.1111/jocn.14755] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/27/2018] [Accepted: 12/05/2018] [Indexed: 11/28/2022]
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129
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van Ool JS, Snoeijen-Schouwenaars FM, Tan IY, Schelhaas HJ, Aldenkamp AP, Hendriksen JGM. Classification of intellectual disability according to domains of adaptive functioning and between-domains discrepancy in adults with epilepsy. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:40-48. [PMID: 30318652 DOI: 10.1111/jir.12556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/30/2018] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND In the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5), the diagnostic criteria of intellectual disability (ID) include three domains of adaptive deficits: the conceptual, social and practical. Substantial intra-individual differences between domains can be considered an ID domain discrepancy. METHOD We explored the associations between ID domains, discrepancies and epilepsy in 189 adults (mean age = 47.9; SD = 15.6). Each DSM-5 ID domain was assessed separately, using subscales of the Vineland II for the social and practical domains, and psychological instruments, including intelligence tests, for the conceptual domain. A set of standardised criteria is proposed to identify an ID domain discrepancy. RESULTS An ID domain discrepancy seemed to be present in about one-third of subjects and was particularly present in subjects with moderate ID (53.4%). Impairment in the social domain was most often the reason for the discrepancy. The presence of a discrepancy was significantly related to a focal (localised) epilepsy type (OR = 2.3, P = .028) and a mixed seizure type (OR = 1.4, P = .009). Epilepsy characteristics that are indicative of a more severe and refractory epilepsy, including various seizure types, a high seizure frequency, a combined epilepsy type (both focal and generalised epilepsy) and an early age at onset, were significantly related to more severe impairments in conceptual, social and practical adaptive behaviour (all P values <.01). CONCLUSIONS With a substantial proportion of the subjects who had both ID and epilepsy with an ID discrepancy, professionals should be aware of this and take all domains of ID into account when studying or working with this vulnerable population.
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Affiliation(s)
- J S van Ool
- Department of Residential Care, Kempenhaeghe Epilepsy Centre, Heeze, The Netherlands
| | | | - I Y Tan
- Department of Residential Care, Kempenhaeghe Epilepsy Centre, Heeze, The Netherlands
| | - H J Schelhaas
- Department of Neurology, Academic Center for Epileptology Kempenhaeghe, Heeze, The Netherlands
| | - A P Aldenkamp
- Department of Behavioral Sciences, Kempenhaeghe Epilepsy Centre, Heeze, The Netherlands
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J G M Hendriksen
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Center of Neurological Learning Disabilities, Kempenhaeghe, Heeze, The Netherlands
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130
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Snoeijen-Schouwenaars FM, van Ool JS, Verhoeven JS, van Mierlo P, Braakman HMH, Smeets EE, Nicolai J, Schoots J, Teunissen MWA, Rouhl RPW, Tan IY, Yntema HG, Brunner HG, Pfundt R, Stegmann AP, Kamsteeg EJ, Schelhaas HJ, Willemsen MH. Diagnostic exome sequencing in 100 consecutive patients with both epilepsy and intellectual disability. Epilepsia 2018; 60:155-164. [DOI: 10.1111/epi.14618] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | - Jans S. van Ool
- Department of Residential Care; Epilepsy Center Kempenhaeghe; Heeze The Netherlands
| | - Judith S. Verhoeven
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center; Heeze The Netherlands
| | - Petra van Mierlo
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center; Heeze The Netherlands
| | - Hilde M. H. Braakman
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center; Heeze The Netherlands
| | - Eric E. Smeets
- Department of Human Genetics; Maastricht University Medical Center; Maastricht The Netherlands
| | - Joost Nicolai
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center; Heeze The Netherlands
- Department of Neurology; Maastricht University Medical Center; Maastricht The Netherlands
| | - Jeroen Schoots
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - Mariel W. A. Teunissen
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center; Maastricht The Netherlands
| | - Rob P. W. Rouhl
- Department of Neurology; Maastricht University Medical Center; Maastricht The Netherlands
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center; Maastricht The Netherlands
- School for Mental Health and Neurosciences; Maastricht University; Maastricht The Netherlands
| | - In Y. Tan
- Department of Residential Care; Epilepsy Center Kempenhaeghe; Heeze The Netherlands
| | - Helger G. Yntema
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - Han G. Brunner
- Department of Human Genetics; Maastricht University Medical Center; Maastricht The Netherlands
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - Rolph Pfundt
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - Alexander P. Stegmann
- Department of Human Genetics; Maastricht University Medical Center; Maastricht The Netherlands
| | - Erik-Jan Kamsteeg
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
| | - Helenius J. Schelhaas
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center; Heeze The Netherlands
| | - Marjolein H. Willemsen
- Department of Human Genetics; Maastricht University Medical Center; Maastricht The Netherlands
- Department of Human Genetics; Radboud University Medical Center; Nijmegen The Netherlands
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131
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Lines G, Henley W, Winterhalder R, Shankar R. Awareness, attitudes, skills and training needs of psychiatrists working with adults with intellectual disability in managing epilepsy. Seizure 2018; 63:105-112. [PMID: 30471519 DOI: 10.1016/j.seizure.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Comorbid epilepsy is found in 22.5% of people with intellectual disability (ID). Responding to the continuing lack of clarity to the role of the ID psychiatrist in the United Kingdom with regards to epilepsy care, the Royal College of Psychiatrists (RCPsych) published the College Report (CR) 203 in May 2017. This proposed a three-tiered model of competency in ID epilepsy care, with minimum acceptable standards described as Bronze and greater expertise as Silver and Gold. This article documents the perceptions of ID psychiatrists as to their skills and training needs, and the perceived impact of CR203 on the profession. METHODS An e- questionnaire, matching the standards on CR203 and encouraging comments was designed, reviewed and approved by the RCPsych ID executive faculty. The survey was sent by email to all UK-registered RCPsych ID Faculty members via the RCPsych communications. RESULTS Of the expected 332 ID psychiatrists in the UK, 141 responses were received (42.4%). Key findings included that ID psychiatrists as a group have an interest in epilepsy but Bronze standards were frequently unmet, with variation across the UK. There was a noted lack of agreement on role among ID psychiatrists again linked to geographical variation. Regional disparity correlated to population density and proximity to tertiary neurological centres. CONCLUSION There are significant implications on training, both pre- and post- accreditation for the ID psychiatry speciality. The CR203 standards appear to be steps in the right direction to help define the role ID psychiatrists have in the delivery of epilepsy care.
