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Kerr M, Linehan C, Brandt C, Kanemoto K, Kawasaki J, Sugai K, Tadokoro Y, Villanueva V, Wilmshurst J, Wilson S. Behavioral disorder in people with an intellectual disability and epilepsy: A report of the Intellectual Disability Task Force of the Neuropsychiatric Commission of ILAE. Epilepsia Open 2016; 1:102-111. [PMID: 29588933 PMCID: PMC5719831 DOI: 10.1002/epi4.12018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 11/25/2022] Open
Abstract
The management and needs of people with intellectual disability (ID) and epilepsy are well evidenced; less so, the comorbidity of behavioral disorder in this population. "Behavioral disorder" is defined as behaviors that are difficult or disruptive, including stereotypes, difficult or disruptive behavior, aggressive behavior toward other people, behaviors that lead to injury to self or others, and destruction of property. These have an important link to emotional disturbance. This report, produced by the Intellectual Disability Task Force of the Neuropsychiatric Commission of the ILAE, aims to provide a brief review of some key areas of concern regarding behavioral disorder among this population and proposes a range of research and clinical practice recommendations generated by task force members. The areas covered in this report were identified by experts in the field as being of specific relevance to the broad epilepsy community when considering behavioral disorder in persons with epilepsy and ID; they are not intended to be exhaustive. The practice recommendations are based on the authors' review of the limited research in this field combined with their experience supporting this population. These points are not graded but can be seen as expert opinion guiding future research and clinical practice.
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Affiliation(s)
- Mike Kerr
- Institute of Psychological Medicine and Clinical NeuroscienceCardiff UniversityCardiffUnited Kingdom
| | - Christine Linehan
- UCD Centre for Disability StudiesUniversity College DublinDublinIreland
- Tizard CentreUniversity of KentCanterburyUnited Kingdom
| | - Christian Brandt
- Department of General EpileptologyBethel Epilepsy CentreMara HospitalBielefeldGermany
| | | | | | - Kenji Sugai
- Department of Child NeurologyNational Center of Neurology and PsychiatryKodairaJapan
| | - Yukari Tadokoro
- Department of NeuropsychiatryAichi Medical UniversityAichiJapan
| | - Vicente Villanueva
- Multidisciplinary Epilepsy UnitNeurology ServiceUniversity Hospital and Polytechnic La FeValenciaSpain
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Paediatrics and Child HealthRed Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
| | - Sarah Wilson
- Melbourne School of Psychological Sciencesthe University of MelbourneMelbourneVictoriaAustralia
- Comprehensive Epilepsy ProgramAustin HealthMelbourneVictoriaAustralia
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152
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Mengoni SE, Gates B, Parkes G, Wellsted D, Barton G, Ring H, Khoo ME, Monji-Patel D, Friedli K, Zia A, Irvine L, Durand MA. Wordless intervention for people with epilepsy and learning disabilities (WIELD): a randomised controlled feasibility trial. BMJ Open 2016; 6:e012993. [PMID: 28186943 PMCID: PMC5128894 DOI: 10.1136/bmjopen-2016-012993] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/01/2016] [Accepted: 08/25/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of a full-scale randomised controlled trial of a picture booklet to improve quality of life for people with epilepsy and learning disabilities. TRIAL DESIGN A randomised controlled feasibility trial. Randomisation was not blinded and was conducted using a centralised secure database and a blocked 1:1 allocation ratio. SETTING Epilepsy clinics in 1 English National Health Service (NHS) Trust. PARTICIPANTS Patients with learning disabilities and epilepsy who had: a seizure within the past 12 months, meaningful communication and a carer with sufficient proficiency in English. INTERVENTION Participants in the intervention group used a picture booklet with a trained researcher, and a carer present. These participants kept the booklet, and were asked to use it at least twice more over 20 weeks. The control group received treatment as usual, and were provided with a booklet at the end of the study. OUTCOME MEASURES 7 feasibility criteria were used relating to recruitment, data collection, attrition, potential effect on epilepsy-related quality of life (Epilepsy and Learning Disabilities Quality of Life Scale, ELDQOL) at 4-week, 12-week and 20-week follow-ups, feasibility of methodology, acceptability of the intervention and potential to calculate cost-effectiveness. OUTCOME The recruitment rate of eligible patients was 34% and the target of 40 participants was reached. There was minimal missing data and attrition. An intention-to-treat analysis was performed; data from the outcome measures suggest a benefit from the intervention on the ELDQOL behaviour and mood subscales at 4 and 20 weeks follow-up. The booklet and study methods were positively received, and no adverse events were reported. There was a positive indication of the potential for a cost-effectiveness analysis. CONCLUSIONS All feasibility criteria were fully or partially met, therefore confirming feasibility of a definitive trial. TRIAL REGISTRATION NUMBER ISRCTN80067039.
