Given that both antipsychotic and antidepressant medications are commonly prescribed among adults with intellectual disabilities,Reference Deb and Singh89 their interaction with anti-epileptics must be considered in any assessment of challenging behaviour. The name is lost. The narrative analysis of data from 34 included articles (14 168 adults with intellectual disabilities, 4781 of whom also had epilepsy) showed no significant association between epilepsy and challenging behaviour. and B.L. About 3 million US adults aged 18 or older have active epilepsy. Federal government websites often end in .gov or .mil. Seizures can affect language in different ways. Careers. Fig. Epilepsy, Cognition, and Behavior: The clinical picture - PMC Rates of behaviours such as stereotypy, inappropriate sexual behaviour, irritability, hyperactivity, verbal aggression, antisocial behaviours and lethargy. Changes in how you go about making plans? This site needs JavaScript to work properly. CognitiveLinguistic Functions in Adults With Epilepsy: Preliminary First, when data from all available studies were pooled, no statistically significant intergroup difference emerged, although the heterogeneity among studies was very high. 2022. Ozer, Mikail using the Cochrane risk-of-bias toolReference Sterne, Savovi, Page, Elbers, Blencowe and Boutron33 and the quality of all 32 eligible studies was assessed during the data collection process using the SIGN 50 checklist.34, Publication bias was assessed using a funnel plot, and the studies included were assessed for consistency and precision. Mood, anxiety, and perceived quality of life in adults with epilepsy and intellectual disability. Only a small number of studies were involved in this meta-analysis and the heterogeneity level was high. Fig. Bertelli, Marco O. The behavior exceeded clinical norms in 7%, 18%, and 12%, respectively. "coreUseNewShare": false, Prokudina, Olga I. Both are likely to benefit patientand family. Association between epilepsy and challenging behaviour in While most children outgrow absence seizures, some: Must take Although we used a stringent method for literature search, it is still possible that we missed some relevant articles. We included 34 articles in our systematic review that met the eligibility criteria. Ready for help? Mulryan, Niamh This arbitrary cut-off was used in accordance with our previous systematic reviews.Reference Deb, Kwok, Bertelli, Salvador-Carulla, Bradley and Torr10. Of these, nine studiesReference Deb, Cowie and Richens36Reference Smith and Matson44 had equal numbers of participants in both groups and the groups were matched on various demographic variables. Forest plot of total challenging behaviour score data from 16 studies. Fig. Get information, tips, and more to help you manage your epilepsy. Communication lines formed between different areas so the brain would have a well-developed backup system. It is as if the librarian has gone on strike. Note: Neuropsychological evaluation is not a substitute for Psychiatric evaluation. "useRatesEcommerce": true Challenging behaviour is defined using a variety of methods in different studies. We excluded the grey literature and conference abstracts, as we felt it would be difficult to apply our eligibility criteria and risk-of-bias assessment on the basis of abstracts only. The hippocampus is very sensitive to changes in brain activity. Whether you've had one or many seizures, you probably want to know how seizures affect the way you think. 25 September 2020. However, peri-ictally some people may show aggression, which is not goal directed but inadvertently may injure others. B.L. 2 Forest plot of total challenging behaviour score data from 16 studies. There was no publication bias present for self-injurious behaviour (P=0.307). B.A.B. It is difficult to draw any definite conclusion from this review, as only one study reported the rate of challenging behaviour related to specific anti-epileptic drugs (59% of participants on carbamazepine, 55% on sodium valproate, 53% on phenytoin and 78% on lamotrigine monopharmacy showed challenging behaviour). Are you concerned about changes you see in yourself? We included a comprehensive Cochrane risk-of-bias table, which was not done by any of the previous systematic reviews. The list of search terms used can be found in the supplementary material available at https://doi.org/10.1192/bjo.2020.96. Epub 2018 Oct 14. So if your seizures start on the right side of your brain, your language may not be affected at all. To understand words that you hear or read, Wernicke's area steps in. other