The use of antiepileptic medication in adults with intellectual disabilities: A serious conundrum

Until the early 1990s, six major drugs existed in the treatment of epilepsy. By 2004, ten new antiepilepsy drugs (AEDs) were made available in the UK. Currently, the available number of AEDs has grown to over 20. There are a number of concerns posed by these medications, ranging from teratogenic concerns to negative impact upon cognitive function to worsening behavior, all which can have an effect upon quality of life of the person with epilepsy (PWE). While treatment guidelines have suggested that the newer AEDs tend to be better tolerated and affect cognitive functioning to a lesser degree than older AED options, the evidence base applied to people with intellectual disability (ID) has not been suitably explored. About 25 % of PWE also have an ID. This group has communication issues, premature mortality, more treatment resistance, difficulties in making informed choices, and greater risks of physical and mental health comorbidities. There is no specific prescribing guidance for this large, heterogeneous, and vulnerable group. Identifying adverse effects to treatment is extremely challenging in PWE with an ID due to the presence of complex comorbidities and often profound communication barriers. This chapter looks to consolidate the current evidence and good practice needed to prescribe specifically in a PWE and ID. It takes into consideration and brings together a wide range of contextual good practice literature from both the ID research world, such as concepts of mental capacity, and the epilepsy world, such as the latest epilepsy medication and drug effects, thus helping straddle the diverse yet fast-developing nature of both the epilepsy and ID scientific worlds. To help present concepts and to highlight clinical complexity, ten case vignettes have been presented. It would be considered an essential read to any clinical practitioner who manages PWE and ID.