Delivery of epilepsy care to adults with intellectual and developmental disabilities.

Abstract:

:Epilepsy is common in people with intellectual and developmental disabilities (IDD). In adulthood, patients with IDD and epilepsy (IDD-E) have neurologic, psychiatric, medical, and social challenges compounded by fragmented and limited care. With increasing neurologic disability, there is a higher frequency of epilepsy, especially symptomatic generalized and treatment-resistant epilepsies. The causes of IDD-E are increasingly recognized to be genetic based on chromosomal microarray analysis to identify copy number variants, gene panels (epilepsy, autism spectrum disorder, intellectual disability), and whole-exome sequencing. A specific genetic diagnosis may guide care by pointing to comorbid disorders and best therapy. Therapy to control seizures should be individualized, with drug selection based on seizure types, epilepsy syndrome, concomitant medications, and comorbid disorders. There are limited comparative antiepileptic drug data in the IDD-E population. Vagus nerve and responsive neural stimulation therapies and resective surgery should be considered. Among the many comorbid disorders that affect patients with IDD-E, psychiatric and sleep disorders are common but often unrecognized and typically not treated. Transition from holistic and coordinated pediatric to adult care is often a vulnerable period. Communication among adult health care providers is complex but essential to ensure best care when these patients are seen in outpatient, emergency room, and inpatient settings. We propose specific recommendations for minimum care standards for people with IDD-E.

journal_name

Neurology

journal_title

Neurology

authors

Devinsky O,Asato M,Camfield P,Geller E,Kanner AM,Keller S,Kerr M,Kossoff EH,Lau H,Kothare S,Singh BK,Wirrell E

doi

10.1212/WNL.0000000000002060

subject

Has Abstract

pub_date

2015-10-27 00:00:00

pages

1512-21

issue

17

eissn

0028-3878

issn

1526-632X

pii

WNL.0000000000002060

journal_volume

85

pub_type

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