Clinical services for adults with an intellectual disability and epilepsy: A comparison of management alternatives

Adam P. Wagner, Tim J. Croudace, Naomi Bateman, Mark W. Pennington, Elizabeth Prince, Marcus Redley, Simon R. White, Howard Ring (Lead / Corresponding author)

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Abstract

Background: Intellectual disability (ID) is relatively common in people with epilepsy, with prevalence estimated to be around 25%. Surprisingly, given this relatively high frequency, along with higher rates of refractory epilepsy than in those without ID, little is known about outcomes of different management approaches/clinical services treating epilepsy in adults with ID-we investigate this area.

Materials & Methods: We undertook a naturalistic observational cohort study measuring outcomes in n = 91 adults with ID over a 7-month period (recruited within the period March 2008 to April 2010). Participants were receiving treatment for refractory epilepsy (primarily) in one of two clinical service settings: community ID teams (CIDTs) or hospital Neurology services.

Results: The pattern of comorbidities appeared important in predicting clinical service, with Neurologists managing the epilepsy of relatively more of those with neurological comorbidities whilst CIDTs managed the epilepsy of relatively more of those with psychiatric comorbidities. Epilepsy-related outcomes, as measured by the Glasgow Epilepsy Outcome Scale 35 (GEOS-35) and the Epilepsy and Learning Disabilities Quality of Life Scale (ELDQoL) did not differ significantly between Neurology services and CIDTs.

Discussion: In the context of this study, the absence of evidence for differences in epilepsy-related outcomes amongst adults with ID and refractory epilepsy between mainstream neurology and specialist ID clinical services is considered. Determining the selection of the service managing the epilepsy of adults with an ID on the basis of the skill sets also required to treat associated comorbidities may hence be a reasonable heuristic.

Original languageEnglish
Article numbere0180266
Pages (from-to)1-12
Number of pages12
JournalPLoS ONE
Volume12
Issue number7
DOIs
Publication statusPublished - 3 Jul 2017

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epilepsy
Neurology
Intellectual Disability
Refractory materials
Epilepsy
Comorbidity
Glasgow Outcome Scale
community service
Learning Disorders
cohort studies
quality of life
Observational Studies
Psychiatry
Cohort Studies
learning
Quality of Life

Cite this

Wagner, Adam P. ; Croudace, Tim J. ; Bateman, Naomi ; Pennington, Mark W. ; Prince, Elizabeth ; Redley, Marcus ; White, Simon R. ; Ring, Howard. / Clinical services for adults with an intellectual disability and epilepsy : A comparison of management alternatives. In: PLoS ONE. 2017 ; Vol. 12, No. 7. pp. 1-12.
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abstract = "Background: Intellectual disability (ID) is relatively common in people with epilepsy, with prevalence estimated to be around 25{\%}. Surprisingly, given this relatively high frequency, along with higher rates of refractory epilepsy than in those without ID, little is known about outcomes of different management approaches/clinical services treating epilepsy in adults with ID-we investigate this area.Materials & Methods: We undertook a naturalistic observational cohort study measuring outcomes in n = 91 adults with ID over a 7-month period (recruited within the period March 2008 to April 2010). Participants were receiving treatment for refractory epilepsy (primarily) in one of two clinical service settings: community ID teams (CIDTs) or hospital Neurology services.Results: The pattern of comorbidities appeared important in predicting clinical service, with Neurologists managing the epilepsy of relatively more of those with neurological comorbidities whilst CIDTs managed the epilepsy of relatively more of those with psychiatric comorbidities. Epilepsy-related outcomes, as measured by the Glasgow Epilepsy Outcome Scale 35 (GEOS-35) and the Epilepsy and Learning Disabilities Quality of Life Scale (ELDQoL) did not differ significantly between Neurology services and CIDTs.Discussion: In the context of this study, the absence of evidence for differences in epilepsy-related outcomes amongst adults with ID and refractory epilepsy between mainstream neurology and specialist ID clinical services is considered. Determining the selection of the service managing the epilepsy of adults with an ID on the basis of the skill sets also required to treat associated comorbidities may hence be a reasonable heuristic.",
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Wagner, AP, Croudace, TJ, Bateman, N, Pennington, MW, Prince, E, Redley, M, White, SR & Ring, H 2017, 'Clinical services for adults with an intellectual disability and epilepsy: A comparison of management alternatives', PLoS ONE, vol. 12, no. 7, e0180266, pp. 1-12. https://doi.org/10.1371/journal.pone.0180266

Clinical services for adults with an intellectual disability and epilepsy : A comparison of management alternatives. / Wagner, Adam P.; Croudace, Tim J.; Bateman, Naomi; Pennington, Mark W.; Prince, Elizabeth; Redley, Marcus; White, Simon R.; Ring, Howard (Lead / Corresponding author).

In: PLoS ONE, Vol. 12, No. 7, e0180266, 03.07.2017, p. 1-12.

Research output: Contribution to journalArticle

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T2 - A comparison of management alternatives

AU - Wagner, Adam P.

AU - Croudace, Tim J.

AU - Bateman, Naomi

AU - Pennington, Mark W.

AU - Prince, Elizabeth

AU - Redley, Marcus

AU - White, Simon R.

AU - Ring, Howard

N1 - This paper presents independent research funded by the National Institute for Health Research (NIHR - www.nihr.ac.uk) under its Research for Patient Benefit (RfPB - https://www.nihr.ac.uk/funding-and-support/funding-for-research-studies/funding-programmes/research-for-patient-benefit/) Programme (Grant PB-PG-0706-10051; PI Dr H Ring). During the time that this research was carried out, AP Wagner, TJ Croudace, M Redley and H Ring also received support from the NIHR CLAHRC for Cambridgeshire and Peterborough (http://clahrc-cp.nihr.ac.uk/). In preparing this manuscript AP Wagner and H Ring received support from the NIHR Collaboration for Leadership in Applied Health Research and Care East of England at the Cambridgeshire and Peterborough NHS Foundation Trust (http://www.clahrc-eoe.nihr.ac.uk/). SR White was supported by the Medical Research Council (Unit Programme no. U105292687 - http://www.mrc.ac.uk/).

PY - 2017/7/3

Y1 - 2017/7/3

N2 - Background: Intellectual disability (ID) is relatively common in people with epilepsy, with prevalence estimated to be around 25%. Surprisingly, given this relatively high frequency, along with higher rates of refractory epilepsy than in those without ID, little is known about outcomes of different management approaches/clinical services treating epilepsy in adults with ID-we investigate this area.Materials & Methods: We undertook a naturalistic observational cohort study measuring outcomes in n = 91 adults with ID over a 7-month period (recruited within the period March 2008 to April 2010). Participants were receiving treatment for refractory epilepsy (primarily) in one of two clinical service settings: community ID teams (CIDTs) or hospital Neurology services.Results: The pattern of comorbidities appeared important in predicting clinical service, with Neurologists managing the epilepsy of relatively more of those with neurological comorbidities whilst CIDTs managed the epilepsy of relatively more of those with psychiatric comorbidities. Epilepsy-related outcomes, as measured by the Glasgow Epilepsy Outcome Scale 35 (GEOS-35) and the Epilepsy and Learning Disabilities Quality of Life Scale (ELDQoL) did not differ significantly between Neurology services and CIDTs.Discussion: In the context of this study, the absence of evidence for differences in epilepsy-related outcomes amongst adults with ID and refractory epilepsy between mainstream neurology and specialist ID clinical services is considered. Determining the selection of the service managing the epilepsy of adults with an ID on the basis of the skill sets also required to treat associated comorbidities may hence be a reasonable heuristic.

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