Skip to main content

Associated Physical Problems of Epilepsy in Intellectual Disabilities

  • Chapter
  • First Online:
Epilepsy and Intellectual Disabilities

Abstract

Persons with intellectual disabilities and epilepsy will have an increased risk of physical epilepsy-related health issues. In particular, fatal and nonfatal accidental injuries and acute or chronic side effects of antiepileptic medication. This chapter will review sudden unexpected deaths in persons with epilepsy and comment on a number of events which are a cause for concern in this population: burns, drownings, fractures, and head injuries. There is comparatively little research on serious injuries in persons with intellectual disabilities and epilepsy and much must be extrapolated from the general population. Recommendations regarding close supervision and measures for prevention will need to be balanced against the need for individuals to live a full and independent life.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Kerr MP, Bowley C. Epilepsy and intellectual disability. J Intellect Disabil Res. 2000;44:529–43.

    Article  PubMed  Google Scholar 

  2. Robertson J, Hatton C, Emerson E, Baines S. Prevalence of epilepsy among people with intellectual disabilities: a systematic review. Seizure. 2015;29:46–62.

    Article  PubMed  Google Scholar 

  3. Goodridge DM, Shorvon SD. Epileptic seizures in a population of 6000. I. Demography, diagnosis and classification, and role of the hospital services. BMJ. 1983;287:641–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Sander JW. The epidemiology of epilepsy revisited. Curr Opin Neurol. 2003;16:165–70.

    Article  PubMed  Google Scholar 

  5. Richardson SA, Koller H, Katz M, McLaren J. A functional classification of a seizures and its distribution in a mentally retarded population. Am J Ment Defic. 1981;85:457–66.

    CAS  PubMed  Google Scholar 

  6. Amiet C, Gourfinkel-An I, Bouzamondo A, Tordjman S, Baulac M, Lechat P, et al. Epilepsy in autism is associated with intellectual disability and gender: evidence from a meta-analysis. Biol Psychiatry. 2008;64:577–82.

    Article  PubMed  Google Scholar 

  7. Pueschel SM, Rynders JE. Down syndrome: advances in biomedicine and the behavioral sciences. Cambridge: Ware Press; 1982. p. 169–225.

    Google Scholar 

  8. Aicardi J. Epilepsy as a presenting manifestation of brain tumors and of other selected brain disorders. In: Aicardi J, editor. Epilepsy in children (the international review of child neurology). 2nd ed. New York: Raven; 1994. p. 350–1.

    Google Scholar 

  9. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy april 2006. Dev Med Child Neurol Suppl. 2007;109:8–14.

    PubMed  Google Scholar 

  10. van den Broek M, Beghi E, RESt-1 Group. Morbidity in patients with epilepsy: type and complications: a European cohort study. Epilepsia. 2004;45:71–6.

    Article  PubMed  Google Scholar 

  11. Morgan CL, Baxter HA, Kerr MP. Prevalence of epilepsy and associated health service utilization and mortality among patients with intellectual disability. Am J Ment Retard. 2003;108:293–300.

    Article  PubMed  Google Scholar 

  12. Patja K, Molsa P, Ivanainen M. Cause-specific mortality of people with intellectual disability in a population-based, 35-year follow-up study. J Intellect Disabil Res. 2001;45:30–40.

    Article  CAS  PubMed  Google Scholar 

  13. Holland AJ. Ageing and mental retardation. Br J Psych. 2000;76:26–31.

    Article  Google Scholar 

  14. Strauss D, Eyman RK. Mortality of people with mental retardation in California with and without Down syndrome, 1986–1991. Am J Ment Retard. 1996;6(100):643–53.

    Google Scholar 

  15. Wirrel EC. Epilepsy related injuries. Epilepsia. 2006;47 Suppl 1:79–86.

    Article  Google Scholar 

  16. Kwon CS, Liu M, Quan H, Wiebe S, McChesney J, Wirrell E, et al. The incidence of injuries in persons with and without epilepsy--a population-based study. Epilepsia. 2010;51:2247–53.

