Abstract
Managing epilepsy in people with an intellectual disability remains a therapeutic challenge and must take into account additional issues such as diagnostic difficulties and frequent drug resistance. Advances in genomic technologies improved our understanding of epilepsy and raised the possibility to develop patients-tailored treatments acting on the key molecular mechanisms involved in the development of the disease. In addition to conventional antiseizure medications (ASMs), ketogenic diet, hormone therapy and epilepsy surgery play an important role, especially in cases of drugresistance. This review aims to provide a comprehensive overview of the mainfactors influencing cognition in children and adolescents with epilepsy and the main therapeutic options available for the epilepsies associated with intellectual disability.
Keywords: Epilepsy, cognitive impairment, intellectual disability, anti-seizure medication, ketogenic diet, ganaxolone, gene therapy.
[http://dx.doi.org/10.1124/pr.120.019539] [PMID: 32540959]
[http://dx.doi.org/10.1016/j.seizure.2015.03.016] [PMID: 26076844]
[http://dx.doi.org/10.1111/j.1528-1167.2011.03092.x] [PMID: 21569019]
[http://dx.doi.org/10.1016/j.yebeh.2003.11.008] [PMID: 14725848]
[http://dx.doi.org/10.1038/nrneurol.2016.98] [PMID: 27448186]
[http://dx.doi.org/10.1016/j.nbd.2013.11.012] [PMID: 24269731]
[http://dx.doi.org/10.5698/1535-7511-16.4.273] [PMID: 27582673]
[http://dx.doi.org/10.1684/epd.2015.0739] [PMID: 25905906]
[http://dx.doi.org/10.1016/j.neucli.2011.11.004] [PMID: 22200342]
[http://dx.doi.org/10.1212/WNL.0b013e318297ee50] [PMID: 23685931]
[http://dx.doi.org/10.1016/0920-1211(87)90031-3] [PMID: 3504400]
[http://dx.doi.org/10.1111/j.1528-1167.2007.01461.x] [PMID: 18070088]
[http://dx.doi.org/10.1080/13803395.2015.1024103] [PMID: 25921696]
[http://dx.doi.org/10.1017/S0012162201241048] [PMID: 11508929]
[http://dx.doi.org/10.1111/epi.13125] [PMID: 26337046]
[http://dx.doi.org/10.1016/j.yebeh.2019.05.046] [PMID: 31252277]
[http://dx.doi.org/10.1016/j.yebeh.2016.05.013] [PMID: 27442497]
[http://dx.doi.org/10.1111/epi.12938] [PMID: 25705968]
[http://dx.doi.org/10.1016/j.yebeh.2016.12.011] [PMID: 28088680]
[http://dx.doi.org/10.1542/peds.112.6.1338] [PMID: 14654607]
[http://dx.doi.org/10.1097/WCO.0000000000000304] [PMID: 26886357]
[http://dx.doi.org/10.1007/s00401-015-1481-5] [PMID: 26423537]
[http://dx.doi.org/10.1016/S1474-4422(14)70110-3] [PMID: 24943345]
[http://dx.doi.org/10.1111/j.1528-1167.2010.02906.x]
[http://dx.doi.org/10.2147/NDT.S142032] [PMID: 28761347]
[http://dx.doi.org/10.3389/fped.2021.526779] [PMID: 33681094]
[http://dx.doi.org/10.1016/j.nbd.2015.08.003]
[http://dx.doi.org/10.1016/j.seizure.2016.11.030] [PMID: 28007376]