neurodevelopmental disorders such as autism spectrum disorder, attention-deficit hyperactivity disorder), medical conditions and psychosocial factors can all affect challenging behaviour in adults with intellectual disabilities.Reference Hemmings, Deb, Chaplin, Hardy and Mukherjee14, Reference Deb, Unwin, Rojahn, Cooper, Bertelli, Deb, Munir, Hassiotis and Salvador-Carulla18 Epilepsy is one such factor that may influence a person's behaviour. Of these three, oneReference Matson, Bamburg, Mayville and Khan41 was at a significant level and the level of significance for other twoReference Espie, Watkins, Curtice, Espie, Duncan and Ryan46, Reference Pawar and Akuffo49 is not known. Epub 2016 Apr 23. Epub 2018 Jan 5. National Library of Medicine 1). to arbitrate. We have registered our review with a well-established database, PROSPERO, so that our protocol is available for public scrutiny. Vocational Success: Consider referral to Vocational rehabilitation program/system as available in patients region.Evaluate extent of ability to work affected by adverse effects of: Behavioral/psychological/psychiatric problems: Screen for symptoms of depression and anxiety and otherbehavioral problems, including suicidal thoughts or wishes and treat or refer accordingly. Deb & HunterReference Deb and Hunter61 hypothesised that it is possible that underlying brain damage (in adults with severe and profound intellectual disabilities) and psychosocial factors (in those with mild intellectual disabilities) are stronger determinants of challenging behaviour than the presence of epilepsy. The frontal lobe has a major role in decision making. and A number of epilepsy-related factors have been linked to increased rates of behavioral disorder including high seizure frequency, presence of tonicclonic seizures, However, a more practical explanation may be that medication side-effects make the behaviour worse in some, despite improving epilepsy symptoms. "coreDisableEcommerceForArticlePurchase": false, The https:// ensures that you are connecting to the Meta-analysis of pooled data from these 16 studies did not show a significant intergroup difference in the overall rate of challenging behaviour but showed a high heterogeneity. 2021. Thus, it is difficult to compare data among studies as it is difficult to know when data were pooled and whether all studies are describing the same challenging behaviour. The main language problem caused by seizures is with finding words. The full texts were then reviewed and independently assessed for eligibility by B.A.B. These feelings may be present most of the time, or appear just before, during, or after a seizure. Some people become depressed, others may be irritable. The most common mood disorders in people with epilepsy are major depression and dysthymia. Another problem is that none of these specific behavioural types was defined using any standardised criteria (such as the Modified Overt Aggression Scale for rating aggression)Reference Deb, Deb, Faruqui, Bodani and Agrawal15, Reference Ratey and Gutheil82 but were based on single-item scoring. Epilepsy & Seizures in Older Adults | Epilepsy | Features | CDC Faces are stored at the bottom back section of the temporal lobe. 7). to resolve any differences. Discrepancies identified were reviewed and discussed between B.A.B. using a standardised data extraction template adapted from Cochrane review guidelines (supplementary Appendix 2).Reference Li, Higgins, Deeks, Higgins, Thomas, Chandler, Cumpston, Li and Page30 S.D. J Intellect Disabil Res. Although some of the epilepsy and ID characteristics seemed to contribute independently to these types of No definite association was found in the rate of challenging behaviour and polypharmacy with anti-epileptic medications. This showed no significant intergroup difference but after sensitivity analysis meta-analysis of 10 studies showed a significantly higher rate of overall challenging behaviour in the epilepsy group (effect size: 0.16) compared with the non-epilepsy group. Table 3 Challenging behaviours in adults with intellectual disabilities according to different epilepsy variables. Purpose Cognition and language difficulties are frequently reported in both children and adults with epilepsy. Once the information is needed again, the hippocampus helps retrieve it. If you have mostly primary generalized seizures (like absence, myoclonic, or tonic-clonic seizures), you are much less likely to have problems with your thinking than someone who has partial-onset seizures (seizures that begin in one area of the brain, often the temporal