    Article  PubMed  Google Scholar 

  17. Beghi E. Accidents and injuries in patients with epilepsy. Expert Rev Neurother. 2009;9:291–8.

    Article  PubMed  Google Scholar 

  18. Buck D, Baker GA, Jacoby A, Smith DF, Chadwick DW. Patients’ experiences of injury as a result of epilepsy. Epilepsia. 1997;38:439–44.

    Article  CAS  PubMed  Google Scholar 

  19. Lawn ND, Bamlet WR, Radhakrishnan K, O’Brien PC, So EL. Injuries due to seizures in persons with epilepsy: a population-based study. Neurology. 2004;63:1565–70.

    Article  CAS  PubMed  Google Scholar 

  20. Beghi E, Cornaggia C. Morbidity and accidents in patients with epilepsy: results of a European cohort study. Epilepsia. 2002;43:1076–83.

    Article  PubMed  Google Scholar 

  21. Sherrard J, Tonge BJ, Ozanne-Smith J. Injury risk in young people with intellectual disability. J Intellect Disabil Res. 2002;46:6–10.

    Article  CAS  PubMed  Google Scholar 

  22. Nakken KO, Lossius R. Seizure related injuries in multihandicapped patients with therapy resistant epilepsy. Epilepsia. 1993;34:836–40.

    Article  CAS  PubMed  Google Scholar 

  23. Prasad V, Kendrick D, Sayal K. Injury among children and young adults with epilepsy. Pediatrics. 2014;133:827–35.

    Article  PubMed  Google Scholar 

  24. Hampton KK, Peatfield RC, Pullar T, Bodansky HJ, Walton C, Feely M. Burns because of epilepsy. BMJ. 1998;296:1659–60.

    Article  Google Scholar 

  25. Josty JC, Narayanan V, Dickson WA. Burns in patients with epilepsy: changes in epidemiology and implications for burn treatment and prevention. Epilepsia. 2000;41:453–6.

    Article  CAS  PubMed  Google Scholar 

  26. Spitz MC, Towbin JA, Shantz D, Adler LE. Risk factors for burns as a consequence of seizures in persons with epilepsy. Epilepsia. 1994;35:764–7.

    Article  CAS  PubMed  Google Scholar 

  27. Sherrard J, Tonge BJ, Ozanne-Smith J. Injury in young people with intellectual disability: descriptive epidemiology. Inj Prev. 2001;7:56–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Backstein R, Peters W, Neligan P. Burns in the disabled. Burns. 1993;19:192–7.

    Article  CAS  PubMed  Google Scholar 

  29. Cerovac S, Roberts AH. Burns sustained by hot bath and shower water. Burns. 2000;26:251–9.

    Article  CAS  PubMed  Google Scholar 

  30. Unglaub F, Woodruff S, Demir E, Pallua N. Patients with epilepsy: a high-risk population prone to severe burns as a consequence of seizures while showering. J Burn Care Rehabil. 2005;26:526–8.

    Article  PubMed  Google Scholar 

  31. Ryan CA, Dowling G. Drowning deaths in people with epilepsy. CMAJ. 1993;148:781–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Bell GS, Gaitatzis A, Bell CL. Drowning in people with epilepsy: how great is the risk? Neurology. 2008;71:578–82.

    Article  CAS  PubMed  Google Scholar 

  33. Diekema DS, Quan L, Holt VL. Epilepsy as a risk factor for submersion injury in children. Pediatrics. 1993;91:612–6.

    CAS  PubMed  Google Scholar 

  34. Kemp AM, Sibert JR. Epilepsy in children and the risk of drowning. Arch Dis Child. 1993;69:684–5.

    Article  Google Scholar 

  35. Day SM, Wu YW, Strauss DJ, Shavelle RM, Reynolds RJ. Causes of death in remote symptomatic epilepsy. Neurology. 2005;65:216–22.

    Article  CAS  PubMed  Google Scholar 

  36. Stokes T, Shaw EJ, Juarez-Garcia A. Clinical guidelines and evidence review for the epilepsies: diagnosis and management in adults and children in primary and secondary care. London: Royal College of General Practitioners; 2004.