[http://dx.doi.org/10.1111/ane.13006] [PMID: 30109707]
[http://dx.doi.org/10.1002/brb3.2219] [PMID: 34292674]
[http://dx.doi.org/10.1016/j.ejmg.2021.104250] [PMID: 34022416]
[http://dx.doi.org/10.11817/j.issn.1672-7347.2021.190756]
[http://dx.doi.org/10.1055/s-0041-1722878] [PMID: 33578439]
[http://dx.doi.org/10.1684/epd.2020.1204] [PMID: 33063670]
[http://dx.doi.org/10.1016/j.ejmg.2020.104083] [PMID: 33039685]
[http://dx.doi.org/10.1016/j.ejpn.2019.12.016] [PMID: 31924505]
[http://dx.doi.org/10.1002/mgg3.1289] [PMID: 32415730]
[http://dx.doi.org/10.1016/j.yebeh.2020.107097] [PMID: 32402703]
[http://dx.doi.org/10.1016/j.ejpn.2019.12.007] [PMID: 31918992]
[http://dx.doi.org/10.1016/j.braindev.2019.08.001] [PMID: 31477274]
[http://dx.doi.org/10.1016/j.braindev.2019.09.004] [PMID: 31677917]
[http://dx.doi.org/10.1016/j.yebeh.2019.106539]
[http://dx.doi.org/10.1002/ajmg.a.61328] [PMID: 31432588]
[http://dx.doi.org/10.1212/WNL.0000000000002457] [PMID: 26865513]
[http://dx.doi.org/10.3390/cells8070669] [PMID: 31269740]
[http://dx.doi.org/10.1016/j.pediatrneurol.2019.03.017] [PMID: 31147226]
[http://dx.doi.org/10.1002/ajmg.a.61206] [PMID: 31136090]
[http://dx.doi.org/10.1002/mgg3.739] [PMID: 31087544]
[http://dx.doi.org/10.1002/ajmg.a.61127] [PMID: 30903679]
[http://dx.doi.org/10.1136/jmedgenet-2017-104946] [PMID: 29097605]
[http://dx.doi.org/10.1002/ajmg.b.32677] [PMID: 30345598]
[http://dx.doi.org/10.1111/epi.13109] [PMID: 26293783]
[http://dx.doi.org/10.1111/epi.13107] [PMID: 26293588]
[http://dx.doi.org/10.1016/j.eplepsyres.2014.11.012] [PMID: 25524855]
[http://dx.doi.org/10.1016/j.yebeh.2016.04.006] [PMID: 27240307]
[http://dx.doi.org/10.1016/j.spen.2016.05.001] [PMID: 27544468]
[http://dx.doi.org/10.4103/0976-9668.210016] [PMID: 28781476]
[http://dx.doi.org/10.1111/epi.12350] [PMID: 24032627]
[http://dx.doi.org/10.1016/j.yebeh.2015.06.005] [PMID: 26159729]
[http://dx.doi.org/10.1371/journal.pone.0039078] [PMID: 22808026]
[http://dx.doi.org/10.1016/S1474-4422(03)00584-2] [PMID: 14636777]
[http://dx.doi.org/10.1111/epi.13108] [PMID: 26293670]
[http://dx.doi.org/10.3906/sag-2010-27] [PMID: 33600098]
[http://dx.doi.org/10.1080/14728214.2018.1527903] [PMID: 30251907]
[http://dx.doi.org/10.1016/j.ncl.2010.03.026] [PMID: 20816265]
[http://dx.doi.org/10.1016/j.yebeh.2005.07.006] [PMID: 16140593]
[http://dx.doi.org/10.1016/j.yebeh.2019.106648] [PMID: 31715510]
[http://dx.doi.org/10.1016/j.ejpn.2021.04.004] [PMID: 33895643]
[http://dx.doi.org/10.1016/S1059-1311(00)90474-6] [PMID: 11407953]
[http://dx.doi.org/10.1592/phco.31.3.298] [PMID: 21361740]
[http://dx.doi.org/10.1080/14656566.2020.1732351] [PMID: 32077772]
[http://dx.doi.org/10.1017/cjn.2016.249] [PMID: 27264138]