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Affiliation(s)
- Geraldine Lines
- Oxleas NHS Foundation Trust, Pinewood Hse, Pinewood Pl, Dartford DA2 7WG, United Kingdom; King's College Medical School, United Kingdom
| | | | - Robert Winterhalder
- Oxleas NHS Foundation Trust, Pinewood Hse, Pinewood Pl, Dartford DA2 7WG, United Kingdom
| | - Rohit Shankar
- Exeter Medical School, United Kingdom; Cornwall Partnership NHS Foundation Trust, Chy Govenek, Threemilestone Industrial Estate, Truro TR4 9LD, United Kingdom.
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132
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Kessi M, Xiong J, Wu L, Yang L, He F, Chen C, Pang N, Duan H, Zhang W, Arafat A, Yin F, Peng J. Rare Copy Number Variations and Predictors in Children With Intellectual Disability and Epilepsy. Front Neurol 2018; 9:947. [PMID: 30510536 PMCID: PMC6252327 DOI: 10.3389/fneur.2018.00947] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/23/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction: The concurrence of intellectual disability/global developmental delay and epilepsy (ID/GDD-EP) is very common in the pediatric population. The etiologies for both conditions are complex and largely unknown. The predictors of significant copy number variations (CNVs) are known for the cases with ID/GDD, but unknown for those with exclusive ID/GDD-EP. Importantly, the known predictors are largely from the same ethnic group; hence, they lack replication. Purpose: We aimed to determine and investigate the diagnostic yield of CNV tests, new causative CNVs, and the independent predictors of significant CNVs in Chinese children with unexplained ID/GDD-EP. Materials and methods: A total of 100 pediatric patients with unexplained ID/GDD-EP and 1,000 healthy controls were recruited. The American College of Medical Genetics guideline was used to classify the CNVs. Additionally, clinical information was collected and compared between those with significant and non-significant CNVs. Results: Twenty-eight percent of the patients had significant CNVs, 16% had variants of unknown significance, and 56% had non-significant CNVs. In total, 31 CNVs were identified in 28% (28/100) of cases: 25 pathogenic and 6 likely pathogenic. Eighteen known syndromes were diagnosed in 17 cases. Thirteen rare CNVs (8 novel and 5 reported in literature) were identified, of which three spanned dosage-sensitive genes: 19q13.2 deletion (ATP1A3), Xp11.4-p11.3 deletion (CASK), and 6q25.3-q25.3 deletion (ARID1B). By comparing clinical features in patients with significant CNVs against those with non-significant CNVs, a statistically significant association was found between the presence of significant CNVs and speech and language delay for those aged above 2 years and for those with facial malformations, microcephaly, congenital heart disease, fair skin, eye malformations, and mega cisterna magna. Multivariate logistic regression analysis allowed the identification of two independent significant CNV predictors, which are eye malformations and facial malformations. Conclusion: Our study supports the performance of CNV tests in pediatric patients with unexplained ID/GDD-EP, as there is high diagnostic yield, which informs genetic counseling. It adds 13 rare CNVs (8 novel), which can be accountable for both conditions. Moreover, congenital eye and facial malformations are clinical markers that can aid clinicians to understand which patients can benefit from the CNV testing and which will not, thus helping patients to avoid unnecessary and expensive tests.
