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. Treatment of behavioral problems in intellectually disabled adult Table 3 Challenging behaviours in adults with intellectual disabilities according to different epilepsy variables. Fig. ODwyer, Mire The frontal lobe has the final say in your social behavior. The .gov means its official. 2022. Majid, Madiha We hand-searched for relevant articles in the past 20 years issues, from January 1990 to May 2020, in the following intellectual disabilities journals: (a) Journal of Intellectual Disability Research, (b) Journal of Applied Research in Intellectual Disabilities (JARID) and (c) Research in Developmental Disabilities; and the following epilepsy journals: (a) Seizure, (b) Epilepsy & Behavior and (c) Epilepsia. Copyright 2018 Elsevier Inc. All rights reserved. 2022 Mar 29;14(1):25. doi: 10.1186/s11689-022-09426-0. 2006). Fig. Seizures, by themselves, do not stop people from speaking or understanding words. "useRatesEcommerce": true This is because seizures can damage the area where the word is stored, as well as the communication lines that carry or transport the word. So if your seizures start on the right side of your brain, your language may not be affected at all. First of all, let's talk about what goes into the way you think. The behavior exceeded clinical norms in 7%, 18%, and 12%, respectively. Has data issue: false Therefore, this finding has to be interpreted with caution. Roy, Meera O'Dwyer M, Peklar J, Mulryan N, McCallion P, McCarron M, Henman MC. 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). Three of these functions are memory, language, and what we call "executive function." Epilepsy - Diagnosis and treatment - Mayo Clinic 7 Cochrane risk-of-bias summary for the 19 controlled studies. 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). becomes abnormal, causing seizures or periods of unusual behavior, sensations and sometimes loss of awareness. We have only included data on challenging behaviour in this review. Mayo Clinic Overview A seizure is a sudden, uncontrolled burst of electrical activity in the brain. Most studies were carried out in the UK (n=24), some in the USA (n=4) and one each in Ireland, Sweden, The Netherlands and Spain. No ethical approval was required for this study as no individual patient-related data were collected or analysed. Fig. Henman, Martin C. Our review received a high rating on the AMSTAR 2 quality control checklist for systematic reviews, as we complied with all of its requirements (supplementary Appendix 3). BJPsych Open. 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 Association between epilepsy and challenging behaviour in adults with intellectual disabilities: systematic review and meta-analysis. Subgroup comparisons do not provide adequate power to detect clinically significant difference because of the small numbers involved in each subgroup and the lack of a control group. 3540 Crain Highway, Suite 675,Bowie, MD 20716, 2023 Epilepsy Foundation, is a non-profit organization with a 501(c)(3) tax-exempt status. Ideally, we should have used raw data for the meta-analysis, but this was not possible. Table 2 shows the rates of different types of challenging behaviour in the epilepsy and the non-epilepsy groups. Deb, Shoumitro The psychosocial impact of epilepsy in adults - ScienceDirect Please enable it to take advantage of the complete set of features! Pooled data did not show any significant intergroup difference in the rate of stereotyped behaviour. 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. We devised a list of eligibility criteria based on PROSPERO22 and Cochrane review guidelinesReference Lefebvre, Glanville, Briscoe, Littlewood, Marshall, Metzendorf, Higgins, Thomas, Chandler, Cumpston, Li and Page25 and adapted from similar systematic reviews on psychotropic medicationsReference Deb, Farmah, Arshad, Deb, Roy and Unwin26Reference Unwin and Deb28 (supplementary Appendix 1). Call our Epilepsy and Seizures 24/7 Helpline and talk with an epilepsy information specialist or submit a question online. 1. Even though you may know the name of an object, the part of the brain that knows can't tell the rest of your brain. B.A.B. So if seizures happen in the area in charge of language, you may not be able to name an object when you see it. Health and Economic Impact of Epilepsy. Quality of Life/Psychosocial adjustment: Ask patient how epilepsy affects them the most in everyday activitiesand explore resources to address those concerns/needs. Whether you've had one or many seizures, you probably want to know how seizures affect the way you think. 2022. 5) and on stereotypy from three (Fig. Cognitive and behavioral functions generally improve for individuals who are seizure-free. Mulryan, Niamh 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. An excellent place to find diagrams and information about the brain is at the website Neuroscience for Kidsgood for all ages! Your doctor may test Epilepsia. The frontal lobe has a major role in decision making. Roy, Ashok We searched for articles in English only. 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. 