Management of Acute Seizures in Persons with Intellectual Disabilities

The acute management of seizures in people with intellectual disabilities (ID) comprises at least seven different situations: the first seizure, subsequent seizures/seizure exacerbations in established epilepsy, loss of skills related to frequent daytime seizures, nonconvulsive status epilepticus, loss of skills related to nocturnal seizures, electrical status epilepticus of slow wave sleep, and treatment of (convulsive) status epilepticus. These situations will be discussed in turn. Because epilepsy is not only more common in people with ID but also more difficult to treat, the emergency treatment of epilepsy is of particular importance in this group. Furthermore, people with ID are sometimes prescribed other medications that may lower the seizure threshold, increasing the risk of seizures and the need for training in their acute management. Loss of skills as a result of the epilepsy is a serious matter in any patient group but can be avoided or prevented in many cases. In people with limited intellectual ability, additional loss of skills can be of major importance, emphasizing the need for a good understanding of the principles of effective epilepsy management.