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Pathophysiological Heterogeneity of the BBSOA Neurodevelopmental Syndrome. Cells 2022; 11:cells11081260. [PMID: 35455940 PMCID: PMC9024734 DOI: 10.3390/cells11081260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
The formation and maturation of the human brain is regulated by highly coordinated developmental events, such as neural cell proliferation, migration and differentiation. Any impairment of these interconnected multi-factorial processes can affect brain structure and function and lead to distinctive neurodevelopmental disorders. Here, we review the pathophysiology of the Bosch–Boonstra–Schaaf Optic Atrophy Syndrome (BBSOAS; OMIM 615722; ORPHA 401777), a recently described monogenic neurodevelopmental syndrome caused by the haploinsufficiency of NR2F1 gene, a key transcriptional regulator of brain development. Although intellectual disability, developmental delay and visual impairment are arguably the most common symptoms affecting BBSOAS patients, multiple additional features are often reported, including epilepsy, autistic traits and hypotonia. The presence of specific symptoms and their variable level of severity might depend on still poorly characterized genotype–phenotype correlations. We begin with an overview of the several mutations of NR2F1 identified to date, then further focuses on the main pathological features of BBSOAS patients, providing evidence—whenever possible—for the existing genotype–phenotype correlations. On the clinical side, we lay out an up-to-date list of clinical examinations and therapeutic interventions recommended for children with BBSOAS. On the experimental side, we describe state-of-the-art in vivo and in vitro studies aiming at deciphering the role of mouse Nr2f1, in physiological conditions and in pathological contexts, underlying the BBSOAS features. Furthermore, by modeling distinct NR2F1 genetic alterations in terms of dimer formation and nuclear receptor binding efficiencies, we attempt to estimate the total amounts of functional NR2F1 acting in developing brain cells in normal and pathological conditions. Finally, using the NR2F1 gene and BBSOAS as a paradigm of monogenic rare neurodevelopmental disorder, we aim to set the path for future explorations of causative links between impaired brain development and the appearance of symptoms in human neurological syndromes.
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Takano T. Self-injury as a predominant challenging behavior in epilepsy: A study in a residential facility for profoundly disabled patients. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 120:104149. [PMID: 34922088 DOI: 10.1016/j.ridd.2021.104149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 11/17/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The association between challenging behavior (CB) and epilepsy in people with intellectual disability (ID) remains largely controversial. AIM To clarify the correlation between CB and epilepsy, we investigated the clinical characteristics of CB in both people with and without epilepsy among individuals with ID hospitalized in our residential facility. METHODS AND PROCEDURES A total of 63 individuals with CB was retrospectively investigated using the Behavior Problems Inventory, and the following items were collected from the medical records: sex, age, hospitalization period, etiology and risk factors, level of ID, type of CB, administration of psychotropic drugs, presence or absence of epilepsy and clinical features of epilepsy. OUTCOMES AND RESULTS Almost all individuals with CB showed profound ID. There was no significant difference in the rate of CB between people with and without epilepsy. A type analysis of CB revealed that self-injurious behavior was observed more frequently in epilepsy cases (66.7 %) than in cases without epilepsy (36.4 %) (p = 0.015), and self-injurious behavior was the predominant clinical form in people with epilepsy among the three subgroups of CB (self-injurious, aggressive and self-injurious and aggressive behavior). CONCLUSIONS AND IMPLICATIONS The high incidence of self-injurious behavior in epilepsy with profound disabilities may imply the presence of common pathological basis of self-injurious behavior and epilepsy.
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Affiliation(s)
- Tomoyuki Takano
- Department of Pediatrics, Biwako-Gakuen Medical and Welfare Center of Yasu, 978-2 Kitazakura, Yasu, 520-2321, Japan; Department of Pediatrics, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, 520-2192, Japan.