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Affiliation(s)
- Silvana E Mengoni
- Department of Psychology, Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
| | - Bob Gates
- Institute for Practice, Interdisciplinary Research and Enterprise (INSPIRE), University of West London, London, UK
| | - Georgina Parkes
- Learning Disabilities Services, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - David Wellsted
- Department of Psychology, Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
| | - Garry Barton
- Norwich Medical School and Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Howard Ring
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Mary Ellen Khoo
- Research and Development, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Deela Monji-Patel
- Research and Development, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
- Division 4, Mental Health, NIHR Clinical Research Network: Eastern, UK
| | - Karin Friedli
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Asif Zia
- Learning Disabilities Services, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Lisa Irvine
- Norwich Medical School and Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Marie-Anne Durand
- Department of Psychology, Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
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153
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Mengoni SE, Gates B, Parkes G, Wellsted D, Barton G, Ring H, Khoo ME, Monji-Patel D, Friedli K, Zia A, Durand MA. "Sometimes, it just stops me from doing anything": A qualitative exploration of epilepsy management in people with intellectual disabilities and their carers. Epilepsy Behav 2016; 64:133-139. [PMID: 27736660 PMCID: PMC5140003 DOI: 10.1016/j.yebeh.2016.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/02/2016] [Accepted: 09/18/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Epilepsy affects 1 in 5 people with an intellectual disability (ID), but little is known about their experiences of living with epilepsy. A qualitative study was conducted to investigate the impact and management of epilepsy in people with ID. MATERIALS AND METHODS People with epilepsy and ID and their carers were invited to take part in semi-structured interviews. Eleven participants with ID and their carers were interviewed together, one participant with ID and their carer were interviewed separately, two interviews took place with the participant with ID only, and one interview took place with the carer only. The interviews were transcribed verbatim, coded, and analyzed thematically (dual independent coding for 30% of the transcripts). RESULTS Three themes emerged (participant characteristics, living with epilepsy, epilepsy management and information needs) which indicated the following: 1) diversity regarding health profiles, communication abilities, severity of epilepsy, perceived control of epilepsy, and support needs; 2) a reduction in severity and frequency of seizures for a sizeable proportion of participants through antiepileptic drugs; 3) the lifelong impact of epilepsy and related seizures on participants' activities and quality of life; 4) the perceived burden of epilepsy and difficulty managing the condition for a large proportion of participants; 5) high levels of satisfaction with epilepsy-related services and care; and 6) an overall lack of written accessible information about epilepsy. CONCLUSIONS This study has highlighted a significant impact of epilepsy and related seizures on the daily lives and quality of life of people with ID. Although a sizeable proportion of participants and their carers considered their epilepsy to be well controlled, the majority reported difficulties managing epilepsy and minimizing its impact on their wellbeing. Excluding care staff and the support provided by epilepsy clinics, the participants had not accessed any adapted self-management or information resources about epilepsy.
