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Allard J, Henley W, Sellers A, O'Shaughnessy E, Thomson O, McLean B, Parrett M, Rajakulendran S, Watkins L, Maguire M, Ellawela S, Tittensor P, Sen A, Mohanraj R, Bagary M, Ram S, Brown A, Shankar R. Efficacy and tolerability of Brivaracetam in people with intellectual disability compared to those without intellectual disability. Epilepsy Behav 2024; 158:109906. [PMID: 38936308 DOI: 10.1016/j.yebeh.2024.109906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/19/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION In England, nearly a quarter of people with intellectual disability (PwID) have epilepsy. Though 70 % of PwID have pharmaco-resistant seizures only 10 % are prescribed anti-seizure medication (ASMs) licenced for pharmaco-resistance. Brivaracetam (BRV) licenced in 2016 has had nine post-marketing studies involving PwID. These studies are limited either by lack of controls or not looking at outcomes based on differing levels of ID severity. This study looks at evidence comparing effectiveness and side-effects in PwID to those without ID prescribed Brivaracetam (BRV). METHODS Pooled case note data for patients prescribed BRV (2016-2022) at 12 UK NHS Trusts were analysed. Demographics, starting and maximum dose, side-effects, dropouts and seizure frequency between ID (mild vs. moderate-profound (M/P)) and general population for a 12-month period were compared. Descriptive analysis, Mann-Whitney, Fisher's exact and logistic regression methods were employed. RESULTS 37 PwID (mild 17 M/P 20) were compared to 102 without ID. Mean start and maximum dose was lower for PwID than non-ID. Mean maximum dose reduced slightly with ID severity. No difference was found between ID and non-ID or between ID groups (Mild vs M/P) in BRV's efficacy i.e. >50 % seizure reduction or tolerability. Mental and behavioural side-effects were more prevalent for PwID (27.0 % ID, 17.6 % no ID) but not significantly higher (P = 0.441) or associated with ID severity (p = 0.255). CONCLUSION This is the first study on BRV, which compares ID cohorts with differing severity and non-ID. Efficacy, tolerability and side-effects reported are similar across differing ID severity to those with no ID.
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Affiliation(s)
- Jon Allard
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, United Kingdom; CIDER, Peninsula School of Medicine, University of Plymouth, United Kingdom
| | | | - Adrian Sellers
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, United Kingdom
| | - Emma O'Shaughnessy
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, United Kingdom
| | - Oliver Thomson
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, United Kingdom
| | - Brendan McLean
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, United Kingdom; CIDER, Peninsula School of Medicine, University of Plymouth, United Kingdom
| | - Mary Parrett
- Royal Cornwall Hospital NHS Trust, United Kingdom
| | - Sanjeev Rajakulendran
- The National Hospital for Neurology and Neurosurgery, University College Hospitals, United Kingdom
| | - Lance Watkins
- CIDER, Peninsula School of Medicine, University of Plymouth, United Kingdom; Swansea Bay University Health Board, United Kingdom
| | | | - Shan Ellawela
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | | | - Arjune Sen
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | | | - Manny Bagary
- Birmingham and Solihull Mental Health NHS Foundation Trust, United Kingdom
| | - Sunil Ram
- Somerset NHS Foundation Trust, United Kingdom
| | - Allan Brown
- Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, United Kingdom; CIDER, Peninsula School of Medicine, University of Plymouth, United Kingdom.
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Branford D, Sun JJ, Shankar R. Antiseizure medications prescribing for behavioural and psychiatric concerns in adults with an intellectual disability living in England. Br J Psychiatry 2023; 222:191-195. [PMID: 36786124 DOI: 10.1192/bjp.2022.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Antiseizure medications (ASMs) are the second most widely prescribed psychotropic for people with intellectual disabilities in England. Multiple psychotropic prescribing is prevalent in almost half of people with intellectual disabilities on ASMs. This analysis identifies limited evidence of ASM benefit in challenging behaviour management and suggests improvements needed to inform clinical practice.
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Affiliation(s)
- David Branford
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, UK
| | - James J Sun
- Royal Free London NHS Foundation Trust, London, UK
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Bodmin, UK
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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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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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