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. 2024 Aug:120:25-32.
doi: 10.1016/j.seizure.2024.05.010. Epub 2024 May 16.

Efficacy and tolerability of levetiracetam in people with and without intellectual disabilities: A naturalistic case control study

Jon Allard  1 , Adrian Sellers  2 , William Henley  3 , Brendan McLean  1 , Mary Parrett  4 , Sanjeev Rajakulendran  5 , Lance Watkins  6 , Melissa Maguire  7 , Shan Ellawela  8 , Phil Tittensor  9 , Juliet Bransgrove  10 , Arjune Sen  11 , Rajiv Mohanraj  12 , Many Bagary  13 , Sunil Ram  14 , Nathan Vernon  15 , Sandy Baldwin  11 , Jagdish Gill  11 , Rohit Shankar  16
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Free article

Efficacy and tolerability of levetiracetam in people with and without intellectual disabilities: A naturalistic case control study

Jon Allard et al. Seizure. 2024 Aug.
Free article

Abstract

Introduction: People with Intellectual Disabilities (PwID) are twenty times more likely than general population to have epilepsy. Guidance for prescribing antiseizure medication (ASM) to PwID is driven by trials excluding them. Levetiracetam (LEV) is a first-line ASM in the UK. Concerns exist regarding LEV's behavioural and psychological adverse effects, particularly in PwID. There is no high-quality evidence comparing effectiveness and adverse effects in PwID to those without, prescribed LEV.

Methods: Pooled casenote data for patients prescribed LEV (2000-2020) at 18 UK NHS Trusts were analysed. Demographics, starting and maximum dose, adverse effects, dropouts and seizure frequency between ID (mild vs. moderate-profound (M/P)) and general population for a 12-month period were compared. Descriptive analysis, Mann-Whitney, Fisher's exact and logistic regression methods were employed.

Results: 173 PwID (mild 53 M/P 120) were compared to 200 without ID. Mean start and maximum dose were similar across all groups. PwID (Mild & M/P) were less likely to withdraw from treatment (P = 0.036). No difference was found between ID and non-ID or between ID groups (Mild vs M/P) in LEV's efficacy i.e. >50 % seizure reduction. Significant association emerged between ID severity and psychiatric adverse effects (P = 0.035). More irritability (14.2 %) and aggression (10.8 %) were reported in M/P PwID.

Conclusion: PwID and epilepsy have high rates of premature mortality, comorbidities, treatment resistance and polypharmacy but remain poorly researched for ASM use. This is the largest studied cohort of PwID trialled on LEV compared to general population controls. Findings support prescribing of LEV for PwID as a first-line ASM.

Keywords: Antiseizure medication; Developmental disorder; Intellectual disabilities; Learning disability; Neurodevelopment; Seizures.

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Conflict of interest statement

Declaration of competing interest RS has received institutional and research support from LivaNova, UCB, Eisai, Veriton Pharma, Bial, Angelini, UnEEG and Jazz/GW pharma outside the submitted work. He holds grants from NIHR AI, SBRI and other funding bodies all outside this work. No other author has any declared conflict of interest to this paper.

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