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Affiliation(s)
- Miriam Kessi
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Juan Xiong
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Liwen Wu
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Lifen Yang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Fang He
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Chen Chen
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Nan Pang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Haolin Duan
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Wen Zhang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Ahmed Arafat
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Jing Peng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
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Heutmekers M, Naaldenberg J, Verheggen SA, Assendelft WJJ, van Schrojenstein Lantman-de Valk HMJ, Tobi H, Leusink GL. Health problems of people with intellectual disabilities in Dutch out-of-hours primary care. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:475-481. [DOI: 10.1111/jar.12537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Marloes Heutmekers
- Department of Primary and Community Care; Radboud Institute for Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - Jenneken Naaldenberg
- Department of Primary and Community Care; Radboud Institute for Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | - Sabine A. Verheggen
- General Practitioner Cooperative Nijmegen and Boxmeer; Nijmegen The Netherlands
| | - Willem J. J. Assendelft
- Department of Primary and Community Care; Radboud Institute for Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
| | | | - Hilde Tobi
- Biometris; Wageningen University and Research; Wageningen The Netherlands
| | - Geraline L. Leusink
- Department of Primary and Community Care; Radboud Institute for Health Sciences; Radboud University Medical Center; Nijmegen The Netherlands
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134
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Folch A, Salvador‐Carulla L, Vicens P, Cortés MJ, Irazábal M, Muñoz S, Rovira L, Orejuela C, González JA, Martínez‐Leal R. Health indicators in intellectual developmental disorders: The key findings of the
POMONA
‐
ESP
project. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:23-34. [DOI: 10.1111/jar.12498] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Annabel Folch
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD) ‐ Fundació Villablanca IISPV Universitat Rovira i Virgili Reus Spain
- Department of Psychology Universitat Rovira i Virgili Tarragona Spain
| | - Luis Salvador‐Carulla
- Centre for Mental Health Research Research School of Population Health ANU College of Health and Medicine Australian National University Canberra ACT Australia
| | - Paloma Vicens
- Department of Psychology Universitat Rovira i Virgili Tarragona Spain
- Research Center in Behavioral Assessment (CRAMC) Universitat Rovira i Virgili Tarragona Spain
- Laboratory of Toxicology and Environmental Health Universitat Rovira i Virgili Tarragona Spain
| | - Maria José Cortés
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD) ‐ Fundació Villablanca IISPV Universitat Rovira i Virgili Reus Spain
- Centre of Biomedical Research Network on Mental Health (CIBERSAM) Madrid Spain
| | - Marcia Irazábal
- Parc Sanitari Sant Joan de Déu Sant Boi de Llobregat Spain
- Faculty of Education Universitat de Barcelona Barcelona Spain
| | | | - Lluís Rovira
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD) ‐ Fundació Villablanca IISPV Universitat Rovira i Virgili Reus Spain
| | - Carmen Orejuela
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD) ‐ Fundació Villablanca IISPV Universitat Rovira i Virgili Reus Spain
| | - Juan A. González
- Asociación en Favor de las Personas con Discapacidad Intelectual de Córdoba‐ APROSUB Córdoba Spain
| | - Rafael Martínez‐Leal
- Intellectual Disability and Developmental Disorders Research Unit (UNIVIDD) ‐ Fundació Villablanca IISPV Universitat Rovira i Virgili Reus Spain
- Department of Psychology Universitat Rovira i Virgili Tarragona Spain
- Centre of Biomedical Research Network on Mental Health (CIBERSAM) Madrid Spain
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135
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Shankar R, Rowe C, Van Hoorn A, Henley W, Laugharne R, Cox D, Pande R, Roy A, Sander JW. Under representation of people with epilepsy and intellectual disability in research. PLoS One 2018; 13:e0198261. [PMID: 29927966 PMCID: PMC6013187 DOI: 10.1371/journal.pone.0198261] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/16/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose One quarter of people with epilepsy have an intellectual disability (ID) and one fifth of people with an ID have epilepsy. Both conditions are associated with higher levels of morbidity, stigma and premature mortality. There have been calls for action to promote more research in this group. We examined if this group are represented adequately in current research. Methods The proportion of research output in epilepsy conferences and publications relevant to ID and the proportion in ID conferences and publications on epilepsy for 2015–2016 were identified. As the percentage of children in the population with epilepsy is 17%, research output of this group was compared with the ID group. Recognised material was classified based on whether it applied to general epilepsy/ID research, children with epilepsy or people with epilepsy and ID. Data was analysed to determine the proportion of presented research specifically identifying people with epilepsy and ID. Results Fewer than 2% of presentations at epilepsy conferences specifically related to the ID and epilepsy group compared to 15% relating to children with epilepsy. Similarly only 1.4% of the research presented at major ID conferences related to those with people with epilepsy and ID. About 5% of published research in the field of epilepsy related to those with ID as compared with 24% for children with epilepsy. Twelve percent of published research in ID specifically identified epilepsy. Conclusion Publications and conference presentations, on the population with epilepsy and comorbid ID is under-represented. Increased research in this area might assist in improving the quality of care for this relatively neglected group.
