Abstract：
BACKGROUND: 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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：患有智力障碍（PwID）的人患癫痫的可能性是普通人群的20倍。为PwID开出抗癫痫药物（ASM）的指导是由排除它们的试验驱动的。左乙拉西坦（LEV）是英国的一线ASM。存在对LEV行为和心理不良影响的担忧，特别是在PwID。没有高质量的证据比较PwID的有效性和不良反应，规定的LEV。
方法：分析了在18个英国NHS信托基金中使用LEV（2000-2020）的患者的汇总案例数据。人口统计,起始和最大剂量，不利影响，失学和癫痫发作频率介于ID(轻度vs.中等深度（M/P））和一般人群进行了12个月的比较。描述性分析,Mann-Whitney,采用Fisher精确和逻辑回归方法。
结果：将173个PwID（轻度53M/P120）与200个无ID进行比较。所有组的平均开始剂量和最大剂量相似。PwID（轻度和M/P）不太可能退出治疗（P=0.036）。ID和非ID或ID组(轻度vsM/P)的LEV疗效无差异,即癫痫发作减少>50%。ID严重程度与精神病不良反应之间存在显着相关性（P=0.035）。在M/PPwID中报告了更多的易怒（14.2％）和攻击性（10.8％）。
结论：PwID和癫痫有较高的过早死亡率，合并症,治疗耐药性和多重用药，但对于ASM的使用研究仍然很少。与一般人群对照相比，这是在LEV上进行的最大的PwID研究队列。调查结果支持将PwID的LEV规定为一线ASM。
方法：分析了在18个英国NHS信托基金中使用LEV（2000-2020）的患者的汇总案例数据。人口统计,起始和最大剂量，不利影响，失学和癫痫发作频率介于ID(轻度vs.中等深度（M/P））和一般人群进行了12个月的比较。描述性分析,Mann-Whitney,采用Fisher精确和逻辑回归方法。
结果：将173个PwID（轻度53M/P120）与200个无ID进行比较。所有组的平均开始剂量和最大剂量相似。PwID（轻度和M/P）不太可能退出治疗（P=0.036）。ID和非ID或ID组(轻度vsM/P)的LEV疗效无差异,即癫痫发作减少>50%。ID严重程度与精神病不良反应之间存在显着相关性（P=0.035）。在M/PPwID中报告了更多的易怒（14.2％）和攻击性（10.8％）。
结论：PwID和癫痫有较高的过早死亡率，合并症,治疗耐药性和多重用药，但对于ASM的使用研究仍然很少。与一般人群对照相比，这是在LEV上进行的最大的PwID研究队列。调查结果支持将PwID的LEV规定为一线ASM。
