Challenging behavior in adults with epilepsy and No eLetters have been published for this article. Introduction. 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. Your evaluation may include: A neurological exam. WebEpilepsy is a complex set of brain disorders with epileptic seizures being the quintessential defining element. The selection process is shown in Fig. Cognitive and Behavioral Effects of Epilepsy: Adults with In one studyReference Andrews, Everitt and Sander67 aggression was less common in the epilepsy group. First, when data from all available studies were pooled, no statistically significant intergroup difference emerged, although the heterogeneity among studies was very high. Fig. However, peri-ictally some people may show aggression, which is not goal directed but inadvertently may injure others. 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. But even if your seizures start on the left side of your brain, hope is not lost. 1). Service, Kathryn P. Treat or refer accordingly. Epilepsy, Cognition, and Behavior: The clinical picture - PMC However, after sensitivity analysis meta-analysis of pooled data from 10 studies showed a significantly higher rate of overall challenging behaviour in the epilepsy group compared with the non-epilepsy group. Only a small number of studies were involved in this meta-analysis and the heterogeneity level was high. Duplicates, non-human studies and studies involving children were identified by Zotero and removed manually (by B.A.B.). According to two studiesReference Gillies, Espie and Montgomery38, Reference Tyrer, McGrother, Thorp, Donaldson, Bhaumik and Watson59 the epilepsy group showed a statistically significant higher rate of aggression compared with the non-epilepsy group. and B.L. Many people cannot think of the name of something, even when it is right in front of them. The findings are contradictory and must be interpreted with caution because of the difficulty in pooling data from varied studies, which is likely to introduce confounding. Changes in how you go about making plans? However, it is possible that anti-epileptic polypharmacy made these participants more sedated, thus dampening down the expression of challenging behaviour. Two studies each published two papers on the same sample but on different outcome measures. Seizures affect thinking in different ways for everyone. For speaking, Broca's area takes the lead role. No one is there to find what you need. Has data issue: false The hippocampus is very sensitive to changes in brain activity. Abundant evidence makes it clear that there is a spectrum of cognitive, Fig. 2023. Our analysis showed conflicting evidence, in that the meta-analysis of pooled data from a larger number of studies did not show a significant intergroup difference, whereas pooled data from a smaller number of studies after sensitivity analysis showed a significant difference. "coreUseNewShare": false, WebAll types of epilepsy can make children prone to behavior problems: Complex partial seizures, especially of early onsethyperactivity, problems in paying attention or The quality of the overall systematic review was assessed using AMSTAR 2 criteria (see Appendix 3; supplementary material).Reference Shea, Reeves, Wells, Thuku, Hamel and Moran35. However, in five studiesReference Espie, Pashley, Bonham, Sourindhrin and O'donovan37, Reference Turkistani47, Reference Creaby, Warner, Jamil and Jawad54, Reference Deb and Joyce55, Reference Collacott, Cooper, Branford and McGrother58 no such significant intergroup difference was found. Forte, Luciana All authors contributed to manuscript writing and authorised the final version of the manuscript. 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 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). 25 September 2020. 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. 2021. The frequency and severity of self-injurious, (motoric) stereotyped, and aggressive/destructive behavior among 189 patients was assessed using the Behavior Problem Inventory. When a person, place, or thing causes an emotional reaction, the amygdala attaches the emotion to the memory. is funded by the UK's National Institute of Health Research (NIHR) Research for Patient Benefit (RfPB) Programme (grant PBPG-0817-20010). The risk assessment should be part of the person's overall person-centred support plan and should be monitored and reviewed regularly with the person, their family/caregivers, other relevant professionals and the multidisciplinary team. Merli, Micaela Piva J Intellect Disabil Res. Programs Briefs | Epilepsy Foundation, Discrimination in Federally Funded Programs Briefs, First Responders and Seizure Management Briefs, Resources and Seizure Action Plans for Summer Camp, Explaining Epilepsy to Friends and Family, Epilepsy Foundation Individual and Family Services, About Research and Funding at Epilepsy Foundation, The Epilepsy Learning Healthcare System (ELHS), Access the Rare Epilepsy Network Registry, #AimForZero: Striving Toward a Future Free from Sudden Unexpected Death in Epilepsy, Advocacy: Access Prescription Medications, Advocacy: Affordable Comprehensive Health Coverage, Teens Speak Up! 4 Forest plot of aggression score data. 2021. 