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Affiliation(s)
- Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom
- University of Exeter Medical School, Exeter, United Kingdom
- * E-mail:
| | - Charles Rowe
- Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom
| | - Alje Van Hoorn
- Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom
| | - William Henley
- University of Exeter Medical School, Exeter, United Kingdom
| | - Richard Laugharne
- Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom
- University of Exeter Medical School, Exeter, United Kingdom
| | - David Cox
- Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom
| | - Raj Pande
- Cornwall Partnership NHS Foundation Trust, Bodmin, United Kingdom
| | - Ashok Roy
- Coventry and Warwickshire NHS Trust, Solihul, United Kingdom
- Chair of the Faculty of Psychiatry of Intellectual Disability - Royal College of Psychiatrists, London, United Kingdom
| | - Josemir W. Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, United Kingdom
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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136
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Axmon A, Sandberg M, Ahlström G, Midlöv P. Fall-risk-increasing drugs and falls requiring health care among older people with intellectual disability in comparison with the general population: A register study. PLoS One 2018; 13:e0199218. [PMID: 29920564 PMCID: PMC6007903 DOI: 10.1371/journal.pone.0199218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/04/2018] [Indexed: 01/27/2023] Open
Abstract
Background Falls are the most common cause of injury for older people in the general population as well as among those with intellectual disability. There are many risk factors for falls, including a range of drugs which are considered to be fall-risk-increasing (FRIDs). The aim of the present study was to describe prescription patterns of FRIDs in itself as well as in relation to falls requiring health care among older people with intellectual disability and their age-peers in the general population. Moreover, to investigate possible differences between the two groups. Methods A cohort of people with intellectual disability and a referent cohort, one-to-one-matched by sex and year of birth, were established. Each cohort comprised 7936 people aged 55+ years at the end of 2012. Register data were collected for 2006–2012 on prescription of antidepressants, anxiolytics, hypnotics and sedatives, opioids, and antipsychotics, as well as for fall-related health care contacts. Analyses were performed on yearly data, using repeated measures models. Results People with intellectual disability were more likely to be prescribed at least one FRID (Relative Risk [RR] 2.31). The increase was highest for antipsychotics (RR 25.0), followed by anxiolytics (RR 4.18), antidepressants (RR 2.72), and hypnotics and sedatives (RR 1.42). For opioids, however, a lower prevalence (RR 0.74) was found. In both cohorts, those with prescription of at least one FRID were more likely to have a fall-related injury that required health care. The increased risk was higher in the referent cohort (RR 3.98) than among people with intellectual disability (RR 2.27), although people with intellectual disability and prescription still had a higher risk of falls than those with prescription in the referent cohort (RR 1.27). A similar pattern was found for all drug groups, except for opioids, where prescription carried the same risk of having a fall-related injury that required health care in both cohorts. Conclusions With or without prescription of FRIDs, older people with ID have a higher risk of falls requiring health care than their age-peers in the general population. It is important to be aware of this when prescribing drugs that further increase the risk of falls.
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Affiliation(s)
- Anna Axmon
- Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
- * E-mail:
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
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A recurrent de novo CUX2 missense variant associated with intellectual disability, seizures, and autism spectrum disorder. Eur J Hum Genet 2018; 26:1388-1391. [PMID: 29795476 DOI: 10.1038/s41431-018-0184-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/16/2018] [Accepted: 05/09/2018] [Indexed: 01/19/2023] Open
Abstract
In most patients with intellectual disability (ID), the etiology is unknown, but lately several de novo variants have been associated with ID. One of the involved genes, CUX2, has twice been reported to be affected by a de novo variant c.1768G>A; p.(Glu590Lys) in patients with ID or epileptic encephalopathy. CUX2 is expressed primarily in nervous tissues where it may act as a transcription factor involved in neural specification. Here we describe a third case who was diagnosed with epilepsy including general and myoclonic seizures, moderate to severe cognitive disability, and infantile autism. The patient was heterozygous for the c.1768G>A; p.(Glu590Lys) variant in CUX2 identified by whole exome sequencing. These findings strongly suggest a causal impact of this variant and add to our understanding of a subset of patients with ID, seizures, and autism spectrum disorder as well as suggest an important role for the CUX2 gene in human brain function.
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138
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Schulte JT, Wierenga CJ, Bruining H. Chloride transporters and GABA polarity in developmental, neurological and psychiatric conditions. Neurosci Biobehav Rev 2018; 90:260-271. [PMID: 29729285 DOI: 10.1016/j.neubiorev.2018.05.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/20/2018] [Accepted: 05/01/2018] [Indexed: 12/22/2022]
Abstract
Neuronal chloride regulation is a determinant factor for the dynamic tuning of GABAergic inhibition during and beyond brain development. This regulation is mainly dependent on the two co-transporters K+/Cl- co-transporter KCC2 and Na+/K+/Cl- co-transporter NKCC1, whose activity can decrease or increase neuronal chloride concentrations respectively. Altered expression and/or activity of either of these co-transporters has been associated with a wide variety of brain disorders including developmental disorders, epilepsy, schizophrenia and stroke. Here, we review current knowledge on chloride transporter expression and activity regulation and highlight the intriguing potential for existing and future interventions to support chloride homeostasis across a wide range of mental disorders and neurological conditions.
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Affiliation(s)
- Joran T Schulte
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center, Heidelberglaan 100, 3508 GA Utrecht The Netherlands
| | - Corette J Wierenga
- Division of Biology, Faculty of Science, Utrecht University, Padualaan 8, 3584 CH, Utrecht, The Netherlands
| | - Hilgo Bruining
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center, Heidelberglaan 100, 3508 GA Utrecht The Netherlands.
