Treatment considerations: role of vagus nerve stimulator

The relationship among side effects associated with anti-epileptic medications in those with intellectual disability

Seizures are fairly common in those with intellectual disabilities. In order to treat these seizures, antiepileptic drugs (AEDs) are often used and in many cases are effective. However, these medications often create a variety of associated side effects. In order to monitor these side effects, measures such as the SEIZES-B have been used. While many side effects have been found to occur with the use of AEDs, research has not explored if certain side effects are more likely to co-occur. For the current study, 281 people with intellectual disability were administered the SEIZES-B to monitor side effects associated with AEDs. Correlations between side effect subscales were then computed. Several subscales were found to be significantly correlated: hepatic disturbance with dermatological changes and cognitive disturbance; respiratory disturbance with dermatological changes, sedation, and electrolyte disturbance; and cognitive disturbance with sedation and dermatological disturbance. Possible implications of these findings are discussed.

The effect of seizure disorder on symptom presentation in atypically developing children and children with autism spectrum disorders based on the BDI-2

PURPOSE

Autism Spectrum Disorders (ASD) and seizures are highly comorbid conditions. However, little research has been done to examine this relationship. The purpose of the current study was to examine the effect that seizure disorder has on symptom presentation in children with autism spectrum disorders as compared to atypically developing children.

METHOD

The Battelle Developmental Inventory, Second Edition (BDI-2) was used as a measure of impairment across adaptive, personal-social, communication, motor and cognitive skills.

RESULTS

A MANOVA indicated significant main effects between diagnostic group and seizure status, without a significant interaction. Follow-up univariate tests were conducted.

CONCLUSIONS

Overall, results indicated that children with ASD were more impaired than atypically developing children. In addition, children with seizures tended to be more impaired than children without seizures.

Expanding the role of surgery in intractable extratemporal pediatric epilepsy

The aim of epilepsy surgery in children is not only to control seizures but also to curtail future adverse neurological sequelae and improve quality of life. If presurgical evaluation demonstrates discordant or multifocal disease, intracranial surgery may be denied as a viable treatment option. When surgical therapy is offered not just as curative but also as palliative therapy, many children not considered optimal surgical candidates may benefit. From a consecutive series of 57 cases involving children who underwent intracranial epilepsy surgery at Rainbow Babies and Children's Hospital during 2001-2005, the authors present in detail 3 cases involving children who benefited significantly from such an aggressive approach. Marked improvement occurred not only in seizure control, but also in developmental and social functioning.

The reliability of the Scale for the Evaluation and Identification of Seizures, Epilepsy, and Anticonvulsant Side Effects-B (SEIZES B)

The use of anti-epileptic medications (AEDs) is much higher in individuals with intellectual disabilities than in the general population. As many of these individuals rely on such medications, clinicians should consider psychometrically sound instruments for assessing adverse side effects of these medications as one aspect of routine clinical practice. The Scale for the Evaluation and Identification of Seizures, Epilepsy, and Anticonvulsant Side Effects-B (SEIZES B) was developed as a means to identify side effects specific to AEDs. The authors conducted a preliminary evaluation of the inter-rater and test-retest reliability of the SEIZES B on an adult population with developmental disabilities. The SEIZES B had moderately high stability across raters and adequate stability over time. Implications of these data for future research and practice are discussed.

Vagus nerve stimulation therapy: 2-year prospective open-label study of 40 subjects with refractory epilepsy and low IQ who are living in long-term care facilities

Treating seizures among patients with mental retardation/developmental disabilities (MR/DD) is difficult owing in large part to the presence of additional comorbidities and the resulting need for polytherapy. Therefore, a nonpharmacological treatment option is needed for this population. This prospective, open-label study documented the long-term outcome of 40 low-IQ (<70) patients living in long-term care facilities who received vagus nerve stimulation (VNS) therapy for pharmacoresistant epilepsy. Subjects were seen every 1 to 3 months by their neurologist (R.H.). Seizure frequency, antiepileptic medication, and quality-of-life information were documented preimplantation and quarterly thereafter through 2 years. The surgery and therapy were well tolerated. Seizures were reduced by at least 50% for 11 subjects. Antiepileptic medications were reduced from 3.3 per subject at baseline to an average of 2.3 per subject after 2 years. According to caregiver reports, overall quality of life improved for the majority of subjects; also, using the Client Development Evaluation Report (CDER), statistically significant improvements were reported at both 1 and 2 years in attention span, word usage, clarity of speech, standing balance, washing dishes, and household chores. VNS is a viable treatment option for low-IQ patients with pharmacoresistant epilepsy who are living in long-term care facilities.

Management of epilepsy in mentally retarded children using the newer antiepileptic drugs, vagus nerve stimulation, and surgery

Clusters of seizures, prolonged seizures, and status epilepticus occur more frequently in children with multiple disabilities, and chronic seizures are more likely to be refractory to treatment. In many patients, the seizures appear to contribute to the mental retardation. Thus, if the lives of these children are to improve, seizure control is essential. However, medical treatment can interfere with cognition and cause behavioral disturbances, making life very difficult for the child and the child's family. With the introduction of 10 new antiepileptic drugs in the last decade, the treatment of epilepsy in multiply handicapped children has significantly advanced. These new antiepileptic drugs may improve seizure control, medication tolerance, or both. Although the ultimate therapeutic goal is to keep children seizure free and alert, compromises regarding medication choice and dosage are still necessary in many cases. Novel treatment options, such as the vagus nerve stimulator, may decrease seizure frequency without behavioral or cognitive side effects. In carefully selected children with specific epilepsy syndromes, epilepsy surgery can provide partial or complete relief from seizures.

The effects of antiepileptic medications on the social skills of individuals with mental retardation

Prevalence rates of epilepsy are much higher among persons with developmental disabilities compared to the general population. Anticonvulsant medication is the most common method of treating seizure disorders. Many of these antiepileptic medications (AEDs) are associated with various side effects, which may have detrimental effects on the social skills of those with developmental disabilities. The present study investigated the effects of AEDs on the social skills of individuals with mental retardation (MR) residing in an institutional facility. The social skills of 130 individuals were assessed by the Matson Evaluation of Social Skills for Individuals with sEvere Retardation (MESSIER). Sixty-five of these individuals were diagnosed with a seizure disorder and received only one AED at the time of this study. These individuals were taking one of three AEDs (carbamazepine, valproic acid, or phenytoin). Participants belonging to one of these three medication groups were matched with residents for age, gender, level of MR and race, who did not have seizures or receive AEDs. MESSIER scores of each medication group were compared to its respective control group. Those individuals receiving phenytoin presented less positive social skills than their matched counterparts in the phenytoin-control group.