    Google Scholar 

  37. Kemp AM, Sibert JR. Epilepsy in children and the risk of drowning. Arch Dis Child. 1993;68:684–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Besag FMC. Tonic seizures are a particular risk factor for drowning in people with epilepsy. BMJ. 2001;322:975–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Souverein PC, Webb DJ, Petri H, Weil J, Van Staa TP, Egberts T. Incidence of fractures among epilepsy patients: a population-based retrospective cohort study in the general practice research database. Epilepsia. 2005;46:304–10.

    Article  PubMed  Google Scholar 

  40. Lee RH, Lyles KW, Colón-Emeric C. A review of the effect of anticonvulsant medications on bone mineral density and fracture risk. Am J Geriatr Pharmacother. 2010;8:34–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Souverein PC, Webb DJ, Weil JG, Van Staa TP, Egberts AC. Use of antiepileptic drugs and risk of fractures: case–control study among patients with epilepsy. Neurology. 2006;66:1318–24.

    Article  CAS  PubMed  Google Scholar 

  42. Jancar J, Jancar MP. Age-related fractures in people with intellectual disability and epilepsy. J Intellect Disabil Res. 1998;42:429–33.

    Article  PubMed  Google Scholar 

  43. Lohiya GS, Crinella FM, Tan-Figueroa L, Caires S, Lohiya S. Fracture epidemiology and control in a developmental center. West J Med. 1999;170:203–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Ryder KM, Williams J, Womack C, Nayak NG, Nasef S, Bush A, et al. Appendicular fractures: a significant problem among institutionalized adults with developmental disabilities. Am J Ment Retard. 2003;108:340–6.

    Article  CAS  PubMed  Google Scholar 

  45. Bischof F, Basu D, Pettifor JM. Pathological long-bone fractures in residents with cerebral palsy in a long-term care facility in South Africa. Dev Med Child Neurol. 2002;44:119–22.

    Article  CAS  PubMed  Google Scholar 

  46. Kinjo M, Setoguchi S, Schneeweiss S, Solomon DH. Bone mineral density in subjects using central nervous system-active medications. Am J Med. 2005;118:1414.

    Article  PubMed  Google Scholar 

  47. Pack A. Bone health in people with epilepsy: is it impaired and what are the risk factors? Seizure. 2008;17:181–6.

    Article  PubMed  Google Scholar 

  48. Tolman KG, Jubiz W, Sannella JJ, Madsen JA, Belsey RE, Goldsmith RS, et al. Osteomalacia associated with anticonvulsant drug therapy in mentally retarded children. Pediatrics. 1975;56:45–50.

    CAS  PubMed  Google Scholar 

  49. Shiek Ahmad B, Hill KD, O’Brien TJ, Gorelik A, Habib N, Wark JD. Falls and fractures in patients chronically treated with antiepileptic drugs. Neurology. 2012;79:145–51.

    Article  PubMed  Google Scholar 

  50. Ali II, Schuh L, Barley GL, Gates JR. Antiepileptic drugs and reduced bone mineral density. Epilepsy Behav. 2004;5:296–300.

    Article  PubMed  Google Scholar 

  51. Winnacker JL, Yeager H, Saunders JA, Russell B, Anast CS. Rickets in children receiving anticonvulsant drugs: biochemical and hormonal markers. Am J Dis Child. 1977;131:286–90.

    Article  CAS  PubMed  Google Scholar 

  52. Schmidt EV, Byars JR, Flamuth DH, Schott JJ, Sever CM. Prevalence of low bone–mineral density among mentally retarded and developmentally disabled residents in intermediate care. Consult Pharm. 2004;19:45–51.

    Article  PubMed  Google Scholar 

  53. Lohiya GS, Tan-Figueroa L, Iannucci A. Identification of low bone mass in a developmental center: finger bone mineral density measurement in 562 residents. J Am Med Dir Assoc. 2004;5:371–6.

    Article  PubMed  Google Scholar 

  54. Persson HB, Alberts KA, Farahmand BY, Tomson T. Risk of extremity fractures in adult outpatients with epilepsy. Epilepsia. 2002;43:768–72.