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139
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The provision of care to adults with an intellectual disability in the UK. A Special report from the intellectual disability UK chapter ILAE. Seizure 2018; 56:41-46. [DOI: 10.1016/j.seizure.2018.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 11/20/2022] Open
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O'Dwyer M, Peklar J, Mulryan N, McCallion P, McCarron M, Henman MC. Prevalence and patterns of anti-epileptic medication prescribing in the treatment of epilepsy in older adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:245-261. [PMID: 29314463 DOI: 10.1111/jir.12461] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 09/28/2017] [Accepted: 11/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The prevalence of epilepsy is higher in people with intellectual disability (ID) and increases with the degree of ID. Although life expectancy for people with ID is increasing, people with ID coexisting with epilepsy have a higher mortality rate, particularly those who had recent seizures. There have been few observational studies of the prevalence and patterns of anti-epileptic prescribing among older people with ID and epilepsy. The aim of this study was to investigate prevalence and patterns of anti-epileptic prescribing in the treatment of epilepsy in a representative population of older people with ID and epilepsy. METHODS This was an observational cross-sectional study from wave 1 (2009/2010) of Intellectual Disability Supplement to the Irish Longitudinal Study on Aging, a nationally representative sample of 753 persons with ID aged between 41 and 90 years. Participants and/or proxies recorded medicines used on a regular basis and reported doctor's diagnosis of epilepsy; medication data were available for 736 (98%). Prescribing of anti-epileptic drugs (AEDs) for epilepsy in those with a doctor's diagnosis of epilepsy (N = 205) was the primary exposure of interest for this study. Participant exposure to these AEDs was then categorised into AED monotherapy and polytherapy. Participants/carers reported seizure frequency, when epilepsy was last reviewed and which practitioner reviewed epilepsy. In addition, medications that may lower the seizure threshold that were listed in the Maudsley prescribing guidelines in psychiatry were examined. RESULTS Of the 736 participants with reported medicines use, 38.9% (n = 287) were exposed to AEDs, and 30.6% (225) had a doctor's diagnosis of epilepsy. Of those with epilepsy (n = 225), 90.9% (n = 205) reported concurrent use of AEDs and epilepsy. Of these 205 participants, 50.3% (n = 103) were exposed to AED polytherapy, and 63 different polytherapy regimes were reported. The most frequently reported AEDs were valproic acid (n = 100, 48.7%), carbamazepine (n = 89, 46.3%) and lamotrigine (n = 57, 27.8%). In total, 13.7% had a concurrent psychotropic, which should be avoided in epilepsy, and 32.6% had a psychotropic where caution is required. Antipsychotics with potential epileptogenic potential accounted for 80% of these medications. Of those with AED polytherapy (n = 103), 29.5% (28) reported being seizure free for the previous 2 years. CONCLUSIONS Prevalence of epilepsy was high among older people with ID, and half were exposed to two or more AEDs. Despite the use of AED therapy, over half had seizures in the previous 2 years. As the primary goals of optimal AED treatment are to achieve seizure freedom without unacceptable adverse effects, this was not achievable for many older patients with ID and epilepsy. Our findings indicated that people with ID and epilepsy were often exposed to psychotropic medications that may lower the seizure threshold. Regular review of epilepsy and medicines (including medicines that may interact with AEDs or lower the seizure threshold) by multidisciplinary teams working to agreed standards may improve quality of prescribing. Improved exchange of information and coordination of care between specialists and primary care practitioners in line with expert consensus recommendations could bring substantial benefit.
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Affiliation(s)
- M O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
- IDS-TILDA, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - J Peklar
- School of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - N Mulryan
- IDS-TILDA, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - P McCallion
- School of Social Work. College of Public Health, Temple University, Philadelphia, PA, USA
| | - M McCarron
- Dean of the Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - M C Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
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Wagner AP, Croudace TJ, Bateman N, Pennington MW, Prince E, Redley M, White SR, Ring H. Clinical services for adults with an intellectual disability and epilepsy: A comparison of management alternatives. PLoS One 2017; 12:e0180266. [PMID: 28671982 PMCID: PMC5495336 DOI: 10.1371/journal.pone.0180266] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/13/2017] [Indexed: 12/21/2022] Open
Abstract
Background Intellectual disability (ID) is relatively common in people with epilepsy, with prevalence estimated to be around 25%. Surprisingly, given this relatively high frequency, along with higher rates of refractory epilepsy than in those without ID, little is known about outcomes of different management approaches/clinical services treating epilepsy in adults with ID—we investigate this area. Materials & methods We undertook a naturalistic observational cohort study measuring outcomes in n = 91 adults with ID over a 7-month period (recruited within the period March 2008 to April 2010). Participants were receiving treatment for refractory epilepsy (primarily) in one of two clinical service settings: community ID teams (CIDTs) or hospital Neurology services. Results The pattern of comorbidities appeared important in predicting clinical service, with Neurologists managing the epilepsy of relatively more of those with neurological comorbidities whilst CIDTs managed the epilepsy of relatively more of those with psychiatric comorbidities. Epilepsy-related outcomes, as measured by the Glasgow Epilepsy Outcome Scale 35 (GEOS-35) and the Epilepsy and Learning Disabilities Quality of Life Scale (ELDQoL) did not differ significantly between Neurology services and CIDTs. Discussion In the context of this study, the absence of evidence for differences in epilepsy-related outcomes amongst adults with ID and refractory epilepsy between mainstream neurology and specialist ID clinical services is considered. Determining the selection of the service managing the epilepsy of adults with an ID on the basis of the skill sets also required to treat associated comorbidities may hence be a reasonable heuristic.