[http://dx.doi.org/10.1177/1756285611417920] [PMID: 22164192]
[http://dx.doi.org/10.1016/j.yebeh.2019.106879]
[http://dx.doi.org/10.3389/fneur.2021.696946] [PMID: 34305800]
[http://dx.doi.org/10.1055/s-2008-1079336] [PMID: 18777478]
[http://dx.doi.org/10.1016/j.yebeh.2021.108069]
[http://dx.doi.org/10.1016/j.yebeh.2020.107445] [PMID: 32920379]
[http://dx.doi.org/10.1212/01.wnl.0000247045.85646.c0] [PMID: 17159095]
[http://dx.doi.org/10.1016/bs.podrm.2018.11.005] [PMID: 31029222]
[http://dx.doi.org/10.1186/s12889-016-3309-1] [PMID: 27460572]
[http://dx.doi.org/10.1097/WCO.0000000000000902] [PMID: 33395108]
[http://dx.doi.org/10.1111/epi.14596] [PMID: 30426482]
[http://dx.doi.org/10.1056/NEJM200002033420503] [PMID: 10660394]
[http://dx.doi.org/10.1111/epi.16386] [PMID: 31904117]
[http://dx.doi.org/10.1002/acn3.39] [PMID: 24839611]
[http://dx.doi.org/10.1055/s-0039-3401028] [PMID: 32765929]
[http://dx.doi.org/10.1002/ana.24128] [PMID: 24591078]
[http://dx.doi.org/10.1002/ana.24520] [PMID: 26369628]
[http://dx.doi.org/10.1212/WNL.0000000000004762] [PMID: 29196579]
[http://dx.doi.org/10.1136/jmedgenet-2015-103508] [PMID: 26740507]
[http://dx.doi.org/10.1111/epi.16314] [PMID: 31418850]
[http://dx.doi.org/10.1111/j.1528-1167.2011.03365.x] [PMID: 22220513]
[http://dx.doi.org/10.1212/NXG.0000000000000096] [PMID: 27602407]
[http://dx.doi.org/10.1111/epi.14935] [PMID: 31904126]
[http://dx.doi.org/10.1007/s13311-015-0372-8] [PMID: 26252990]
[http://dx.doi.org/10.1093/braincomms/fcab222]
[http://dx.doi.org/10.1111/j.1528-1167.2008.01833.x] [PMID: 19049586]
[http://dx.doi.org/10.1016/j.ejpn.2019.12.008] [PMID: 31882278]
[http://dx.doi.org/10.1111/jnc.15168] [PMID: 32880951]
[http://dx.doi.org/10.1038/s41573-019-0017-4] [PMID: 30846871]
[http://dx.doi.org/10.1038/nrneurol.2017.148] [PMID: 29192260]
[http://dx.doi.org/10.1186/s11689-018-9234-0] [PMID: 29776328]
[http://dx.doi.org/10.1186/s13041-020-00679-1] [PMID: 33054827]
[http://dx.doi.org/10.3389/fnins.2021.632522] [PMID: 33679313]
[http://dx.doi.org/10.1038/mt.2012.200] [PMID: 23011033]
[http://dx.doi.org/10.1523/JNEUROSCI.1854-13.2013] [PMID: 23966684]
[http://dx.doi.org/10.1016/j.nbd.2016.12.009] [PMID: 27974239]
[http://dx.doi.org/10.1016/j.omtm.2017.04.006] [PMID: 28497072]
[http://dx.doi.org/10.7554/eLife.52629] [PMID: 32207685]
[http://dx.doi.org/10.1016/j.nbd.2020.105235] [PMID: 33383186]
[http://dx.doi.org/10.1038/npp.2014.167] [PMID: 24998620]
[http://dx.doi.org/10.1038/gt.2009.83] [PMID: 19571888]
[http://dx.doi.org/10.3389/fnmol.2018.00282] [PMID: 30158855]
[http://dx.doi.org/10.1016/j.celrep.2015.08.084] [PMID: 26440889]
[http://dx.doi.org/10.1371/journal.pone.0165499] [PMID: 27768763]
[http://dx.doi.org/10.1038/s41586-020-2835-2] [PMID: 33087932]