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. In some people anti-epileptics improve both epilepsy symptoms and behaviour. Having epilepsy can restrict social activities and wider social integration. government site. Another reason for carrying out this review is to conduct meta-analyses that were not done in any of the previous reviews. Data from studies meeting eligibility criteria were extracted independently by B.A.B. Hostname: page-component-5d895b6665-ltcbv Bissell S, Oliver C, Moss J, Heald M, Waite J, Crawford H, Kothari V, Rumbellow L, Walters G, Richards C. J Neurodev Disord. Cognitive and Behavioral Effects of Epilepsy: Adults with Sappok, Tanja and B.L. Deb, Shoumitro One studyReference McGrother, Bhaumik, Thorp, Hauck, Branford and Watson48 showed a significantly higher rate of behaviours such as disturbing others at night, seeking attention and being uncooperative in the epilepsy group compared with the non-epilepsy group. Data on subgroup comparisons according to different types of seizure, seizure frequency and different pharmacological regimes (e.g. 2022 Jul 17;19(14):8701. doi: 10.3390/ijerph19148701. Does each seizure permanently change the way your brain works? Buonaguro, Elisabetta Filomena 2021. inappropriate treatment and/or environment) factors for challenging behaviour in general. However, to counteract the problem with study heterogeneity we used sensitivity analyses. Mood, anxiety, and perceived quality of life in adults with epilepsy and intellectual disability. Also, both antipsychotics and antidepressants are likely to lower seizure threshold (particularly the older generation ones and at a high dose), which may precipitate more seizures and may lead to challenging behaviour. Jokinen, Nancy S. Heterogeneity was tested using the 2-test and I 2-statistic. and B.L.). Each area has developed over time to become very good at performing it. View all Google Scholar citations Strydom, Andr For example, the names of animals are stored toward the front of the temporal lobe. Aggression was the behavior evaluated most often as being problematic, despite its reported frequency being the lowest. Forest plot of self-injurious behaviour score data. Epilepsy | CDC - Centers for Disease Control and Prevention After sensitivity analysis we removed data from studies that produced the highest level of heterogeneity and had a high risk of bias according to the Cochrane risk-of-bias tool. 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. "corePageComponentGetUserInfoFromSharedSession": true, We included a comprehensive Cochrane risk-of-bias table, which was not done by any of the previous systematic reviews. All participants had intellectual disabilities, were aged 16 years or over and displayed various types of challenging behaviour. Classification of intellectual disability according to domains of adaptive functioning and between-domains discrepancy in adults with epilepsy. In total, data on 14168 adults with intellectual disabilities are presented (4781 with epilepsy and 9387 without epilepsy). Cooper, Sally-Ann For example, a number of studies used the ABC-C total score, which is not valid.Reference Aman, Burrow and Wolford66 Fifth, many studies used an arbitrary cut-off score on behaviour rating scales to define challenging behaviour, and different studies used different scales and different cut-off scores. 2 Forest plot of total challenging behaviour score data from 16 studies.NEP, no epilepsy; EP, epilepsy. Epilepsy and Seizures | National Institute of Neurological Disorders 1. "coreUseNewShare": false, HHS Vulnerability Disclosure, Help Accessibility 4 Forest plot of aggression score data.NEP, no epilepsy; EP, epilepsy. and S.D. Only a small number of studies were involved in this meta-analysis and the heterogeneity level was high. Fig. Challenging behavior in adults with epilepsy and Treat or refer accordingly. Snoeijen-Schouwenaars FM, van Ool JS, Tan IY, Aldenkamp AP, Schelhaas HJ, Hendriksen JGM. It is difficult to amalgamate data from studies that used such diverse methodologies and defined challenging behaviour in so many different ways. It also may be harder for you to stop unwanted behavior. 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. Plekanchuk, V. S. 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. Many people cannot think of the name of something, even when it is right in front of them. 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. However, a more practical explanation may be that medication side-effects make the behaviour worse in some, despite improving epilepsy symptoms. Therefore, our findings must be interpreted with caution, as a lot of confounders could not be controlled for. +, bias present; , bias absent; ?, bias possible. The frontal lobe also helps you to stop unwanted behavior. 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. genetic syndromes), precipitating (e.g. 