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Affiliation(s)
- Adam P. Wagner
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England, Cambridge, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Tim J. Croudace
- School of Nursing and Midwifery and Social Dimensions of Health Institute, University of Dundee, Dundee, United Kingdom
| | - Naomi Bateman
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | | | - Elizabeth Prince
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Marcus Redley
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Simon R. White
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Howard Ring
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
- * E-mail:
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142
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Shankar R, Henley W, Wehner T, Wiggans C, McLean B, Pace A, Mohan M, Sadler M, Doran Z, Hudson S, Allard J, Sander JW. Perampanel in the general population and in people with intellectual disability: Differing responses. Seizure 2017; 49:30-35. [DOI: 10.1016/j.seizure.2017.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022] Open
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143
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Abstract
The prevalence of epilepsy in people with intellectual disability is higher than in the general population and prevalence rates increase with increasing levels of disability. Prevalence rates of epilepsy are highest among those living in residential care. The healthcare needs of people with intellectual disability and epilepsy are complex and deserve special consideration in terms of healthcare provision and access to specialist epilepsy clinics, which are usually held in acute hospital campuses. This patient population is at risk of suboptimal care because of significant difficulties accessing specialist epilepsy care which is typically delivered in the environs of acute hospitals. In 2014, the epilepsy service at Cork University Hospital established an Epilepsy Outreach Service providing regular, ambulatory outpatient follow up at residential care facilities in Cork city and county in an effort to improve access to care, reduce the burden and expense of patient and carer travel to hospital outpatient appointments, and to provide a dedicated specialist phone service for epilepsy related queries in order to reduce emergency room visits when possible. We present the findings of an economic analysis of the outreach service model of care compared to the traditional hospital outpatient service and demonstrate significant cost savings and improved access to care with this model. Ideally these cost savings should be used to develop novel ways to enhance epilepsy care for persons with disability. We propose that this model of care can be more suitable for persons with disability living in residential care who are at risk of losing access to specialist epilepsy care.
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Affiliation(s)
- Eimer Maloney
- Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland.
| | - Ronan N McGinty
- Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland
| | - Daniel J Costello
- Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland
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144
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Moavero R, Santarone ME, Galasso C, Curatolo P. Cognitive and behavioral effects of new antiepileptic drugs in pediatric epilepsy. Brain Dev 2017; 39:464-469. [PMID: 28202262 DOI: 10.1016/j.braindev.2017.01.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/28/2016] [Accepted: 01/16/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND In pediatric epilepsy, neurodevelopmental comorbidities could be sometimes even more disabling than seizures themselves, therefore it is crucial for the clinicians to understand how to benefit these children, and to choose the proper antiepileptic drug for the treatment of epilepsy associated to a specific neurodevelopmental disorder. Aim of this paper is to discuss the potential impact on cognition and behavior of new and newest AEDs and to guide the choice of the clinicians for a targeted use in epilepsy associated with specific neurodevelopmental disorders. METHODS Information in this review is mainly based on peer-reviewed medical publications from 2002 until October 2016 (PubMed). We choose to include in our review only the AEDs of second and third generation approved for pediatric population. RESULTS Vigabatrin, lamotrigine, topiramate, levetiracetam, oxcarbazepine, zonisamide, rufinamide, lacosamide, eslicarbazepine, and perampanel have been included in this review. The most tolerated AEDs from a cognitive and behavioral point of view are lamotrigine and rufinamide, thus representing optimal drugs for children with cognitive and/or attention problems. DISCUSSION Most of the new AEDs are initially licensed for adult patients. Data on children are usually very limited, both in terms of efficacy and safety, and the use standardized cognitive and behavioral outcome measures are very limited in pediatric clinical trials. CONCLUSION Several factors including polytherapy, administration of AEDs with the same mechanism of action and the dose and titration of the drug, should be considered as important in the development of cognitive and behavioral side effects.
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Affiliation(s)
- Romina Moavero
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Italy; Child Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | | | - Cinzia Galasso
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Italy
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Italy
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145
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Mircher C, Cieuta-Walti C, Marey I, Rebillat AS, Cretu L, Milenko E, Conte M, Sturtz F, Rethore MO, Ravel A. Acute Regression in Young People with Down Syndrome. Brain Sci 2017; 7:brainsci7060057. [PMID: 28555009 PMCID: PMC5483630 DOI: 10.3390/brainsci7060057] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 12/21/2022] Open
Abstract
Abstract: Adolescents and young adults with Down syndrome (DS) can present a rapid regression with loss of independence and daily skills. Causes of regression are unknown and treatment is most of the time symptomatic. We did a retrospective cohort study of regression cases: patients were born between 1959 and 2000, and were followed from 1984 to now. We found 30 DS patients aged 11 to 30 years old with history of regression. Regression occurred regardless of the cognitive level (severe, moderate, or mild intellectual disability (ID)). Patients presented psychiatric symptoms (catatonia, depression, delusions, stereotypies, etc.), partial or total loss of independence in activities of daily living (dressing, toilet, meals, and continence), language impairment (silence, whispered voice, etc.), and loss of academic skills. All patients experienced severe emotional stress prior to regression, which may be considered the trigger. Partial or total recovery was observed for about 50% of them. In our cohort, girls were more frequently affected than boys (64%). Neurobiological hypotheses are discussed as well as preventative and therapeutic approaches.
