The relationship between antiepileptic drug load and challenging behaviors in older adults with intellectual disability and epilepsy

Rosemary Monaghan,Máire O'Dwyer,Retha Luus,Niamh Mulryan,Philip Mccallion,Mary Mccarron,Martin C Henman

doi:10.1016/j.yebeh.2021.108191

Rosemary Monaghan, Máire O'Dwyer + Show 5 more

Open Access

https://doi.org/10.1016/j.yebeh.2021.108191

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Journal: Epilepsy & Behavior	Publication Date: Jul 12, 2021
Citations: 5	License type: cc-by

Affiliation: Trinity College Dublin, Temple University

Abstract

Antiepileptic drugs (AEDs) may affect mood and behavior in people with epilepsy and intellectual disability. A high AED load, derived from AED polytherapy and/or high doses of AEDs, has been suggested to be a risk factor for behavioral side effects. Data were drawn from Wave 3 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). The Behavior Problems Inventory Short Form (BPI-S) was used to assess challenging behaviors. AED load was calculated and median AED loads obtained. Non-parametric tests and binary logistic regression were performed to determine the relationship between AED load and challenging behaviors. Of participants with a reported diagnosis of epilepsy who were taking a regular AED and had completed BPI-S (n = 142), 62.7% (n = 89) exhibited challenging behaviors. Challenging behavior was found to be more prevalent in those with more severe levels of intellectual disability (p < 0.001). Aggressive/destructive behavior and stereotyped behavior were significantly more likely in participants living in residential/campus settings. For participants with a severe/profound intellectual disability, a significantly higher median AED load was found for participants exhibiting aggressive/destructive behavior and self-injurious behavior (SIB) compared to participants not exhibiting these behaviors, indicating a high AED load may contribute to some behavioral problems in this population group. However, many factors can influence behavioral outcomes, creating difficulties in determining those that are associated and the nature of the association. Careful monitoring of AED load, together with increased vigilance for breakthrough behavioral issues is essential for dealing with these complex cases. Larger studies are needed to account for the potential confounding factors.

Highlights

The burden of epilepsy is associated with psychiatric, cognitive, and behavioral comorbidity [1,2], factors more prevalent in people with intellectual disability [2]
Of participants with a reported diagnosis of epilepsy, taking at least one regular Antiepileptic drugs (AEDs) and having completed Behavior Problems Inventory Short Form (BPI-S) (n = 142), challenging behaviors were found to be exhibited by 62.7% (n = 89) (Table 1)
The level of intellectual disability was found to be significantly associated with exhibiting challenging behaviors (p < 0.001) with a higher prevalence of challenging behaviors associated with greater severity of intellectual disability

Summary

Introduction

The burden of epilepsy is associated with psychiatric, cognitive, and behavioral comorbidity [1,2], factors more prevalent in people with intellectual disability [2]. Challenging behaviors occur in over 50% of people with intellectual disability, and are severe in 10% [3,4]. Systematic reviews examining epilepsy as a possible marker [5] for challenging behaviors in people with intellectual disability have yielded inconclusive results [2,5,9,10], with some studies showing an increased prevalence in people with epilepsy and additional factors such as seizures of greater frequency and/or severity, medication side effects, and generalized EEG activity [10].

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