title: A systematic review of neuropsychiatric comorbidities in patients with both epilepsy and intellectual disability.
abstract: Epilepsy is a neurological condition that is particularly common in people with intellectual disability (ID). The care for people with both epilepsy and ID is often complicated by the presence of neuropsychiatric disorders, defined as psychiatric symptoms, psychiatric disorders, and behavioral problems. The aim of this study was to investigate associations between epilepsy or epilepsy-related factors and neuropsychiatric comorbidities in patients with ID and between ID and neuropsychiatric comorbidities in patients with epilepsy. We performed a systematic review of the literature, published between January 1995 and January 2015 and retrieved from PubMed/Medline, PsycINFO, and ERIC and assessed the risk of bias using the SIGN-50 methodology. Forty-two studies were identified, fifteen of which were assessed as having a low or acceptable risk-of-bias evaluation. Neuropsychiatric comorbidities were examined in relation to epilepsy in nine studies; in relation to epilepsy-related factors, such as seizure activity, seizure type, and medication in four studies; and in relation to the presence and degree of ID in five studies. We conclude that the presence of epilepsy only was not a clear determinant of neuropsychiatric comorbidity in patients with ID, although a tendency towards negative mood symptoms was identified. Epilepsy-related factors indicating a more severe form of epilepsy were associated with neuropsychiatric comorbidity as was the presence of ID as compared to those without ID in patients with epilepsy, although this should be validated in future research. A large proportion of the studies in this area is associated with a substantial risk of bias. There is a need for high quality studies using standardized methods to enable clear conclusions to be drawn that might assist in improving the quality of care for this population.
authors.affiliation: Department of Residential Care, Kempenhaeghe Epilepsy Center, P.O. Box 61, 5590AB Heeze, The Netherlands. Electronic address: OolJ@kempenhaeghe.nl.
authors.forename: Jans S
authors.initials: JS
authors.lastname: van Ool
authors.affiliation: Department of Residential Care, Kempenhaeghe Epilepsy Center, P.O. Box 61, 5590AB Heeze, The Netherlands.
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Snoeijen-Schouwenaars
authors.affiliation: Department of Neurology, Academic Center for Epileptology Kempenhaeghe, P.O. Box 61, 5590AB Heeze, The Netherlands.
authors.forename: Helenius J
authors.initials: HJ
authors.lastname: Schelhaas
authors.affiliation: Department of Residential Care, Kempenhaeghe Epilepsy Center, P.O. Box 61, 5590AB Heeze, The Netherlands.
authors.forename: In Y
authors.initials: IY
authors.lastname: Tan
authors.affiliation: Department of Behavioral Sciences, Kempenhaeghe Epilepsy Center, P.O. Box 61, 5590AB Heeze, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200MD Maastricht, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202AZ Maastricht, The Netherlands; Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium; Department of Electrical Engineering, University of Technology, P.O. Box 513, Eindhoven, The Netherlands.
authors.forename: Albert P
authors.initials: AP
authors.lastname: Aldenkamp
authors.affiliation: Department of Behavioral Sciences, Kempenhaeghe Epilepsy Center, P.O. Box 61, 5590AB Heeze, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202AZ Maastricht, The Netherlands; Department of Neurological Learning Disabilities, Kempenhaeghe Epilepsy Center, P.O. Box 61, 5590AB Heeze, The Netherlands. Electronic address: hendriksenj@kempenhaeghe.nl.
authors.forename: Jos G M
authors.initials: JGM
authors.lastname: Hendriksen
mesh_terms: D000328:Adult; D015897:Comorbidity; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D008297:Male; D036301:Qualitative Research; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology
keywords: Behavioral problems; Comorbidity; Epilepsy; Intellectual disability; Psychiatric disorders