lobe). The SIGN 50 checklist identified only 5 of the 32 studies to be of high quality and the Cochrane risk-of-bias assessment of the 19 controlled studies showed a high risk of bias in most domains for most of the studies (Fig. We included both randomised and non-randomised studies; controlled and non-controlled observational or cross-sectional studies; and controlled studies with both matched and non-matched control groups. carried out meta-analysis. The final meta-analysis, using a random-effects model, of pooled data from the remaining 10 studies showed a statistically significant higher rate of overall challenging behaviour in the epilepsy group compared with the non-epilepsy group, with a very small effect size of 0.16. Information may be stored, but in a disorganized way. Seizures can also stop the communication between different areas. When a person, place, or thing causes an emotional reaction, the amygdala attaches the emotion to the memory. Eleven articles reported receiving funding from external sources, one did not receive any funding and the rest (n=22) did not declare the funding source. All rights reserved. Does intellectual disability increase sudden unexpected death in epilepsy (SUDEP) risk? Epilepsy Foundation Statement at Clark-Pleasant Community School Corporation Board Meeting, Epilepsy Foundation Partners with Vector Solutions to Offer Seizure First Aid Trainings to Educators, Ohio Governor DeWine Signs Sarahs Law for Seizure Safe Schools. Roy, Ashok In addition, we also cross-referenced pertinent reviews and articles. WebAll types of epilepsy can make children prone to behavior problems: Complex partial seizures, especially of early onsethyperactivity, problems in paying attention or The majority of the existing research has focused on hasContentIssue false, This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, Copyright The Author(s), 2020. polypharmacy versus monopharmacy of anti-epileptic medications; treatment with carbamazepine versus valproate) were collected to identify the role of different epilepsy-related factors in the development of challenging behaviour. We included a much higher number of articles covering data from a much larger number of participants compared with the previous systematic reviews. Majid, Madiha Furthermore, DebReference Deb62 has shown that a high proportion of adults with intellectual disabilities who had a clinical diagnosis of primary generalised seizure showed focal epileptiform changes in their EEGs, thus raising the possibility that in many cases these generalised seizures are secondarily generalised from focal seizures. Limbu, Bharati You may say what's on your mind even when it's not the right time. However, no such significant intergroup difference was found in five studies.Reference Espie, Pashley, Bonham, Sourindhrin and O'donovan37, Reference Turkistani47, Reference Blickwedel, Vickerstaff, Walker and Hassiotis53, Reference Creaby, Warner, Jamil and Jawad54, Reference Deb and Joyce56 Interestingly, two studiesReference Creaby, Warner, Jamil and Jawad54, Reference van Ool, Snoeijen-Schouwenaars, Tan, Schelhaas, Aldenkamp and Hendriksen72 reported a higher rate of challenging behaviour in the monopharmacy group than in the polypharmacy group, and in one of these studies this intergroup difference was significant.Reference van Ool, Snoeijen-Schouwenaars, Tan, Schelhaas, Aldenkamp and Hendriksen72 Only one study reported the rate of challenging behaviour in various monopharmacy groups (phenytoin, sodium valproate, carbamazepine and lamotrigine monopharmacy) but it made no intergroup comparison.Reference Deb and Joyce56. Aggression and self-injurious behaviour both showed a statistically significant higher rate in the epilepsy group, with very small effect sizes (0.16 and 0.28 respectively). and Also, in the subgroups there is no consistency in the types of challenging behaviour described, as some studies provided the rate of overall challenging behaviour, but others reported the rates of different types of challenging behaviour, such as aggression, self-injurious behaviour and stereotypy, making it difficult to amalgamate data from different studies. It receives information from the many parts of the brain where words are stored. Therefore, our findings must be interpreted with caution, as a lot of confounders could not be controlled for. Three systematic reviews looked at the association between challenging behaviour and epilepsy in people with intellectual disabilities: none of these found any association.Reference Blickwedel, Ali and Hassiotis19Reference van