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Affiliation(s)
| | | | | | | | - Laura Cretu
- Jérôme Lejeune Institute, Paris 75015, France.
| | | | | | | | | | - Aimé Ravel
- Jérôme Lejeune Institute, Paris 75015, France.
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146
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Dunn K, Hughes-McCormack L, Cooper SA. Hospital admissions for physical health conditions for people with intellectual disabilities: Systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31 Suppl 1:1-10. [PMID: 28467010 DOI: 10.1111/jar.12360] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND People with intellectual disabilities may have inequalities in hospital admissions compared with the general population. The present authors aimed to investigate admissions for physical health conditions in this population. METHODS The present authors conducted a systematic review, searching six databases using terms on intellectual disabilities and hospital admission. Papers were selected based on pre-defined inclusion/exclusion criteria, data extracted, tabulated and synthesized and quality assessed. PROSPERO registration number: CRD42015020575. RESULTS Seven of 29,613 papers were included. There were more admissions, and a different pattern of admissions (more medical and dental), for people with intellectual disabilities, but most studies did not take account of higher disease prevalence. Three papers considered admissions for ambulatory care-sensitive conditions, two of which accounted for disease prevalence (asthma, diabetes) and found higher admission rates for people with intellectual disabilities. CONCLUSION Admissions are common. Asthma and diabetes admission data suggest suboptimal primary health care for people with intellectual disabilities compared with the general population, but evidence is limited.
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Affiliation(s)
- Kirsty Dunn
- Institute of Health and Wellbeing, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
| | - Laura Hughes-McCormack
- Institute of Health and Wellbeing, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
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147
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Wang Z, Guo C, Chen G, Zhang L, Wen X, Zheng X. Mutual associations between intellectual disability and epilepsy-related psychiatry disability: Population-based study. Medicine (Baltimore) 2017; 96:e6831. [PMID: 28489764 PMCID: PMC5428598 DOI: 10.1097/md.0000000000006831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Epilepsy is the third-leading cause of psychiatry disability in China, and intellectual disability (ID) is also 1 major type of disabilities in China. This study estimates the prevalence of comorbidities with ID and epilepsy-related psychiatry disability (EPD) and examines mutual associations within ID and EPD.Data were taken from the Second China National Sample Survey on Disability, which was a nationally representative, population-based survey. To derive a nationally representative sample, the survey used multistage, stratified, cluster random sampling with probability proportional to size. The disabled people who had ID and EPD based on the World Health Organization International Classification of Functioning, Disability, and Health and the International Statistical Classification of Diseases. The cox-proportional hazards model was used to examine the associations between ID and EPD considering the happened sequence of ID and EPD.The prevalence of ID with EPD was 0.14 (95% confidence interval: 0.09-0.19) per 1000 people. Age was strongly associated with the risk of EPD, which was diagnosed after ID, especially among young ID population. Except for age, other variables were also associated between ID and EPD considering sequence of ID and EPD.This study is the first national study to explore mutual associations with ID and EPD and highlights the young ID children with high risk of development of epilepsy. To address the challenge of ID with EPD disability in China, the government should adjust its strategies for healthcare systems to prevent disability.
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148
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Contestabile A, Magara S, Cancedda L. The GABAergic Hypothesis for Cognitive Disabilities in Down Syndrome. Front Cell Neurosci 2017; 11:54. [PMID: 28326014 PMCID: PMC5339239 DOI: 10.3389/fncel.2017.00054] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/14/2017] [Indexed: 12/04/2022] Open
Abstract
Down syndrome (DS) is a genetic disorder caused by the presence of a third copy of chromosome 21. DS affects multiple organs, but it invariably results in altered brain development and diverse degrees of intellectual disability. A large body of evidence has shown that synaptic deficits and memory impairment are largely determined by altered GABAergic signaling in trisomic mouse models of DS. These alterations arise during brain development while extending into adulthood, and include genesis of GABAergic neurons, variation of the inhibitory drive and modifications in the control of neural-network excitability. Accordingly, different pharmacological interventions targeting GABAergic signaling have proven promising preclinical approaches to rescue cognitive impairment in DS mouse models. In this review, we will discuss recent data regarding the complex scenario of GABAergic dysfunctions in the trisomic brain of DS mice and patients, and we will evaluate the state of current clinical research targeting GABAergic signaling in individuals with DS.