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3
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Kallumkal GH, Jacob R, Edwards L. Etiology and Management of Behavioral Disorder in Adults With Intellectual and Developmental Disabilities. Cureus 2021; 13:e14221. [PMID: 33816039 PMCID: PMC8011745 DOI: 10.7759/cureus.14221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Intellectual disability (ID) encompasses a wide variety of disorders that can severely affect an individual’s cognitive, social, emotional, and physical development, even when identified early in life. Initially, individuals with such disorders had shorter life expectancies. However, medical advances have increased the life expectancy of individuals with ID similar to that of the general population. More attention must be paid to manage diseases affecting the intellectually disabled elderly, such as diabetes, cardiovascular disease, chronic constipation, and behavioral disorders.
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Affiliation(s)
- Govind H Kallumkal
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Rafik Jacob
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Linda Edwards
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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van den Akker N, Kroezen M, Wieland J, Pasma A, Wolkorte R. Behavioural, psychiatric and psychosocial factors associated with aggressive behaviour in adults with intellectual disabilities: A systematic review and narrative analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:327-389. [PMID: 33073443 PMCID: PMC7894289 DOI: 10.1111/jar.12809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/07/2020] [Accepted: 08/30/2020] [Indexed: 12/28/2022]
Abstract
Background Aggressive behaviour is prevalent in people with intellectual disabilities. To understand the aetiology, it is important to recognize factors associated with the behaviour. Method A systematic review was conducted and included studies published between January 2002 and April 2017 on the association of behavioural, psychiatric and psychosocial factors with aggressive behaviour in adults with intellectual disabilities. Results Thirty‐eight studies were included that presented associations with 11 behavioural, psychiatric and psychosocial factors. Conflicting evidence was found on the association of these factors with aggressive behaviour. Conclusions The aetiology of aggressive behaviour is specific for a certain person in a certain context and may be multifactorial. Additional research is required to identify contributing factors, to understand causal relationships and to increase knowledge on possible interaction effects of different factors.
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Affiliation(s)
- Natalie van den Akker
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Marieke Kroezen
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jannelien Wieland
- Cordaan, Center for Excellence on Mental Health and Mild Intellectual Disability, Amsterdam, The Netherlands
| | - Annelieke Pasma
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Ria Wolkorte
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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5
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Buono S, Zagaria T, Recupero M, Elia M, Kerr M, Di Nuovo S, Ferri R. The evolution of self-injurious behaviors in people with intellectual disability and epilepsy: A follow-up study. Seizure 2020; 82:99-104. [PMID: 33045542 DOI: 10.1016/j.seizure.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Longitudinal studies of the evolution of Self-Injurious Behaviors (SIBs) in people with Intellectual Disability (ID) and epilepsy are not common. This study aimed to analyze the evolution (in terms of remission and persistence) and changes in the type, localization, frequency, and intensity of SIBs. METHODS SIBs were assessed in a sample of 52 people with ID and epilepsy, and re-evaluated after a seven-year interval, using the "Scale for the Assessment of Self-Injurious Behaviors". The scale was administered to caregivers (parents or health professionals) through a semi-structured interview conducted by a specifically trained psychologist. RESULTS The most frequent types of SIBs identified were: self-biting, self-hitting with objects, self-hitting with hand, object-finger in cavities. The main localizations of SIBs were: hands, mouth, head and cheeks. SIBs were found to be maintained after seven years, for type, localization, frequency, and intensity, in 90.4% of the sample. SIB types were stable over time, as were the affected areas. Global SIB frequency and intensity scores were found to be unchanged. Finally, a positive correlation was found between the frequency of SIBs and levels of intellectual disability. SIBs (frequency and intensity) and seizure frequency showed no correlation. CONCLUSION Given the negative impact of SIBs on the adaptation and quality of life of people with ID and epilepsy, we believe that further studies on biological, psychological and environmental aspects are needed in order to identify any potential factors that might explain the persistence of SIBs and to find effective interventions to reduce them.