Ool, Snoeijen-Schouwenaars, Schelhaas, Tan, Aldenkamp and Hendriksen21 We decided to carry out an updated systematic review, as important publications either have appeared since the last reviews or were not included in those reviews. An excellent place to find diagrams and information about the brain is at the website Neuroscience for Kidsgood for all ages! Call our Epilepsy and Seizures 24/7 Helpline and talk with an epilepsy information specialist or submit a question online. Fig. 3 Forest plot of total challenging behaviour score data from 10 studies after sensitivity analysis. The hippocampus is the ultimate librarian. The rates of other behaviours, such as inappropriate sexual behaviour, irritability, hyperactivity, verbal aggression, antisocial behaviours and lethargy, were reported in a very small number of studies showing equivocal findings. Published online by Cambridge University Press: Previous systematic reviews showed no significant association between epilepsy and challenging behaviours in adults with intellectual disabilities. Fig. The rest (n=10)Reference Deb, Thomas and Bright12, Reference Prasher45Reference Blickwedel, Vickerstaff, Walker and Hassiotis53 were prevalence studies of challenging behaviour in adults with intellectual disabilities that included a number of participants with epilepsy (around 22% of the cohort). Temporal Lobe Epilepsy and Psychiatric Comorbidity - PMC The largest part of our brain is the part that handles executive function: the frontal lobe. You may not be able to organize your thoughts or your actions in the best way. Only quantitative studies in English were searched. Challenging behavior is a serious issue among adults with epilepsy and ID. Epilepsy - Symptoms and causes - Mayo Clinic The rate increases if the intellectual disability is associated with other neurological disorders, such as cerebral palsy.Reference Deb1, Certain genetic syndromes that lead to intellectual disabilities, such as Angelman, SturgeWeber, fragile-X/ataxia, Rett, LeschNyhan, RubinsteinTaybi, Lowe and Down syndromes and tuberous sclerosis, are commonly associated with epilepsy.Reference Clarke, Deb, Gelder, Andreasen, Lpez-Ibor and Geddes3 A high proportion of people with autism spectrum disorder (22%) also have epilepsy.Reference Deb1 Similarly, certain epilepsy syndromes, such as West syndrome (in infants), LennoxGastaut syndrome, LandauKleffner syndrome and Dravet syndrome, are more commonly associated with intellectual disabilities.Reference Berney, Deb, Shorvon, Guerrini, Cook and Lahtoo4 Compared with the general population of adults who do not have intellectual disabilities, epilepsy among adults with intellectual disabilities is not only more prevalent, but it also often manifests as multiple seizure types, starts at an early age, is of longer duration and is resistant to anti-epileptic treatment (in over 30% in the general population, compared with over 70% in intellectual disabilities).Reference Shankar, Watkins, Alexander, Devapriam, Dolman and Hari5 Diagnosing epilepsy and seizure type can be difficult in this population, and both false-positive (stereotypy, cardiac syncope, non-epileptic attack disorder may all mimic epileptic seizure) and false-negative (difficulty diagnosing absence, focal seizures) diagnoses are possible.Reference Deb, Jacobson and Maulick6 Also, these people are more prone to die from sudden unexpected death in epilepsy (SUDEP).Reference Shankar, Eyeoyibo, Scheepers, Dolman, Watkins and Attavar7, Reference Kerr, Mensah, Besag, De Toffol, Ettinger and Kanemoto8. Prevalence and patterns of anti-epileptic medication prescribing in the treatment of epilepsy in older adults with intellectual disabilities. Therefore, it is difficult to draw any definitive conclusion about the influence of seizure frequency on the rate of challenging behaviour in this population. Even if seizures happen every day for most of your life, you are still able to read, speak, and understand words. Self-injurious behavior was present in 35% of subjects, stereotyped behavior in 60%, and aggressive/destructive behavior in 63%. and Fig. WebEpilepsy is a brain disorder that causes repeated seizures. The behavioural phenotype of SATB2-associated syndrome: a within-group and cross-syndrome analysis. and S.D. The self-injurious behaviour meta-analysis also showed a statistically significant higher rate in the epilepsy group compared with the non-epilepsy group, with a very small effect size of 0.28, but the heterogeneity score was high, albeit below 60% (I 2=54%). Deb, Shoumitro Shoumi Alekhina, Tatiana A. is funded by the UK's