Treatment of epilepsy

The main principles of the treatment of epilepsy of people with mental retardation are basically the same as generally used in the treatment of epileptic patients with normal intelligence. Firstly the diagnosis of epilepsy and its underlying disorder needs to be made without delay. The identification and avoidance of provoking factors likely to precipitate seizures in each individual is an essential aspect of the overall management. If this is insufficient, antiepileptic drug treatment is needed. If this is still insufficient, epilepsy surgery should be considered. However, in the treatment of mentally retarded people with epilepsy some special aspects need to be taken into account. Important points to be considered include not only the nature and severity of an underlying disease, but also the degree and location of brain lesion, the age of the patient at onset of epilepsy, and possible pseudo-retardation caused by epileptic seizures or by inappropriate medication. It is emphasized that treating frequent epileptiform discharges may not only reverse the retardation which in such cases is pseudoretardation or state-dependent intellectual disability, (1,Z) but may also in some cases prevent permanent mental retardation. Mentally retarded people with epilepsy are especially vulnerable to harmful neurotoxic effects—sedation caused by phenobarbital or benzodiazepines or cognitive and cerebellar dysfunction caused by phenytoin alone or often together with other antiepileptic drugs. If these alarming effects are not taken into account, inappropriate medication may even jeopardize the rehabilitation of the patients.

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