[http://dx.doi.org/10.1093/hmg/dds130] [PMID: 22493002]
[http://dx.doi.org/10.1016/j.nbd.2015.04.018] [PMID: 26019056]
[http://dx.doi.org/10.1016/j.omtm.2019.08.003] [PMID: 31534984]
[http://dx.doi.org/10.1016/j.yebeh.2021.108043] [PMID: 34053869]
[http://dx.doi.org/10.1007/s13311-021-01095-6] [PMID: 34378168]
[http://dx.doi.org/10.1016/j.ajhg.2018.10.023] [PMID: 30526861]
[http://dx.doi.org/10.1016/j.nbd.2014.01.006] [PMID: 24434335]
[http://dx.doi.org/10.1016/j.ymthe.2019.08.018] [PMID: 31607539]
[http://dx.doi.org/10.1016/j.nbd.2020.104954] [PMID: 32445790]
[http://dx.doi.org/10.1016/j.seizure.2015.02.012] [PMID: 25765693]
[http://dx.doi.org/10.1001/archneur.1966.00470170075008] [PMID: 4380963]
[http://dx.doi.org/10.1007/s10072-014-1795-4] [PMID: 24748480]
[http://dx.doi.org/10.1111/j.1600-0404.1984.tb07807.x] [PMID: 6430018]
[http://dx.doi.org/10.1002/ana.10732] [PMID: 14595652]
[http://dx.doi.org/10.1038/nrn1703] [PMID: 15959466]
[http://dx.doi.org/10.1016/S0920-1211(00)00170-4] [PMID: 11074186]
[http://dx.doi.org/10.1111/epi.14555] [PMID: 30368788]
[http://dx.doi.org/10.1016/S0022-3476(80)80706-2] [PMID: 6244378]
[http://dx.doi.org/10.1016/S0887-8994(02)00513-1] [PMID: 12770672]
[http://dx.doi.org/10.1016/j.ejpn.2007.09.003] [PMID: 17951084]
[http://dx.doi.org/10.1016/S0887-8994(99)00127-7] [PMID: 10738922]
[http://dx.doi.org/10.1007/s40263-014-0139-5] [PMID: 24504827]
[http://dx.doi.org/10.1016/S0074-7742(02)49013-7] [PMID: 12040892]
[http://dx.doi.org/10.1016/j.braindev.2005.02.010] [PMID: 15925463]
[http://dx.doi.org/10.1016/S0387-7604(99)00053-4] [PMID: 10522523]
[http://dx.doi.org/10.1016/j.jpeds.2005.11.041] [PMID: 16647410]
[http://dx.doi.org/10.1136/adc.2004.051375] [PMID: 15781928]
[http://dx.doi.org/10.1111/j.1528-1167.2008.01821.x] [PMID: 19049574]
[http://dx.doi.org/10.1111/j.1528-1167.2008.01838.x] [PMID: 19049591]
[http://dx.doi.org/10.1016/j.neuropharm.2011.12.015] [PMID: 22210332]
[http://dx.doi.org/10.1016/j.nbd.2010.07.017] [PMID: 20691264]
[http://dx.doi.org/10.1016/j.bj.2021.11.003]
[http://dx.doi.org/10.1016/j.seizure.2017.09.005] [PMID: 28941398]
[http://dx.doi.org/10.1007/s12519-017-0053-2] [PMID: 28702868]
[http://dx.doi.org/10.1002/epi4.12225] [PMID: 29881797]
[http://dx.doi.org/10.1016/j.yebeh.2013.09.032] [PMID: 24386671]
[http://dx.doi.org/10.1179/1476830514Y.0000000162] [PMID: 25383724]
[http://dx.doi.org/10.1212/01.wnl.0000187071.24292.9e] [PMID: 16344529]
[http://dx.doi.org/10.3389/fgene.2021.734481] [PMID: 34880899]
[http://dx.doi.org/10.1016/j.eplepsyres.2012.11.009] [PMID: 23357723]
[http://dx.doi.org/10.2174/1570159X15666171017102547] [PMID: 29046155]
[http://dx.doi.org/10.1111/ane.12830] [PMID: 28875525]
[http://dx.doi.org/10.1111/epi.16543] [PMID: 32452537]
