A comparison of antiepileptic drug therapy in patients with severe intellectual disability and patients with normal intellect

We describe and compare the antiepileptic drug (AED) management in patients with severe intellectual disability (ID) and those with normal intellect (NI) and focal epilepsy at a tertiary epilepsy center. Fifty patients with ID were compared to a control group of 50 patients with NI; the majority of the patients in both groups had medically refractory epilepsy. Patients with ID were currently taking and had been previously exposed to a greater number of different AEDs. Despite the fact that both groups of patients had beene qually exposed to both old and newer AEDs, patients with ID were more likely to be taking at least one old AED and were more commonly treated with benzodiazepines (clobazam was the most commonly used drug in this group). This difference is likely related to greater seizure frequency and co-morbid behavioral disturbance in the ID group as no bias was identified against utilization of the newer AEDs in patients with ID.

► Patients with ID are prescribed a greater number of AEDs than those with NI. ► Both groups have equal exposure to the newer AEDs. ► Patients with ID are more likely to take a benzodiazepine for seizure control. ► Differences noted are likely due to increased seizure severity in patients with ID.