National Institute of Health Research (NIHR) Research for Patient Benefit (RfPB) Programme (grant PBPG-0817-20010). Two studiesReference Matson, Bamburg, Mayville and Khan41, Reference Fitzgerald, Matson and Barker50 used the Diagnostic Assessment for the Severely Handicapped Part 2 (DASH-II).Reference Matson, Gardner, Coe and Sovner65 Two studiesReference Matthews, Weston, Baxter, Felce and Kerr43, Reference Blickwedel, Vickerstaff, Walker and Hassiotis53 used the Aberrant Behaviour Checklist-Community version (ABC-C) total score,Reference Aman, Burrow and Wolford66 and another fourReference Chung and Cassidy42, Reference Espie, Watkins, Curtice, Espie, Duncan and Ryan46, Reference Folch, Corts, Salvador-Carulla, Vicens, Irazbal and Muoz52, Reference Andrews, Everitt and Sander67 used ABC-C subdomain scores.Reference Aman and Singh68 Three studiesReference Espie, Pashley, Bonham, Sourindhrin and O'donovan37, Reference Gillies, Espie and Montgomery38, Reference Espie, Gillies and Montgomery69 used the Psychosocial Behaviour Scale (PBS).Reference Espie, Montgomery and Gillies70 The Behaviour Problem Inventory (BPI)Reference Rojahn, Matson, Lott, Esbensen and Smalls71 was used in two studiesReference Deb, Thomas and Bright12, Reference van Ool, Snoeijen-Schouwenaars, Tan, Schelhaas, Aldenkamp and Hendriksen72 to rate challenging behaviour. McCarron, Mary Child Care/Camps/Rec. Luckily, there is one hippocampus on each side of the brain. "coreDisableEcommerceForBookPurchase": false, Comparisons were made with an adult reference population with ID, based on gender, to determine whether the behavior was clinically deviant. Will seizures that last over 5 minutes stop you from learning new things? ODwyer, Maire Pooled data from the 16 studies using a random-effects meta-analysis of standardised mean differences showed no significant intergroup difference but the heterogeneity among studies was very high (I 2=88%) (Fig. We also carried out a very extensive hand-search of journals in the field of intellectual disability and epilepsy, along with stringent cross-referencing. The stereotypy meta-analysis did not show any significant intergroup difference but showed a high heterogeneity value of over 60% (I 2=69%). Unable to load your collection due to an error, Unable to load your delegates due to an error. The frontal lobe has the final say in your social behavior. 1 The flowchart of the paper selection process. After the definitive search was completed, titles were searched for key terms. When different subgroups according to various epilepsy variables were compared for the rate of challenging behaviour no clear picture emerged. Increased risk for dementia / cognitive problems. Epilepsy can be considered a spectrum disorder because of its different causes, different seizure types, its ability to vary in severity and impact from person to Results: Cognitive (neuropsychological) well-being: In general, cognitive functioning is normal or nearly normal for adultswith epilepsies that are well-controlled with medications. and It is also important to remember that, apart from epilepsy, many circumstances, such as medical, psychological, social and environmental factors, affect the behaviour of someone with intellectual disabilities, and a full multidisciplinary person-centred assessment is required to develop an appropriate formulation for the management of challenging behaviour, including psychosocial interventions.Reference Deb, Kwok, Bertelli, Salvador-Carulla, Bradley and Torr10 Support staff, and the person and their family/carers, need to be informed of the risk factors (including SUDEP) and prognosis.Reference Young, Shankar, Palmer, Craig, Hargreaves and McLean90Reference Devinsky92 This also highlights the requirement for regular health checks for all adults with intellectual disabilities, as highlighted in a recent NHS England publication.93. Zotero reference management software29 was used to manage and record references from each database. Of these three, oneReference Matson, Bamburg, Mayville and Khan41 was at a significant level and the level of significance for the other twoReference Espie, Watkins, Curtice, Espie, Duncan and Ryan46, Reference Pawar and Akuffo49 is not known. No eLetters have been published for this article. 2016 Jul;23(7):1152-7. doi: 10.1111/ene.13016. ABC-C, Aberrant Behaviour Checklist-Community version; ABS-II, Adaptive Behaviour Scale Part II; AED, anti-epileptic drugs; ANCOVA, analysis of covariance; BPI, Behaviour Problem Inventory; DAS, Disability Assessment Schedule; EEG, electroencephalogram; MRI, magnetic resonance imaging; PAA, Profile of Abilities and Adjustment schedule; PBS, Psychosocial Behaviour Scale; SIB, self-injurious behaviour; GTCS, generalised tonicclonic seizures. Some did not use any validated tool. Many types of challenging behaviour were assessed in the included studies. 