A systematic review of neuropsychiatric comorbidities in patients with both epilepsy and intellectual disability

Epilepsy is a neurological condition that is particularly common in people with intellectual disability (ID). The care for people with both epilepsy and ID is often complicated by the presence of neuropsychiatric disorders, defined as psychiatric symptoms, psychiatric disorders, and behavioral problems. The aim of this study was to investigate associations between epilepsy or epilepsy-related factors and neuropsychiatric comorbidities in patients with ID and between ID and neuropsychiatric comorbidities in patients with epilepsy. We performed a systematic review of the literature, published between January 1995 and January 2015 and retrieved from PubMed/Medline, PsycINFO, and ERIC and assessed the risk of bias using the SIGN-50 methodology. Forty-two studies were identified, fifteen of which were assessed as having a low or acceptable risk-of-bias evaluation. Neuropsychiatric comorbidities were examined in relation to epilepsy in nine studies; in relation to epilepsy-related factors, such as seizure activity, seizure type, and medication in four studies; and in relation to the presence and degree of ID in five studies. We conclude that the presence of epilepsy only was not a clear determinant of neuropsychiatric comorbidity in patients with ID, although a tendency towards negative mood symptoms was identified. Epilepsy-related factors indicating a more severe form of epilepsy were associated with neuropsychiatric comorbidity as was the presence of ID as compared to those without ID in patients with epilepsy, although this should be validated in future research. A large proportion of the studies in this area is associated with a substantial risk of bias. There is a need for high quality studies using standardized methods to enable clear conclusions to be drawn that might assist in improving the quality of care for this population.

[1]  E. Beghi,et al.  The epidemiology of epilepsy in Europe – a systematic review , 2005, European journal of neurology.

[2]  G. Kaplan,et al.  Depression in epilepsy , 2013, Neurology.

[3]  D. Clarke.  Practice Guidelines for the Assessment and Diagnosis of Mental Health Problems in Adults with Intellectual Disability , 2002 .

[4]  A. Jackson,et al.  Psychosis and adults with intellectual disabilities , 2007, Social Psychiatry and Psychiatric Epidemiology.

[5]  W. D’Souza,et al.  Risk factors for psychological distress in community-treated epilepsy , 2014, Epilepsy & Behavior.

[6]  L. Wiggs,et al.  A questionnaire survey of sleep and night-time behaviour in a community-based sample of adults with intellectual disability. , 1998, Journal of intellectual disability research : JIDR.

[7]  Y. Okubo,et al.  Intellectual Disability and Psychotic Disorders of Adult Epilepsy , 2005, Epilepsia.

[8]  M. Kerr,et al.  Prevalence of epilepsy and associated health service utilization and mortality among patients with intellectual disability. , 2003, American journal of mental retardation : AJMR.

[9]  J. Matson,et al.  Seizure disorders in people with intellectual disability: an analysis of differences in social functioning, adaptive functioning and maladaptive behaviours. , 1999, Journal of intellectual disability research : JIDR.

[10]  E. Taylor,et al.  Factors affecting the risk of behaviour problems in children with severe intellectual disability. , 2001, Journal of intellectual disability research : JIDR.

[11]  M. Echteld,et al.  Prevalence, associated factors and treatment of sleep problems in adults with intellectual disability: a systematic review. , 2012, Research in developmental disabilities.

[12]  Marco Mula,et al.  Uncovering the neurobehavioural comorbidities of epilepsy over the lifespan , 2012, The Lancet.

[13]  S. Buono,et al.  Self-injury in people with intellectual disability and epilepsy: A matched controlled study , 2012, Seizure.

[14]  E. Pataraia,et al.  Postictal psychosis in temporal lobe epilepsy: a case–control study , 2013, European journal of neurology.

[15]  M. Kerr,et al.  Epilepsy and intellectual disability. , 2000, Journal of intellectual disability research : JIDR.

[16]  S. Deb.  Mental disorder in adults with mental retardation and epilepsy. , 1997, Comprehensive psychiatry.

[17]  S. Bhaumik,et al.  Epilepsy in adults with intellectual disabilities: Prevalence, associations and service implications , 2006, Seizure.

[18]  M. Lubetsky,et al.  Psychiatric and behavior disorders in children with mental retardation and seizure disorder , 1995 .

[19]  C. Molteno,et al.  Behavioural and emotional problems in children with intellectual disability attending special schools in Cape Town, South Africa. , 2001, Journal of intellectual disability research : JIDR.

[20]  C. Cull,et al.  An Investigation of Behaviour Disturbance and Adaptive Behaviour of Children with Severe Intellectual Disabilities and Epilepsy: A Comparative Study , 1998 .

[21]  H. Ring,et al.  Interactions between seizure frequency, psychopathology, and severity of intellectual disability in a population with epilepsy and a learning disability , 2007, Epilepsy & Behavior.

[22]  R Duncan,et al.  Psychopathology in people with epilepsy and intellectual disability; an investigation of potential explanatory variables , 2003, Journal of neurology, neurosurgery, and psychiatry.

[23]  A. Vignoli,et al.  Aggressive behavior and epilepsy: A multicenter study , 2012, Epilepsia.