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Affiliation(s)
- Serafino Buono
- Unit of Psychology, Oasi Research Institute-IRCCS, Troina, Italy.
| | - Tommasa Zagaria
- Unit of Psychology, Oasi Research Institute-IRCCS, Troina, Italy
| | | | - Maurizio Elia
- Unit of Neurology, Oasi Research Institute-IRCCS, Troina, Italy
| | - Mike Kerr
- Institute of psychological medicine and clinical neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Santo Di Nuovo
- Department of Education, University of Catania, Catania, Italy
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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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Rapport F, Shih P, Faris M, Nikpour A, Herkes G, Bleasel A, Kerr M, Clay-Williams R, Mumford V, Braithwaite J. Determinants of health and wellbeing in refractory epilepsy and surgery: The Patient Reported, ImpleMentation sciEnce (PRIME) model. Epilepsy Behav 2019; 92:79-89. [PMID: 30634157 DOI: 10.1016/j.yebeh.2018.11.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 12/12/2022]
Abstract
This paper offers a new way of understanding the course of a chronic, neurological condition through a comprehensive model of patient-reported determinants of health and wellbeing: The Patient Reported ImpleMentation sciEnce (PRIME) model is the first model of its kind to be based on patient-driven insights for the design and implementation of initiatives that could improve tertiary, primary, and community healthcare services for patients with refractory epilepsy, and has broad implications for other disorders; PRIME focuses on: patient-reported determinants of health and wellbeing, pathways through care, gaps in treatment and other system delays, patient need and expectation, and barriers and facilitators to high-quality care provision; PRIME highlights that in the context of refractory epilepsy, patients value appropriate, clear, and speedy referrals from primary care practitioners and community neurologists to specialist healthcare professionals based in tertiary epilepsy centers. Many patients also want to share in decisions around treatment and care, and gain a greater understanding of their debilitating disease, so as to find ways to self-manage their illness more effectively and plan for the future. Here, PRIME is presented using refractory epilepsy as the exemplar case, while the model remains flexible, suitable for adaptation to other settings, patient populations, and conditions; PRIME comprises six critical levels: 1) The Individual Patient Model; 2) The Patient Relationships Model; 3) The Patient Care Pathways Model; 4) The Patient Transitions Model; 5) The Pre- and Postintervention Model; and 6) The Comprehensive Patient Model. Each level is dealt with in detail, while Levels 5 and 6 are presented in terms of where the gaps lie in our current knowledge, in particular in relation to patients' journeys through healthcare, system intersections, and individuals adaptive behavior following resective surgery, as well as others' views of the disease, such as family members.
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Affiliation(s)
- Frances Rapport
- Australian Institute for Health Innovation (AIHI), Macquarie University, North Ryde, NSW 2019, Australia.
| | - Patti Shih
- Australian Institute for Health Innovation (AIHI), Macquarie University, North Ryde, NSW 2019, Australia
| | - Mona Faris
- Australian Institute for Health Innovation (AIHI), Macquarie University, North Ryde, NSW 2019, Australia
| | - Armin Nikpour
- Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Geoffrey Herkes
- Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Andrew Bleasel
- Department of Neurology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Mike Kerr
- Division of Psychological Medicine and Clinical Neuroscience, School of Medicine, Cardiff CF24 4HQ, United Kingdom
| | - Robyn Clay-Williams
- Australian Institute for Health Innovation (AIHI), Macquarie University, North Ryde, NSW 2019, Australia
| | - Virginia Mumford
- Australian Institute for Health Innovation (AIHI), Macquarie University, North Ryde, NSW 2019, Australia
| | - Jeffrey Braithwaite
- Australian Institute for Health Innovation (AIHI), Macquarie University, North Ryde, NSW 2019, Australia
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O’Dwyer M, McCallion P, McCarron M, Henman M. Medication use and potentially inappropriate prescribing in older adults with intellectual disabilities: a neglected area of research. Ther Adv Drug Saf 2018; 9:535-557. [PMID: 30181861 PMCID: PMC6116771 DOI: 10.1177/2042098618782785] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/23/2018] [Indexed: 01/19/2023] Open
Abstract