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Affiliation(s)
- Andrea Contestabile
- Department of Neuroscience and Brain Technologies, Istituto Italiano di Tecnologia (IIT) Genova, Italy
| | - Salvatore Magara
- Department of Neuroscience and Brain Technologies, Istituto Italiano di Tecnologia (IIT) Genova, Italy
| | - Laura Cancedda
- Department of Neuroscience and Brain Technologies, Istituto Italiano di Tecnologia (IIT)Genova, Italy; Dulbecco Telethon InstituteGenova, Italy
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Gholipour T, Mitchell S, Sarkis RA, Chemali Z. The clinical and neurobehavioral course of Down syndrome and dementia with or without new-onset epilepsy. Epilepsy Behav 2017; 68:11-16. [PMID: 28109983 DOI: 10.1016/j.yebeh.2016.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/26/2016] [Accepted: 12/12/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Adult patients with Down syndrome (DS) are at higher risk of developing Alzheimer-type dementia and epilepsy. The relationship between developing dementia and the risk of developing seizures in DS is poorly characterized to date. In addition, treatment response and medication tolerability have not been rigorously studied. METHODS We identified 220 patients with a diagnosis of DS and dementia. Those without a history of developing seizures (DD) were compared to patients with new-onset seizures (DD+S) after the age of 35. Electronic records were reviewed for demographics, seizure characteristics, cognitive status, and psychiatric comorbidities. RESULTS Of the patients included for analysis, twenty-six out of 60 patients had new-onset seizures or developed seizures during the follow-up period (the DD+S group) with a median onset of 2.0years after the dementia diagnosis. Generalized tonic-clonic seizures were the most common seizure type (61.5% of DD+S). Sixteen (61.5%) patients were reported to have myoclonus. Levetiracetam was the most commonly used initial medication, with the majority (73%) of patients treated achieving partial or complete seizure control. The DD+S patients tended to have a similar burden of new-onset neuropsychiatric symptoms compared to the DD group. DISCUSSION New-onset epilepsy seems to occur early in the course of dementia in DS patients. Patients generally respond to treatment. A great burden of neuropsychiatric symptoms is seen. Future studies need to explore the relationship between β-amyloid accumulation and epileptiform activity and attend to the care and needs of DS patients with dementia and seizures.
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Affiliation(s)
- Taha Gholipour
- Department of Neurology, Edward B. Bromfield Epilepsy Center, Brigham and Women's Hospital, Boston, 75 Francis Street, Boston, MA 02115, USA; Department of Neurology, Massachusetts General Hospital, Boston, 55 Fruit Street, Boston, MA 02114, USA.
| | - Sara Mitchell
- Department of Psychiatry, Massachusetts General Hospital, Boston, 55 Fruit Street, Boston, MA 02114, USA.
| | - Rani A Sarkis
- Department of Neurology, Edward B. Bromfield Epilepsy Center, Brigham and Women's Hospital, Boston, 75 Francis Street, Boston, MA 02115, USA.
| | - Zeina Chemali
- Department of Neurology, Massachusetts General Hospital, Boston, 55 Fruit Street, Boston, MA 02114, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, 55 Fruit Street, Boston, MA 02114, USA.
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Guekht A, Zharkinbekova N, Shpak A, Hauser WA. Epilepsy and treatment gap in urban and rural areas of the Southern Kazakhstan in adults. Epilepsy Behav 2017; 67:98-104. [PMID: 28142100 DOI: 10.1016/j.yebeh.2016.11.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE There are no data in the English literature about the epidemiology of epilepsy in the large countries in the Asian region of the former Soviet Union. This paper presents the results of epidemiological studies of active epilepsy in the population 14years of age and older in the Province of South Kazakhstan. METHODS The study population consisted of 306.44 thousand persons: 139.42 in the urban Enbekshinskiy district of the city of Shymkent and 167.02 in the rural Sairam district. To collect patient's data, multiple medical sources were used. For each person with epilepsy (PWE), a questionnaire was completed by members of the research team. Clinical profiles, seizure type, clinical syndrome, etiology, seizure frequency, therapy, educational level, and social status were abstracted. RESULTS Overall, 1351 PWE were identified: 459 in the urban district and 892 in the rural district. The age-adjusted prevalence of epilepsy was 3.14/1000 (CI95%: 2.86-3.45) in the urban district and 4.95/1000 (CI95%: 4.62-5.30) in the rural district. Prevalence for men was higher than for women. Focal seizures predominated in both regions. Traumatic brain injury was the most frequently identified cause of epilepsy. The other important antecedents were pre/perinatal disorders, CNS infection, and cerebrovascular disease. Half of PWE experienced more than 12seizures per year. Substantial social impacts of epilepsy were observed: 44% of PWE received disability pensions from the government; only 15.5% were employed. About a quarter of all PWE were not taking AEDs at the time of the record review. For those on treatment, regimens were frequently suboptimal. CONCLUSION In the first study performed according to the guidelines for epidemiologic studies on epilepsy of ILAE in the Asian part of the former Soviet Union, poor seizure control and a substantial treatment gap were identified. The need for improvement of epilepsy care was highlighted, especially in the rural regions.
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Affiliation(s)
- Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow 115419, Russian Federation; Department of Neurology, Neurosurgery and Medical Genetics, Russian National Research Medical University, 8, Leninsky Prospekt, bl.8, Moscow 119049, Russian Federation.
| | - Nazira Zharkinbekova
- Department of Neurology, Neurosurgery and Medical Genetics, Russian National Research Medical University, 8, Leninsky Prospekt, bl.8, Moscow 119049, Russian Federation; Shymkent Regional Clinical Hospital, 4, Mailykozha Str., Shymkent, South Kazakhstan Province 160050, Kazakhstan.
| | - Alexander Shpak
- The S. Fyodorov Eye Microsurgery Federal State Institution, 59A, Beskudnikovsky Blvd, Moscow 127486, Russian Federation.
| | - W Allen Hauser
- Department of Neurology, Epidemiology and Sergievsky Center, Columbia University, 630, West 168 St., New York, NY 10032, USA.
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