Intellectual disability, epilepsy and bone health: Quality improvement in a specialist epilepsy service

Accessibility summary People with an intellectual disability and epilepsy may suffer with weaker bones as they grow older. There are many reasons for this, including seizures and the medicines used to treat seizures. Taking vitamin D everyday will help stop this happening. Vitamin D comes in many forms including tablets and liquid. Vitamin D is safe with very few side effects. Abstract Background People with epilepsy and intellectual disability should be considered at high risk of developing metabolic bone disease. Risk is increased with number of comorbidities and polypharmacy, particularly anti‐seizure medications. One way of improving bone health is to ensure that every one has adequate levels of vitamin D through supplementation. Methods This audit phase of a wider quality improvement (QI) project monitors the implementation of a Bone Health Project (BHP) for people with epilepsy and intellectual disability. Key Clinical Standard 1 of the BHP aims to ensure that where appropriate everyone prescribed anti‐seizure medication is offered vitamin D supplementation. This audit standard is based upon the Scientific Advisory Committee on Nutrition Guidance. The complete audit cycle was undertaken for the entire patient cohort under the care of a specialist epilepsy service and followed QI methodology. Findings From the initial audit, the total number of patients prescribed vitamin D supplementation increased significantly from 95 (29%) to 182 (79%) by the end of the cycle. For those prescribed enzyme‐inducing anti‐seizure medications, the number of patients prescribed vitamin D supplementation increased significantly from 52 (49%) to 89 (90%).Conclusions Working collaboratively with people with intellectual disability and epilepsy can enhance engagement. Vitamin D supplementation at 800IU has been established as safe and largely efficient in ensuring most people have adequate levels of serum vitamin D. There will be people who require vitamin D replacement therapy, and this requires further intervention including monitoring of bone profiles and referral to other specialists.