It is known that for all adults, prevalence of potentially inappropriate prescribing (PIP) and polypharmacy increases with advancing age and morbidity. This has been associated with adverse drug reactions and poor outcomes. As a result, screening tools have been developed to identify PIP and to improve prescribing and health outcomes. A growing body of evidence supports the fact that there are even greater concerns among older adults with intellectual disability (ID) who are living longer than before but still have premature mortality and poorer health outcomes compared with the general population. They have different patterns of multimorbidity, with higher rates of epilepsy and mental health conditions. Polypharmacy is prevalent and some prescribing practices may be inappropriate. High exposure to anticholinergic and sedative medicines has additional adverse effects on quality of life. There may also be underutilization of clinically needed therapies. There has been substantial controversy internationally relating to extensive use of psychotropic medicines, particularly off-label use for challenging behaviours. Despite the mounting evidence and concerns about the impact of PIP on quality of life, health and safety for people with ID, appropriate methods to measure PIP are lacking, which represents an important gap in the research literature. Differences in morbidity and medicines use patterns in this population mean instruments used to identify inappropriate medicines in the older population are not suitable. In this perspective article we outline the specific health and medicinal needs for people with ID, the prevalence of polypharmacy and presentation of chronic health conditions in older adults with ID. We provide an overview of the psychotropic medicine classes most frequently used in people with ID which carry substantial risk. We highlight studies to date that have attempted to assess PIP and present research priorities to improve prescribing, health outcomes and quality of life for people with ID.
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Affiliation(s)
- Maire O’Dwyer
- School of Pharmacy and Pharmaceutical Sciences,
University of Dublin Trinity College, Trinity College Dublin, Dublin,
Ireland
| | - Philip McCallion
- School of Social Work, College of Public Health,
Temple University, Philadelphia, PA, USA
| | - Mary McCarron
- Faculty of Health Sciences, University of Dublin
Trinity College, Dublin, Ireland
| | - Martin Henman
- School of Pharmacy and Pharmaceutical Sciences,
University of Dublin Trinity College, Dublin, Ireland
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9
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Michaelis R, Tang V, Goldstein LH, Reuber M, LaFrance WC, Lundgren T, Modi AC, Wagner JL. Psychological treatments for adults and children with epilepsy: Evidence-based recommendations by the International League Against Epilepsy Psychology Task Force. Epilepsia 2018; 59:1282-1302. [PMID: 29917225 DOI: 10.1111/epi.14444] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2018] [Indexed: 12/12/2022]
Abstract
Given the significant impact that psychosocial factors and epilepsy treatments can have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is great clinical interest in the role of psychological evaluation and treatments to improve HRQOL and comorbidities. Therefore, the International League Against Epilepsy (ILAE) charged the Psychology Task Force with the development of recommendations for clinical care based on evaluation of the evidence from their recent Cochrane review of psychological treatments in individuals with epilepsy. The literature search for a recent Cochrane review of randomized controlled trials investigating psychological treatments for individuals with epilepsy constitutes the key source of evidence for this article. To provide practical guidance to service providers, we provide ratings on study research designs based on (1) the American Academy of Neurology's Level of Evidence system and (2) the Grading of Recommendations, Assessment, Development, and Evaluation system. This paper is the culmination of an international collaboration process involving pediatric and adult psychologists, neurologists, psychiatrists, and neuropsychiatrists. The process and conclusions were reviewed and approved by the ILAE Executive Committee. The strongest evidence for psychological interventions was identified for the most common mental health problems, including depression, neurocognitive disturbances, and medication adherence. Psychological interventions targeting the enhancement of HRQOL and adherence and a decrease in comorbidity symptoms (anxiety, depression) should be incorporated into comprehensive epilepsy care. There is a range of psychological strategies (ie, cognitive behavioral therapy and mindfulness-based therapies) that show promise for improving the lives of persons with epilepsy, and clinical recommendations are provided to assist epilepsy health care providers in treating the comorbidities and challenges associated with epilepsy and its treatments.
