Conclusions

The quality of life in this population benefits from early diagnosis and differential diagnosis of epilepsy, including epilepsy-related behavioural disorder in patients with mental retardation, identification of its aetiology, and appropriate antiepileptic drug treatment using firstly one drug therapy and, if needed later, rational multiple drug therapy. Currently, valproate is the first choice in generalized seizures while oxcarbazepine or carbamazepine are used for partial seizures with or without secondary generalization. Broad-spectrum new drugs such as lamotrigine, topiramate, or zonisamide are promising. The usefulness of epilepsy surgery should be considered in intractable cases no later than within 2 years, if adequate antiepileptic drug therapy does not help. To minimize sedative and other behavioural and other side-effects caused by antiepileptic drugs the fewest possible drugs should be administered at the lowest effective dose. This means that there should be careful clinical observation of the patients together with determination of drug concentrations in blood. Psychological aspects need to be taken into consideration in the treatment of epilepsy in patients with mental retardation. Doctors and other personnel working in this field need special education.

Future prospects in the treatment of intractable epileptic seizures might involve the development of gene therapy, neuroprotective drugs, and drugs targeting epileptogenesis. Such treatment possibilities may bring new hope for people with epilepsies that are difficult to treat, including the population with a high proportion of refractory cases, namely that with mental retardation.

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