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. Two authors independently screened titles, abstracts and full articles using a standardised eligibility checklist. carried out meta-analysis. The site is secure. The remaining abstracts were screened independently using the pre-piloted eligibility criteria (by B.A.B. We included a comprehensive Cochrane risk-of-bias table, which was not done by any of the previous systematic reviews. 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. The largest part of our brain is the part that handles executive function: the frontal lobe. Although certain anti-epileptics, such as sodium valproate (restricted use in women of child-bearing age because of major worry about its teratogenicity), carbamazepine and lamotrigine, are known to improve mental state and are used to treat psychiatric disorders such as bipolar disorder,Reference Goodwin, Haddad, Ferrier, Aronson, Barnes and Cipriani85 paradoxically some anti-epileptics are known to precipitate psychopathology, including challenging behaviour.Reference Brodie, Besag, Ettinger, Mula, Gobbi and Comai86. Perera, Bhathika Mood, anxiety, and perceived quality of life in adults with epilepsy and intellectual disability. Ryazanova, M. A. About 3 million US adults aged 18 or older have active epilepsy. Fig. Would you like email updates of new search results? Executive function really includes many different things, such as planning, reasoning, and stopping unwanted behavior. There is therefore a need for large-scale properly controlled studies. Each area has developed over time to become very good at performing it. HHS Vulnerability Disclosure, Help Even if seizures happen every day for most of your life, you are still able to read, speak, and understand words. and The included studies primarily concentrated on inter-ictal challenging behaviour. Will seizures that last over 5 minutes stop you from learning new things? Copyright 2018 Elsevier Inc. All rights reserved. to resolve any differences. Each database was searched between 1 January 1985 and 31 May 2020. A summary graph is presented as supplementary Appendix 5. For aggression to property or destructiveness, three studiesReference Lundqvist13, Reference Espie, Pashley, Bonham, Sourindhrin and O'donovan37, Reference McGrother, Bhaumik, Thorp, Hauck, Branford and Watson48 showed no significant intergroup difference and no study showed a higher rate in the epilepsy group compared with the non-epilepsy group. 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 lines are cut, so to speak. 2019 Jan;63(1):40-48. doi: 10.1111/jir.12556. Cognitive (neuropsychological) well-being: In general, cognitive functioning is normal or nearly normal for adultswith epilepsies that are well-controlled with medications. Call our Epilepsy and Seizures 24/7 Helpline and talk with an epilepsy information specialist or submit a question online. Also, by log-transforming some data we may have lost some power in the meta-analysis. McCallion, Philip To study specific types of challenging behaviour, we conducted meta-analyses of pooled data on aggression scores from nine studies (Fig. "coreDisableEcommerceForElementPurchase": false, Some people claim this is where your personality comes from. This site needs JavaScript to work properly. You may say what's on your mind even when it's not the right time. Assessment of Challenging Behavior Exhibited by People with Intellectual and Developmental Disabilities: A Systematic Review. Thinking, Memory, and Epilepsy | Epilepsy Foundation Whether you've had one or many seizures, you probably want to know how seizures affect the way you think. Markel, Arcady L. Epilepsy and seizures themselves probably have had some effect on your child's behavior. But it is far more likely that most of your child's behavior problems are related to the way you and others have reacted to the diagnosis of epilepsy. Children experience these reactions more than they experience the seizures. Search terms were adapted from previous systematic reviews that were carried out to develop a national and an international guide for the use of psychotropic medications in the management of challenging behaviour in adults with intellectual disabilities.Reference Deb, Kwok, Bertelli, Salvador-Carulla, Bradley and Torr10, Reference Unwin and Deb24. Table 1 Rates of challenging behaviour in adults with intellectual disabilities with and without epilepsy. Having epilepsy can restrict social activities and wider social integration. There was no restriction on the type of study design included in this review. First of all, most people have the main part of their language functions on the left side of their brain. infection or anxiety) and perpetuating (e.g. Once the information is needed again, the hippocampus helps retrieve it. Fig. 