Introduction

The frequent coexistence of intellectual disabilities (ID) and epilepsy can pose special challenges to those with the conditions and those delivering care. The considerable crossovers between the two conditions compound these challenges. The first, ID, is essentially a broad term encompassing constructs of intelligence, adaptive functioning, and developmental impact. As such, it can be seen to have biological and social components necessitating an often complex delivery of care spanning education, employment, and health. Epilepsy has similar issues: it is an essentially organic condition influenced by the environment and greatly impacts physical and psychological health. It also contributes to poor social outcomes, and again optimal care requires multiprofessional involvement.

This situation may well be reflected in the strong evidence for the inequality in health care experienced by people with ID. This combination of inequality of health care access and health promotion uptake, along with increased hospitalization and mortality rates, is mirrored, and often exceeded, in those people with ID who also have epilepsy.

The focus of epilepsy management is therefore to address those issues leading to this inequality in health care experience. In this introduction I will use a clinical scenario to show how these issues are linked. This scenario is reflected in the case of John, whom I describe below, and whom you know either as professional, caregiver, friend, or relative and for whom you want to apply or access an individualized care package that includes his wishes and that reduces his epilepsy-related morbidity.