[24]  S. Deb,et al.  Mental disorder in adults with intellectual disability. 2: The rate of behaviour disorders among a community-based population aged between 16 and 64 years. , 2001, Journal of intellectual disability research : JIDR.

[25]  Josemir W Sander,et al.  A descriptive survey of long-term residents with epilepsy and intellectual disability at the Chalfont Centre: is there a relationship between maladaptive behaviour and magnetic resonance imaging findings? , 1999, Journal of intellectual disability research : JIDR.

[26]  R. Didden,et al.  Sleep problems and daytime problem behaviours in children with intellectual disability. , 2002, Journal of intellectual disability research : JIDR.

[27]  M. Cuddy,et al.  Factors associated with the risk of behaviour problems in adolescents with severe intellectual disabilities. , 2008, Journal of intellectual disability research : JIDR.

[28]  C. F. de Winter,et al.  Physical conditions and challenging behaviour in people with intellectual disability: a systematic review. , 2011, Journal of intellectual disability research : JIDR.

[29]  D. Mowat,et al.  Epilepsy and associated psychopathology in young people with intellectual disability , 2000, Journal of paediatrics and child health.

[30]  C. Gillberg,et al.  Neurobehavioral Comorbidities in Children With Active Epilepsy: A Population-Based Study , 2014, Pediatrics.

[31]  E. Kravariti,et al.  Epilepsy and intellectual disability: does epilepsy increase the likelihood of co-morbid psychopathology? , 2011, Research in developmental disabilities.

[32]  C. Gillberg,et al.  Psychiatric disorders in children and adolescents with mental retardation and active epilepsy. , 1996, Archives of neurology.

[33]  J. Matson,et al.  Symptoms of psychopathology in adults with intellectual disability and seizures. , 2011, Research in developmental disabilities.

[34]  J. Matson,et al.  Psychopathology: differences among adults with intellectually disabled, comorbid autism spectrum disorders and epilepsy. , 2010, Research in developmental disabilities.

[35]  Deepak G. Pawar,et al.  Comparative survey of comorbidities in people with learning disability with and without epilepsy , 2008 .

[36]  S. Deb.  Electrophysiological correlates of psychopathology in individuals with mental retardation and epilepsy. , 1995, Journal of intellectual disability research : JIDR.

[37]  A. Aldenkamp,et al.  Behaviour, cognition and epilepsy , 2005, Acta neurologica Scandinavica. Supplementum.

[38]  P. Yoder,et al.  Descriptive analysis of epileptic seizures and problem behavior in adults with developmental disabilities. , 2005, American journal of mental retardation : AJMR.

[39]  C. Gillberg,et al.  Autism spectrum disorders in children with active epilepsy and learning disability: comorbidity, pre‐ and perinatal background, and seizure characteristics , 2003, Developmental medicine and child neurology.

[40]  T. Koskentausta,et al.  Psychiatric disorders in children with intellectual disability , 2002, Nordic journal of psychiatry.

[41]  P. Sturmey,et al.  Descriptive Psychopathology in People With Mental Retardation , 2004, The Journal of nervous and mental disease.

[42]  S. Deb,et al.  Psychiatric illness and behavioural problems in adults with learning disability and epilepsy. , 1998, Behavioural neurology.

[43]  I. Turkistani.  Epilepsy in Learning Disabilities , 2004 .

[44]  F Tyrer,et al.  Physical aggression towards others in adults with learning disabilities: prevalence and associated factors. , 2006, Journal of intellectual disability research : JIDR.

[45]  J. Matson,et al.  Behavior problems: differences among intellectually disabled adults with co-morbid autism spectrum disorders and epilepsy. , 2010, Research in developmental disabilities.

[46]  M. Mula,et al.  Treatment of behavioral problems in intellectually disabled adult patients with epilepsy , 2013, Epilepsia.

[47]  M. Chung,et al.  A Preliminary Report on the Relationship Between Challenging Behaviour and Epilepsy in Learning Disability , 2001 .

[48]  J. Ioannidis,et al.  The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration , 2009, Annals of Internal Medicine [serial online].

[49]  S. Cooper,et al.  Mental ill-health in adults with intellectual disabilities: prevalence and associated factors , 2007, British Journal of Psychiatry.

[50]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[51]  D. Felce,et al.  A prospective case control study of psychiatric disorders in adults with epilepsy and intellectual disability , 2011, Epilepsia.

[52]  J. Matson,et al.  Social skills: differences among adults with intellectual disabilities, co-morbid autism spectrum disorders and epilepsy. , 2010, Research in developmental disabilities.

[53]  M. Matsuura,et al.  A Multicenter Study on the Prevalence of Psychiatric Disorders among New Referrals for Epilepsy in Japan , 2003, Epilepsia.

[54]  D. Felce,et al.  A general practice-based prevalence study of epilepsy among adults with intellectual disabilities and of its association with psychiatric disorder, behaviour disturbance and carer stress. , 2007, Journal of intellectual disability research : JIDR.

[55]  G. Guyatt,et al.  GRADE: an emerging consensus on rating quality of evidence and strength of recommendations , 2008, BMJ : British Medical Journal.

[56]  L. Virta,et al.  Age-specific prevalence of intellectual disability in Finland at the beginning of new millennium--multiple register method. , 2014, Journal of intellectual disability research : JIDR.