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. Forest plot of total challenging behaviour score data from 16 studies. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists. Careers. 3 Forest plot of total challenging behaviour score data from 10 studies after sensitivity analysis. Rojahn, Johannes Epilepsy and Neurophysiology Fellowship Match, Seizures are pharmacoresistant (medication refractory), Risk for cognitive deficit is higher for patients with focal seizure onset (e.g., temporal lobe or frontal lobeepilepsy, Symptomatic (i.e., underlying pathology/abnormality on MRI) epilepsies, Longer duration (time) patient has experienced seizures, History of multiple episodes of status epilepticus (generalized or focal), Seizures/epilepsy and/or antiepileptic drugs. Epub 2019 Mar 21. van Ool JS, Snoeijen-Schouwenaars FM, Tan IY, Schelhaas HJ, Aldenkamp AP, Hendriksen JGM. A number of epilepsy-related factors have been linked to increased rates of behavioral disorder including high seizure frequency, presence of tonicclonic seizures, Of the 868 articles screened, 34 papers (from 32 studies) met the eligibility criteria and were included in the systematic review (Fig. Second, even when the meta-analysis after the sensitivity analysis showed that the epilepsy group had a significantly higher rate of challenging behaviour, the effect size remained very small, so this may not be clinically significant. +, bias present; , bias absent; ?, bias possible. The flowchart of the paper selection process. PMC official website and that any information you provide is encrypted Conclusion: Previous systematic reviews showed no significant association between epilepsy and challenging behaviours in adults with intellectual disabilities. O'Dwyer, Mire Therefore, anti-epileptic drugdrug interaction are more likely, some of which may lead to challenging behaviour. Fig. Epilepsia. Therefore, this finding has to be interpreted with caution. 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. The .gov means its official. Data on subgroup comparisons according to different types of seizure, seizure frequency and different pharmacological regimes (e.g. What If I Have a Seizure While I Exercise? Deb, Shoumitro The hippocampus is the ultimate librarian. It also may be harder for you to stop unwanted behavior. First of all, let's talk about what goes into the way you think. Table 2 compares the rates of different types of challenging behaviour (e.g. 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. Table 3 presents data on participants with epilepsy only and compares rates of challenging behaviour according to various epilepsy variables. Consider referral for neuropsychological evaluation,especially for adults with additional risk factors for cognitive deficits and for cognitive decline over time: Anti-epileptic drugs: Discuss/review the potential impact of anti-epileptic drugs (AEDs) on cognitive functioning andbehavior. Before and Ready for help? Prevalence and patterns of anti-epileptic medication prescribing in the treatment of epilepsy in older adults with intellectual disabilities. In three studiesReference Creaby, Warner, Jamil and Jawad54, Reference Deb and Hunter61, Reference van Ool, Snoeijen-Schouwenaars, Tan, Schelhaas, Aldenkamp and Hendriksen72 the rate of challenging behaviour was significantly higher in those who had generalised seizures compared with those who had focal seizures, but in one studyReference Andrews, Everitt and Sander67 no significant difference was reported between these two groups. FOIA Limbu, Bharati So if your seizures start on the right side of your brain, your language may not be affected at all. Seizures that happen in the frontal lobe can cause your planning ability to become weaker. Although we amalgamated data where possible to carry out a number of meta-analyses, the heterogeneity among studies remains high. 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). Your frontal lobe tells you that you shouldn't do it. 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). Seizures - Symptoms and causes - Mayo Clinic 6 Forest plot of stereotypy score data.NEP, no epilepsy; EP, epilepsy. Deb, Shoumitro Shoumi and B.L. 2023. ICMJE forms are in the supplementary material, available online at http://doi.org/10.1192/bjo.2020.96. The Imperial Biomedical Research Centre Facility, which is funded by the NIHR, has provided support for the study. Alekhina, Tatiana A. The rates of challenging behaviour were compared on the basis of the presence or absence of epilepsy, but the epilepsy groups were not matched with the non-epilepsy groups. Ryazanova, Marina A. The frontal lobe has a major role in decision making. We carried out meta-analyses that were not done in any previous systematic reviews.

Are Noble Gases Reactive, Wang Shuang Louisville, Newport News Elementary, University Of Wisconsin-parkside Ranking, Articles E