2019 Jun;139(6):519-525. doi: 10.1111/ane.13085. Please enable it to take advantage of the complete set of features! Fig. Some people claim this is where your personality comes from. Roy, Meera The most frequent cognitive complaints in adults are feeling slowed down mentally, memory impairment, and attention problems. Hostname: page-component-5d895b6665-ltcbv Changes that affect the way you live your life, and not always for the better? Fig. FOIA Publication bias could not be identified using a funnel plot for stereotypy, as data from only three studies could be amalgamated into the meta-analysis. 4), on self-injurious behaviour from six (Fig. It is worth remembering that, apart from epilepsy, many other medical and psychosocial factors influence these behaviours, including certain genetic syndromes that are known to be associated with aggression and self-injurious behaviour.Reference Deb81 Many of these syndromes also tend to predispose individuals to epilepsy (examples include LeschNyhan and fragile-X syndromes).Reference Deb1 Therefore, it is difficult to draw any conclusion about the association between these specific challenging behaviours and epilepsy in isolation without considering all the other predisposing (e.g. Treatment of behavioral problems in intellectually disabled adult Many people cannot think of the name of something, even when it is right in front of them. The frequency and severity of self-injurious, (motoric) stereotyped, and aggressive/destructive behavior among 189 patients was assessed using the Behavior Problem Inventory. Although monopharmacy with anti-epileptic medication is desirable,88 polypharmacy with anti-epileptics is common in intellectual disability populations. 2021. for this article. Maes-Festen, Dederieke and We aimed to include studies that compared the overall rate of challenging behaviour as well as different types of challenging behaviour in adults with intellectual disabilities with and without epilepsy within the same cohort. We excluded non-human studies, studies involving children and conference abstracts. Copyright 2018 Elsevier Inc. All rights reserved. BJPsych Open. Some people with epilepsy of this kind do have problems with their memory, language, or other kinds of thinking. Wernicke's area is on the top part of the temporal lobe, toward the back. Where there was substantial heterogeneity (I 2>60%), a further sensitivity analysis was carried out. Bibliographies of potential studies were screened to identify articles that required acquisition of the full text. According to both SIGN 50 and Cochrane risk-of-bias assessments most studies appeared to be of moderate to poor quality. Bertelli, Marco A summary graph is presented as supplementary Appendix 5. genetic syndromes), precipitating (e.g. If seizures starting here go untreated, the hippocampus starts to harden and shrink. Your evaluation may include: A neurological exam. Table 3 presents data on participants with epilepsy only and compares rates of challenging behaviour according to various epilepsy variables. An odds ratio was calculated for the studies that presented the proportion of participants in each group displaying challenging behaviour. O'Dwyer, Mire Of the 34 papers, 19 included participants with and without epilepsy, as their authors compared the rates of challenging behaviour in these two groups to assess an association between challenging behaviour and epilepsy (Table 1). A funnel plot and Egger's test of publication bias showed no publication bias among the included studies. and Burke, Eilish Fig. Our finding (based on meta-analysis of pooled data from 10 studies) of a significant intergroup difference differs from that of other systematic reviews,Reference Blickwedel, Ali and Hassiotis19Reference van Ool, Snoeijen-Schouwenaars, Schelhaas, Tan, Aldenkamp and Hendriksen21 which found no such difference. One has to remember to mitigate against the impact on the family/caregivers. Cognitive and behavioral functions generally improve for individuals who are seizure-free. Five studiesReference Pawar and Akuffo49, Reference Creaby, Warner, Jamil and Jawad54Reference Ring, Zia, Lindeman and Himlok57 collected data retrospectively from participants case notes and did not use any validated measures.
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