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Affiliation(s)
- Rosa Michaelis
- Department of Neurology, Herdecke Community Hospital, University of Witten/Herdecke, Herdecke, Germany.,Integrated Curriculum for Anthroposophical Medicine (ICURAM), Witten/Herdecke University, Herdecke, Germany.,Department of Neurology, Center for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Venus Tang
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Clinical Psychology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - William Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Tobias Lundgren
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Janelle L Wagner
- College of Nursing and Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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10
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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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Lakhan R, Ekúndayò OT, Sharma M. Epilepsy, Behavioral Problems, and Intellectual Disability among Children in India: Conundrums and Challenges. J Neurosci Rural Pract 2018; 9:1-2. [PMID: 29456334 PMCID: PMC5812130 DOI: 10.4103/jnrp.jnrp_477_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ram Lakhan
- Department of Health and Human Performance, Berea College, Berea, Kentucky, USA
| | - Olúgbémiga T. Ekúndayò
- Department of Allied Health College of Health Professions, Northern Kentucky University, Kentucky, USA
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, School of Public Health, Jackson State University, Jackson, Mississippi, USA
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12
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Healthcare Justice for Women with Disabilities: The Need for Integrative Primary Care Services and Education for Medical Providers. SEX ROLES 2017. [DOI: 10.1007/s11199-017-0756-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Rapport F, Shih P, Mitchell R, Nikpour A, Bleasel A, Herkes G, Vagholkar S, Mumford V. Better evidence for earlier assessment and surgical intervention for refractory epilepsy (The BEST study): a mixed methods study protocol. BMJ Open 2017; 7:e017148. [PMID: 28827267 PMCID: PMC5724135 DOI: 10.1136/bmjopen-2017-017148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION One-third of patients with refractory epilepsy may be candidates for resective surgery, which can lead to positive clinical outcomes if efficiently managed. In Australia, there is currently between a 6-month and 2-year delay for patients who are candidates for respective epilepsy surgery from the point of referral for surgical assessment to the eventual surgical intervention. This is a major challenge for implementation of effective treatment for individuals who could potentially benefit from surgery. This study examines implications of delays following the point of eligibility for surgery, in the assessment and treatment of patients, and the factors causing treatment delays. METHODS AND ANALYSIS Mixed methods design: Observations of qualitative consultations, patient and healthcare professional interviews, and health-related quality of life assessments for a group of 10 patients and six healthcare professionals (group 1); quantitative retrospective medical records' reviews examining longitudinal outcomes for 50 patients assessed for, or undergoing, resective surgery between 2014 and 2016 (group 2); retrospective epidemiological study of all individuals hospitalised with a diagnosis of epilepsy in New South Wales (NSW) in the last 5 years (2012-2016; approximately 11 000 hospitalisations per year, total 55 000), examining health services' use and treatment for individuals with epilepsy, including refractory surgery outcomes (group 3). ETHICS AND DISSEMINATION Ethical approval has been granted by the North Sydney Local Health District Human Research Ethics Committee (HREC/17/HAWKE/22) and the NSW Population & Health Services Research Ethics Committee (HREC/16/CIPHS/1). Results will be disseminated through publications, reports and conference presentations to patients and families, health professionals and researchers.
