Epilepsy related multimorbidity, polypharmacy and risks in adults with intellectual disabilities: a national study

Autor: James J. Sun, Bhathika Perera, William Henley, Heather Angus-Leppan, Indermeet Sawhney, Lance Watkins, Kiran N. Purandare, Mogbeyiteren Eyeoyibo, Mark Scheepers, Geraldine Lines, Robert Winterhalder, Samantha Ashby, Ravi De Silva, Jonjo Miller, David E. Philpott, Chris Ashwin, Joshua Howkins, Harriet Slater, David Medhurst, Rohit Shankar
Rok vydání: 2022
Předmět:
Zdroj: Journal of Neurology. 269:2750-2760
ISSN: 1432-1459
0340-5354
Popis: A quarter of people with Intellectual Disability (ID) in the UK have epilepsy compared to 0.6% in the general population and die much younger. Epilepsy is associated with two-fifths of all deaths with related polypharmacy and multi-morbidity. Epilepsy research on this population has been poor. This study describes real-world clinical and risk characteristics of a large cohort across England and Wales.A retrospective multi-centre cohort study was conducted. Information on seizure characteristics, ID severity, relevant co-morbidities, psychotropic and antiseizure drugs (ASDs), SUDEP and other risk factors was collected across a year.Of 904 adults across 10 centres (male:female, 1.5:1), 320 (35%) had mild ID and 584 (65%) moderate-profound (M/P) ID. The mean age was 39.9 years (SD 15.0). Seizures were more frequent in M/P ID (p 0.001). Over 50% had physical health co-morbidities, more in mild ID (p 0.01). A third had psychiatric co-morbidity and a fifth had an underlying genetic disorder. Autism Spectrum Disorder was seen in over a third (37%). Participants were on median two ASDs and overall, five medications. Over quarter were on anti-psychotics. Over 90% had an epilepsy review in the past year but 25% did not have an epilepsy care plan, particularly those with mild ID (p 0.001). Only 61% had a documented discussion of SUDEP, again less likely with mild ID or their care stakeholders (p 0.001).Significant levels of multi-morbidity, polypharmacy and a lack of systemised approach to treatment and risk exist. Addressing these concerns is essential to reduce premature mortality.
Databáze: OpenAIRE
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