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Affiliation(s)
- Silvana E Mengoni
- Centre for Health Services and Clinical Research, Department of Psychology, University of Hertfordshire, Hatfield, UK.
| | - Bob Gates
- Institute for Practice, Interdisciplinary Research and Enterprise (INSPIRE), University of West London, UK
| | - Georgina Parkes
- Learning Disabilities Services, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - David Wellsted
- Centre for Health Services and Clinical Research, Department of Psychology, University of Hertfordshire, Hatfield, UK
| | - Garry Barton
- Norwich Medical School and Norwich Clinical Trials Unit, University of East Anglia, UK
| | - Howard Ring
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Box 189, Cambridge Biomedical Campus, Cambridge CB2 2QQ, UK
| | - Mary Ellen Khoo
- Research and Development, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Deela Monji-Patel
- Research and Development, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK; NIHR Clinical Research Network: Eastern, Division 4, Mental Health, UK
| | - Karin Friedli
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Asif Zia
- Learning Disabilities Services, Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Marie-Anne Durand
- Centre for Health Services and Clinical Research, Department of Psychology, University of Hertfordshire, Hatfield, UK; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
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154
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Dannenberg M, Mengoni SE, Gates B, Durand MA. Self-management interventions for epilepsy in people with intellectual disabilities: A scoping review. Seizure 2016; 41:16-25. [DOI: 10.1016/j.seizure.2016.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/10/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022] Open
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155
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Kothare S, Kaleyias J. Is treatment in adults with intellectual and developmental disability also suffering from epilepsy different from adults with uncomplicated epilepsy? Eur J Neurol 2016; 23:1141-2. [DOI: 10.1111/ene.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- S. Kothare
- Department of Neurology; NYU Comprehensive Epilepsy Center − Sleep Center; New York University Langone Medical Center; New York NY USA
| | - J. Kaleyias
- Department of Paediatrics; Colchester University Hospital; Colchester Essex UK
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156
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Zhao H, Carney KE, Falgoust L, Pan JW, Sun D, Zhang Z. Emerging roles of Na⁺/H⁺ exchangers in epilepsy and developmental brain disorders. Prog Neurobiol 2016; 138-140:19-35. [PMID: 26965387 DOI: 10.1016/j.pneurobio.2016.02.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/03/2016] [Accepted: 02/27/2016] [Indexed: 12/15/2022]
Abstract
Epilepsy is a common central nervous system (CNS) disease characterized by recurrent transient neurological events occurring due to abnormally excessive or synchronous neuronal activity in the brain. The CNS is affected by systemic acid-base disorders, and epileptic seizures are sensitive indicators of underlying imbalances in cellular pH regulation. Na(+)/H(+) exchangers (NHEs) are a family of membrane transporter proteins actively involved in regulating intracellular and organellar pH by extruding H(+) in exchange for Na(+) influx. Altering NHE function significantly influences neuronal excitability and plays a role in epilepsy. This review gives an overview of pH regulatory mechanisms in the brain with a special focus on the NHE family and the relationship between epilepsy and dysfunction of NHE isoforms. We first discuss how cells translocate acids and bases across the membrane and establish pH homeostasis as a result of the concerted effort of enzymes and ion transporters. We focus on the specific roles of the NHE family by detailing how the loss of NHE1 in two NHE mutant mice results in enhanced neuronal excitability in these animals. Furthermore, we highlight new findings on the link between mutations of NHE6 and NHE9 and developmental brain disorders including epilepsy, autism, and attention deficit hyperactivity disorder (ADHD). These studies demonstrate the importance of NHE proteins in maintaining H(+) homeostasis and their intricate roles in the regulation of neuronal function. A better understanding of the mechanisms underlying NHE1, 6, and 9 dysfunctions in epilepsy formation may advance the development of new epilepsy treatment strategies.
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Affiliation(s)
- Hanshu Zhao
- Department of Neurology, The First Affiliated Hospital of the Harbin Medical University, Harbin, China.,Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Karen E Carney
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Lindsay Falgoust
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jullie W Pan
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Dandan Sun
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA.,Veterans Affairs Pittsburgh Health Care System, Geriatric Research, Educational and Clinical Center, Pittsburgh, PA 15213, USA
| | - Zhongling Zhang
- Department of Neurology, The First Affiliated Hospital of the Harbin Medical University, Harbin, China
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157
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Robertson J, Baines S, Emerson E, Hatton C. Service Responses to People with Intellectual Disabilities and Epilepsy: A Systematic Review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 30:1-32. [DOI: 10.1111/jar.12228] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
| | - Susannah Baines
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
| | - Eric Emerson
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
- Centre for Disability Research and Policy; University of Sydney; Sydney NSW Australia
| | - Chris Hatton
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
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