    Article  PubMed  Google Scholar 

  55. Neufeld MY, Vishne T, Chistik V, Korczyn AD. Life-long history of injuries related to seizures. Epilepsy Res. 1999;34:123–7.

    Article  CAS  PubMed  Google Scholar 

  56. Shepherd C, Hosking G. Epilepsy in school children with intellectual impairments in Sheffield: the size and nature of the problem and the implications for service provision. J Ment Defic Res. 1989;33:511–4.

    PubMed  Google Scholar 

  57. Mariani E, Ferini-Strambi L, Sala M, Erminio C, Smirne S. Epilepsy in institutionalized patients with encephalopathy: clinical aspects and nosological considerations. Am J Ment Retard. 1993;98(Supp l):27–33.

    PubMed  Google Scholar 

  58. Petty SJ, O’Brien TJ, Wark JD. Anti-epileptic medication and bone health. Osteoporos Int. 2007;18:129–42.

    Article  CAS  PubMed  Google Scholar 

  59. Lawn ND, Bamlet WR, Radhakrishnan K, O’Brien PC, So EL. Injuries due to seizures in persons with epilepsy: a population-based study. Neurology. 2004;63:1565–70.

    Article  CAS  PubMed  Google Scholar 

  60. Nei M, Bagla R. Seizure-related injury and death. Curr Neurol Neurosci Rep. 2007;7:335–41.

    Article  PubMed  Google Scholar 

  61. Russell-Jones DL, Shorvon SD. The frequency and consequences of head injury in epileptic seizures. J Neurol Neurosurg Psychiat. 1989;52:659–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Ficker D. Sudden unexplained death and injury in epilepsy. Epilepsia. 2000;41 Suppl 2:S7–12.

    Article  PubMed  Google Scholar 

  63. Derby LE, Tennis P, Jick H. Sudden unexplained death among subjects with refractory epilepsy. Epilepsia. 1996;37:931–5.

    Article  CAS  PubMed  Google Scholar 

  64. Opeskin K, Berkovic SF. Risk factors for sudden unexpected death in epilepsy: a controlled prospective study based on coroners cases. Seizure. 2003;12:456–64.

    Article  PubMed  Google Scholar 

  65. Kiani R, Tyrer F, Jesu A, Bhaumik S, Gangavati S, Walker G, et al. Mortality from sudden unexpected death in epilepsy (SUDEP) in a cohort of adults with intellectual disability. J Intellect Disabil Res. 2014;58:508–20.

    Article  CAS  PubMed  Google Scholar 

  66. McKee JR, Bodfish JW. Sudden unexpected death in epilepsy in adults with mental retardation. Am J Ment Retard. 2000;105:229–35.

    Article  CAS  PubMed  Google Scholar 

  67. Shankar R, Jalihal V, Walker M, Laugharne R, McLean B, Carlyon E, et al. A community study in Cornwall UK of sudden unexpected death in epilepsy (SUDEP) in a 9-year population sample. Seizure. 2014;23:382–5.

    Article  PubMed  Google Scholar 

  68. Young C, Shankar R, Palmer J, Craig J, Hargreaves C, McLean B, et al. Does intellectual disability increase sudden unexpected death in epilepsy (SUDEP) risk? Seizure. 2015;25:112–6.

    Article  PubMed  Google Scholar 

  69. Walsh KK, Kastner T, Criscione T. Characteristics of hospitalizations for people with developmental disabilities: utilization, costs and impact of care coordination. Am J Ment Retard. 1997;101:505–20.

    CAS  PubMed  Google Scholar 

  70. Glover G, Evison F. Hospital admissions that should not happen. Admissions for ambulatory care sensitive conditions for people with learning disability in England. Improving health and lives: Learning Disabilities Observatory; 2013.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing

About this chapter

Cite this chapter

Morgan, C.L., Lau, J., Prasher, M. (2016). Associated Physical Problems of Epilepsy in Intellectual Disabilities. In: Prasher, V., Kerr, M. (eds) Epilepsy and Intellectual Disabilities. Springer, Cham. https://doi.org/10.1007/978-3-319-39144-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-39144-1_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-39142-7

  • Online ISBN: 978-3-319-39144-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics