Abstract
Purpose: In hospitalized patients with severe motor and intellectual disabilities (SMID), we analyzed the association of the SMID class to factors such as the prevalence of epilepsy, frequency of seizures and number of concomitantly used anti-epileptic drugs (AEDs), and evaluated the usefulness of addition of the new AEDs (gabapentin, topiramate, lamotrigine and levetiracetam) to the treatment regimen. Results: The prevalence of epilepsy in the study population was about 60%. There were 39.5% who were free of epileptic seizures during the 6-year survey period and remained well-controlled with medication. As the SMID increased in severity, the frequency of seizures increased, the number of concomitantly used AEDs increased, and the tendency towards addition of new AEDs became more marked. About the use situation of new AED and old AED, this comparison revealed a tendency towards addition of a new AED when the seizures were poorly controlled in response to concomitant use of multiple old AEDs. The frequency of seizures and the number of concomitantly used AEDs were higher in patients with SMID of high severity than in those with SMID of low severity. Analysis of the time-course of the frequency of seizures before and after the addition of new AEDs revealed a significant reduction in the frequency of seizures following the addition of the new AEDs (P > 0.001). Conclusions: These results suggest that the new AEDs are useful in the management of SMID-associated epilepsy, because of their effect of reducing the frequency of SMID-associated seizures and their high tolerability.
Highlights
The concept of “Severe Motor and Intellectual Disabilities” resembles the global concept of “Profound Intellectual and Multiple Disabilities” (“PIMD”) [1] and “Profound and Multiple Learning Disabilities” (“PMLD”) [2]
Four anti-epileptic drugs (AEDs) approved in Japan in and after 2006, i.e. gabapentin (Sep. 2006), topiramate (Sep. 2007), lamotrigine (Dec. 2008) and levetiracetam (Sep. 2010), were classified as new AEDs, and the AEDs approved before that year were deemed as old AEDs [7]
Statistical analysis was conducted on the survey data, including the data on “disability classification (Yokochi classification)”, “number of concomitantly used AEDs”, Table 1
Summary
The concept of “Severe Motor and Intellectual Disabilities” (hereinafter called “SMID”) resembles the global concept of “Profound Intellectual and Multiple Disabilities” (“PIMD”) [1] and “Profound and Multiple Learning Disabilities” (“PMLD”) [2]. SMID is “patient having severe mental disabilities and severe limbs disorder”. The number of patients with SMID in Japan is estimated to be about 40,000 - 50,000 [3]. Among the diverse clinical symptoms of SMID, CNS disorder-related paralysis or deformation, hypertonia, gastroesophageal reflux (GER) and respiratory failure are the most frequent. The information on the following background variables of the patients was obtained from the medical records. 1) Basic information (age, sex, primary disease); 2) disability classification (Yokochi classification [9]); 3). Statistical analysis was conducted on the survey data (primarily pertaining to SMID-associated epilepsy), including the data on “disability classification (Yokochi classification)”, “number of concomitantly used AEDs”, E6 E5 E4 E3 D6 D5 D4 D3
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