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Affiliation(s)
- Frances Rapport
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Patti Shih
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Rebecca Mitchell
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Armin Nikpour
- Royal Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Andrew Bleasel
- University of Sydney, Sydney, Australia
- Westmead Hospital, Westmead, Australia
| | - Geoffrey Herkes
- University of Sydney, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | - Sanjyot Vagholkar
- Faculty of Medicine and Health Sciences, Primary Care & Wellbeing, Macquarie University, Sydney, Australia
| | - Virginia Mumford
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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van Ool JS, Snoeijen-Schouwenaars FM, Schelhaas HJ, Tan IY, Aldenkamp AP, Hendriksen JGM. A systematic review of neuropsychiatric comorbidities in patients with both epilepsy and intellectual disability. Epilepsy Behav 2016; 60:130-137. [PMID: 27206231 DOI: 10.1016/j.yebeh.2016.04.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 11/26/2022]
Abstract
Epilepsy is a neurological condition that is particularly common in people with intellectual disability (ID). The care for people with both epilepsy and ID is often complicated by the presence of neuropsychiatric disorders, defined as psychiatric symptoms, psychiatric disorders, and behavioral problems. The aim of this study was to investigate associations between epilepsy or epilepsy-related factors and neuropsychiatric comorbidities in patients with ID and between ID and neuropsychiatric comorbidities in patients with epilepsy. We performed a systematic review of the literature, published between January 1995 and January 2015 and retrieved from PubMed/Medline, PsycINFO, and ERIC and assessed the risk of bias using the SIGN-50 methodology. Forty-two studies were identified, fifteen of which were assessed as having a low or acceptable risk-of-bias evaluation. Neuropsychiatric comorbidities were examined in relation to epilepsy in nine studies; in relation to epilepsy-related factors, such as seizure activity, seizure type, and medication in four studies; and in relation to the presence and degree of ID in five studies. We conclude that the presence of epilepsy only was not a clear determinant of neuropsychiatric comorbidity in patients with ID, although a tendency towards negative mood symptoms was identified. Epilepsy-related factors indicating a more severe form of epilepsy were associated with neuropsychiatric comorbidity as was the presence of ID as compared to those without ID in patients with epilepsy, although this should be validated in future research. A large proportion of the studies in this area is associated with a substantial risk of bias. There is a need for high quality studies using standardized methods to enable clear conclusions to be drawn that might assist in improving the quality of care for this population.
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Affiliation(s)
- Jans S van Ool
- Department of Residential Care, Kempenhaeghe Epilepsy Center, P.O. Box 61, 5590AB Heeze, The Netherlands.
| | | | - Helenius J Schelhaas
- Department of Neurology, Academic Center for Epileptology Kempenhaeghe, P.O. Box 61, 5590AB Heeze, The Netherlands
| | - In Y Tan
- Department of Residential Care, Kempenhaeghe Epilepsy Center, P.O. Box 61, 5590AB Heeze, The Netherlands
| | - Albert P Aldenkamp
- Department of Behavioral Sciences, Kempenhaeghe Epilepsy Center, P.O. Box 61, 5590AB Heeze, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202AZ Maastricht, The Netherlands; Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium; Department of Electrical Engineering, University of Technology, P.O. Box 513, Eindhoven, The Netherlands
| | - Jos G M Hendriksen
- Department of Behavioral Sciences, Kempenhaeghe Epilepsy Center, P.O. Box 61, 5590AB Heeze, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202AZ Maastricht, The Netherlands; Department of Neurological Learning Disabilities, Kempenhaeghe Epilepsy Center, P.O. Box 61, 5590AB Heeze, The Netherlands.
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15
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Sarma AK, Khandker N, Kurczewski L, Brophy GM. Medical management of epileptic seizures: challenges and solutions. Neuropsychiatr Dis Treat 2016; 12:467-85. [PMID: 26966367 PMCID: PMC4771397 DOI: 10.2147/ndt.s80586] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Epilepsy is one of the most common neurologic illnesses. This condition afflicts 2.9 million adults and children in the US, leading to an economic impact amounting to $15.5 billion. Despite the significant burden epilepsy places on the population, it is not very well understood. As this understanding continues to evolve, it is important for clinicians to stay up to date with the latest advances to provide the best care for patients. In the last 20 years, the US Food and Drug Administration has approved 15 new antiepileptic drugs (AEDs), with many more currently in development. Other advances have been achieved in terms of diagnostic modalities like electroencephalography technology, treatment devices like vagal nerve and deep-brain stimulators, novel alternate routes of drug administration, and improvement in surgical techniques. Specific patient populations, such as the pregnant, elderly, those with HIV/AIDS, and those with psychiatric illness, present their own unique challenges, with AED side effects, drug interactions, and medical-psychiatric comorbidities adding to the conundrum. The purpose of this article is to review the latest literature guiding the management of acute epileptic seizures, focusing on the current challenges across different practice settings, and it discusses studies in various patient populations, including the pregnant, geriatric, those with HIV/AIDS, comatose, psychiatric, and "pseudoseizure" patients, and offers possible evidence-based solutions or the expert opinion of the authors. Also included is information on newer AEDs, routes of administration, and significant AED-related drug-interaction tables. This review has tried to address only some of these issues that any practitioner who deals with the acute management of seizures may encounter. The document also highlights the numerous avenues for new research that would help practitioners optimize epilepsy management.
