Abstract
PurposeEpilepsy prevalence is significantly higher in people with Intellectual Disability (ID) compared to people with epilepsy (PWE) from the general population. Increased psychological and behavioural problems, healthcare costs, morbidity, mortality and treatment resistance to antiepileptic drugs (AEDs) is associated with epilepsy in ID populations. Prescribing AEDs for PWE and ID is challenging and influenced heavily by studies conducted with the general population.Our study compares Lacosamide (LCM) response for the ID population to those from the general population; using data from an UK based epilepsy database register (EP ID/PDD AED Register). MethodsPooled retrospective case notes data for PWE prescribed LCM at 11 UK NHS Trusts were analysed. Participants were classified as per WHO guidance into groups of moderate-profound ID, mild ID and General population. Demographics, concomitant AEDs, starting and maximum dosage, exposure length, adverse effects, dropout rates, seizure frequency were collected. Group differences were reported as odds ratios estimated from univariable logistic regression models. ResultsOf 232 consented participants, 156 were from the general population and 76 had ID (24 mild, 52 moderate-profound). Twelve month withdrawal rates and reasons, efficacy, side-effects, start and maximum doses were similar between the groups. Dose titration between baseline and three months was significantly slower in the ID group (p = 0.02). ConclusionThere were no differences for LCM outcomes between general and ID groups. Slower LCM titration in ID populations in the first 3 months was associated with higher retention and lower behavioural side effects as compared to similar European studies.
Highlights
Epilepsy prevalence is approximately 0.6–1.0 % across the worldwide general population [1]
Whilst seizure control for all people with epilepsy (PWE) is initially managed by licensed Anti-Epileptic Drugs (AEDs), those with intellectual disability (ID) are excluded from pre-market systemic trials [4]
Despite the limitations detailed above, the findings reported here, and comparisons with broadly similar data from other European retrospective studies of patient medical records, help address the evidence gap around the safe and effective use of LCM within the ID population
Summary
Epilepsy prevalence is approximately 0.6–1.0 % across the worldwide general population [1]. It is much higher in the intellectual disability (ID) population, where around 22 % have epilepsy [2]. It is estimated that as many as one in four people with epilepsy (PWE) have an ID [3]. Whilst seizure control for all PWE is initially managed by licensed Anti-Epileptic Drugs (AEDs), those with ID are excluded from pre-market systemic trials [4]. Rates of treatment resistance are significantly higher in ID populations than general [5].
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