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. B.A.B. Acta Neurol Scand. Ozer, Mikail For example, in three studiesReference Creaby, Warner, Jamil and Jawad54, Reference Deb and Hunter61, Reference van Ool, Snoeijen-Schouwenaars, Tan, Schelhaas, Aldenkamp and Hendriksen72 a significantly higher rate is reported among those with generalised seizures as opposed to focal seizures but in one studyReference Andrews, Everitt and Sander67 the intergroup difference was not significant. Increased risk for dementia / cognitive problems. MeSH travelling alone, taking a bath, seizure-related injuries, unpredictability of the timing of seizures, SUDEP). The name is lost. WebBehavioral disorders are common in people with epilepsy and intellectual disability. 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. This might also be studied in further research. 2013 Mar;54 Suppl 1:34-40. doi: 10.1111/epi.12103. Both are likely to benefit patientand family. Treatment of behavioral problems in intellectually disabled adult patients with epilepsy. It helps you go through the pluses and minuses logically. 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). The relationship between epilepsy and challenging behaviour in adults with intellectual disabilities is complex.Reference Deb, Bouras and Holt9 Challenging behaviour has been defined as socially unacceptable behaviour that causes distress, harm or disadvantage to the persons themselves or to other people, and usually requires some intervention.Reference Deb, Kwok, Bertelli, Salvador-Carulla, Bradley and Torr10 Challenging behaviour is prevalent among adults with intellectual disabilities, affecting up to around 62%.Reference Smith, Branford, Collacott, Cooper and McGrother11Reference Hemmings, Deb, Chaplin, Hardy and Mukherjee14 More severe forms of challenging behaviour are manifested by a lower proportion (18.730%).Reference Lundqvist13, Reference Deb, Deb, Faruqui, Bodani and Agrawal15 The types of challenging behaviour include aggression, destruction of property, disruptive behaviour, self-injurious behaviour, stereotypy, and sexually inappropriate and harmful behaviours.Reference Hemmings, Deb, Chaplin, Hardy and Mukherjee14, Reference Deb, Bethea, Havercamp, Rifkin, Underwood, Fletcher, Barnhill and Cooper16 Aggression is reported in 1020% of adults with intellectual disabilities.Reference Deb, Bethea, Havercamp, Rifkin, Underwood, Fletcher, Barnhill and Cooper16, Reference Sjgafoos, Elkins, Kerr and Attwood17 The aetiology of challenging behaviour is multifactorial, including medical, psychiatric, psychological, social and environmental factors. Maes-Festen, Dederieke FOIA Each database was searched between 1 January 1985 and 31 May 2020. Different variables, such as age, gender and presence/absence of epilepsy, were used to assess whether they are risk factors for developing challenging behaviour. Fig. When seizures happen, they can have two different effects on thinking: Now you probably want to know what area does what, and how seizures in each area affect functioning. Meta-analysis was possible on data from 16 controlled studies. Unable to load your collection due to an error, Unable to load your delegates due to an error. However, peri-ictally some people may show aggression, which is not goal directed but inadvertently may injure others. Association between epilepsy and challenging behaviour in However, it only stores information for a short time. Among the studies that used validated questionnaires, fiveReference Deb, Thomas and Bright12, Reference Deb, Cowie and Richens36, Reference McGrother, Bhaumik, Thorp, Hauck, Branford and Watson48, Reference Collacott, Cooper, Branford and McGrother58, Reference Tyrer, McGrother, Thorp, Donaldson, Bhaumik and Watson59 used challenging behaviour items from the Disability Assessment Schedule (DAS)Reference Holmes, Shah and Wing60 and another threeReference Deb40, Reference Deb and Hunter61, Reference Deb62 used DAS challenging behaviour items from the Profile of Abilities and Adjustment schedule (PAA).Reference Deb and Hunter61, Reference Wing63 Three studiesReference Espie, Pashley, Bonham, Sourindhrin and O'donovan37, Reference Collacott39, Reference Prasher45 used the Adaptive Behaviour Scale Part II (ABS-II),Reference Nihira, Foster, Shellhaas and Leland64 which scores maladaptive behaviours. Wieland, Jannelien It can cause changes in behavior, movements, feelings and levels of Names of people that are close to you are stored at the very front of the temporal lobe, called the temporal pole. Similarly, three studiesReference Gillies, Espie and Montgomery38, Reference Deb and Hunter61, Reference van Ool, Snoeijen-Schouwenaars, Tan, Schelhaas, Aldenkamp and Hendriksen72 showed a higher rate of challenging behaviour among those who presented with frequent seizures as opposed to those who had less frequent seizures. Factors that affect behaviour in the presence of epilepsy are related to: (a) underlying brain damage, such as the location and severity of any deformity, tumour or abnormal electrical discharge in the brain; (b) epilepsy-related factors, such as the presence of certain epileptic syndromes and genetic syndromes that are prone to lead to more challenging behaviour; (c) seizure-related factors, such as the severity, type and frequency of seizures; (d) anti-epileptic medication-related factors, such as the adverse effects of certain anti-epileptics and drugdrug interactions; and (e) psychosocial factors, such as loss of occupation, financial problems, lack of support, and locus of control being outside the person so the person does not have any control over the timing of seizures. 