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Affiliation(s)
- Anand K Sarma
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Nabil Khandker
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Lisa Kurczewski
- Departments of Pharmacotherapy & Outcomes Science and Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Gretchen M Brophy
- Departments of Pharmacotherapy & Outcomes Science and Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
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16
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Häβler F, Thome J, Reis O. Polypharmacy in the treatment of subjects with intellectual disability. J Neural Transm (Vienna) 2014; 122 Suppl 1:S93-100. [DOI: 10.1007/s00702-014-1219-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/08/2014] [Indexed: 02/02/2023]
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Palsamy P, Bidasee KR, Shinohara T. Valproic acid suppresses Nrf2/Keap1 dependent antioxidant protection through induction of endoplasmic reticulum stress and Keap1 promoter DNA demethylation in human lens epithelial cells. Exp Eye Res 2014; 121:26-34. [PMID: 24525405 DOI: 10.1016/j.exer.2014.01.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/27/2014] [Accepted: 01/31/2014] [Indexed: 02/02/2023]
Abstract
Recent epidemiological studies confirm the prevalence of cataract in epileptic patients. Similarly, the drugs used to treat epilepsy also show the connection with increased cataract formation. In this present study, we investigated the suppression of Nrf2/Keap1 dependent antioxidant protection through induction of endoplasmic (ER) stress and Keap1 promoter DNA demethylation in human lens epithelial cells (HLECs) treated with valproic acid (VPA), an antiepileptic drug. 20 mM VPA induces ER stress and activates the unfolded protein response (UPR) within 4 h by activating the ER stress sensor proteins, such as PERK, IRE1α, and ATF6 in HLECs. Consequently, the integrated ER stress signals, such as eIF2α, ATF4, BiP, and CHOP are altered accordingly to induce ER-Ca2+ release, reactive oxygen species (ROS) overproduction, and cell death in HLECs treated with VPA. VPA also suppresses the Nrf2, catalase, and glutathione reductase expressions with significant increases in Keap1 protein. Bisulphite genomic DNA sequencing reveals the promoter DNA demethylation in the Keap1 promoter, which results in the overexpression of Keap1 mRNA and protein in HLECs treated with 20 mM VPA. VPA also alters the expression profiles of passive DNA demethylation pathway enzymes such Dnmt1, Dnmt3a, Dnmt3b, and active DNA demethylation pathway enzyme, TET1 leading to DNA demethylation in the Keap1 promoter of HLECs. Overexpressed Keap1 decreases the Nrf2 level, thereby abolishing the Nrf2 dependent antioxidant protection. This might be responsible for lenticular proteins oxidation and cataract formation.
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Affiliation(s)
- Periyasamy Palsamy
- Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Keshore R Bidasee
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Toshimichi Shinohara
- Department of Ophthalmology and Visual Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA.
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18
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King BH, de Lacy N, Siegel M. Psychiatric assessment of severe presentations in autism spectrum disorders and intellectual disability. Child Adolesc Psychiatr Clin N Am 2014; 23:1-14. [PMID: 24231163 DOI: 10.1016/j.chc.2013.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Children with autism spectrum and related disorders and intellectual disability are not protected from the experience of psychiatric illnesses. Many factors can contribute to exacerbation of existing behavioral symptoms or to the emergence of new psychiatric problems. The psychiatric assessment must thus take into account a range of possible etiologic or contributory factors. The approach outlined in this article highlights the value of assessing 4 broad domains, including diagnostic (genetic) factors, medical considerations, developmental influences, and environmental factors. Examples of how the consideration of each of these domains may inform the diagnostic formulation are highlighted.
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Affiliation(s)
- Bryan H King
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Autism Center, Seattle Children's Hospital, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
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