3). and B.L. The amygdala (a-MIG-dah-lah) is also very important to memory. Determination of whether and/or how to use all or any portion of this document isto be made in your sole and absolute discretion. The frequency and severity of self-injurious, (motoric) stereotyped, and aggressive/destructive behavior among 189 patients was assessed using the Behavior Problem Inventory. Although we amalgamated data where possible to carry out a number of meta-analyses, the heterogeneity among studies remains high. Data on psychiatric illness without challenging behaviour are not presented in the current paper as they will be included in a separate systematic review article. Communication lines formed between different areas so the brain would have a well-developed backup system. After the definitive search was completed, titles were searched for key terms. For self-injurious behaviour, six studiesReference Deb, Thomas and Bright12, Reference Lundqvist13, Reference McGrother, Bhaumik, Thorp, Hauck, Branford and Watson48, Reference Collacott, Cooper, Branford and McGrother58, Reference Cooper, Smiley, Allan, Jackson, Finlayson and Mantry73, Reference Smith and Matson77 showed no significant intergroup difference and one studyReference Espie, Pashley, Bonham, Sourindhrin and O'donovan37 showed significantly less self-injurious behaviour in the epilepsy group compared with the non-epilepsy group. You may not be able to organize your thoughts or your actions in the best way. Anxiety screening may consider brief screening instrument for Generalized Anxiety Disorder (GAD-7; Spitzer etal. Get information, tips, and more to help you manage your epilepsy. 2018 Mar;62(3):245-261. doi: 10.1111/jir.12461. Ryazanova, M. A. The aggression meta-analysis showed a significantly higher rate in the epilepsy group compared with the non-epilepsy group, with a very small effect size of 0.16. The heterogeneity level was low (I 2=27%). When different subgroups according to various epilepsy variables were compared for the rate of challenging behaviour no clear picture emerged. A seizure can disrupt the area of the brain in charge of a particular function. One confounder is the way frequency was rated in different studies, which varied widely. Before We did not aim to include any study that involved only adults with intellectual disabilities who did not have epilepsy. Broca's area is located just above the front of the temporal lobe. New research is finding that names and words may be stored by categories. Seizures, especially ones that start in the temporal lobe, can cause a major blow to the hippocampus. Supplementary material is available online at http://doi.org/10.1192/bjo.2020.96. and Discrepancies identified were reviewed and discussed between B.A.B. Although some of the epilepsy and ID characteristics seemed to contribute independently to these types of challenging behavior, the effects of epilepsy-related characteristics are modest when compared with ID. 3 Forest plot of total challenging behaviour score data from 10 studies after sensitivity analysis. Even if seizures happen every day for most of your life, you are still able to read, speak, and understand words. WebChallenging behavior is a serious issue among adults with epilepsy and ID. ICMJE forms are in the supplementary material, available online at http://doi.org/10.1192/bjo.2020.96. Prevalence and patterns of anti-epileptic medication prescribing in the treatment of epilepsy in older adults with intellectual disabilities. Epilepsy and Psychological Disorders | Epilepsy Foundation Epub 2016 Apr 23. Forest plot of total challenging behaviour score data from 10 studies after sensitivity analysis. A funnel plot and Egger's test of publication bias showed no publication bias among the included studies. Rates of behaviours such as stereotypy, inappropriate sexual behaviour, irritability, hyperactivity, verbal aggression, antisocial behaviours and lethargy. 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. WebCompared with controls, adults with a history of active epilepsy were more likely to report fair or poor health, be unemployed or unable to work, live in households with the lowest annual 2021. Adults with epilepsy report worse physical and mental health and are more likely to report being unable to afford different is funded by the UK's National Institute of Health Research (NIHR) Research for Patient Benefit (RfPB) Programme (grant PBPG-0817-20010). All authors contributed to manuscript writing and authorised the final version of the manuscript. The psychosocial impact of epilepsy in adults is reviewed briefly in this article with a focus on three topics: (1) the scope of the problem, (2) the potential What If I Have a Seizure While I Exercise? But because these tasks are so important, human brains developed so that different areas of the brain can work together. Your attention may drift much sooner than before.
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