[http://dx.doi.org/10.1016/j.yebeh.2019.01.042] [PMID: 30831398]
[http://dx.doi.org/10.3389/fneur.2017.00505] [PMID: 29085326]
[http://dx.doi.org/10.1038/nrneurol.2010.178] [PMID: 21135885]
[http://dx.doi.org/10.1002/14651858.CD005222.pub3] [PMID: 26086765]
[http://dx.doi.org/10.1177/1756285617722347] [PMID: 29399043]
[http://dx.doi.org/10.1212/WNL.0b013e318259e2cf] [PMID: 22689735]
[http://dx.doi.org/10.1016/j.pediatrneurol.2015.05.004] [PMID: 26216500]
[http://dx.doi.org/10.1007/s12098-020-03630-3] [PMID: 33575989]
[http://dx.doi.org/10.1016/j.pediatrneurol.2004.12.006] [PMID: 15866429]
[http://dx.doi.org/10.1016/j.seizure.2015.02.006] [PMID: 25891919]
[http://dx.doi.org/10.1016/S0387-7604(87)80117-1] [PMID: 3124656]
[http://dx.doi.org/10.1016/j.yebeh.2009.10.020] [PMID: 20004620]
[http://dx.doi.org/10.1016/S0887-8994(01)00402-7] [PMID: 11992758]
[http://dx.doi.org/10.1016/j.eplepsyres.2020.106325] [PMID: 32289570]
[http://dx.doi.org/10.1111/ane.13291] [PMID: 32484900]
[http://dx.doi.org/10.1177/1535759719835363] [PMID: 30955421]
[http://dx.doi.org/10.1007/s13311-016-0442-6] [PMID: 27215218]
[http://dx.doi.org/10.1016/S1474-4422(15)00401-9] [PMID: 26906964]
[http://dx.doi.org/10.1177/08830738020170010201] [PMID: 11918462]
[http://dx.doi.org/10.1016/j.seizure.2018.11.007] [PMID: 30473268]
[http://dx.doi.org/10.1016/j.nec.2018.12.005] [PMID: 30898273]
[http://dx.doi.org/10.1016/j.yebeh.2021.107931] [PMID: 33770612]
[http://dx.doi.org/10.1016/j.yebeh.2015.06.001] [PMID: 26247311]
[http://dx.doi.org/10.1001/archneur.1976.00500080037006] [PMID: 821458]
[http://dx.doi.org/10.1007/978-3-211-33081-4_38] [PMID: 17691321]
[http://dx.doi.org/10.1016/j.seizure.2016.12.014] [PMID: 28061418]
[http://dx.doi.org/10.1590/S0036-36342008000800005] [PMID: 18470340]
[http://dx.doi.org/10.1016/j.ejpn.2020.06.019] [PMID: 32718867]
[http://dx.doi.org/10.3389/fneur.2021.658823] [PMID: 33935956]
[http://dx.doi.org/10.1016/j.ejpn.2022.01.011] [PMID: 35134658]
[http://dx.doi.org/10.1016/j.yebeh.2020.107118] [PMID: 32563891]
[http://dx.doi.org/10.1016/j.braindev.2008.03.014] [PMID: 18490122]
[http://dx.doi.org/10.1016/j.ejpn.2011.03.010] [PMID: 21507691]
[http://dx.doi.org/10.1007/s10545-009-1171-3] [PMID: 19642011]
[http://dx.doi.org/10.4103/JPN.JPN_160_16] [PMID: 29899766]
[http://dx.doi.org/10.1002/jimd.12332] [PMID: 33200442]
[http://dx.doi.org/10.1111/epi.12962] [PMID: 25779625]
[http://dx.doi.org/10.1016/B978-0-444-52891-9.00073-7] [PMID: 23622218]
[http://dx.doi.org/10.1002/14651858.CD009885.pub2] [PMID: 26599576]
[http://dx.doi.org/10.1007/s40261-017-0585-1] [PMID: 29071470]
[http://dx.doi.org/10.1097/XEB.0000000000000085] [PMID: 27259002]
[http://dx.doi.org/10.1177/0883073811415853] [PMID: 21940691]
[http://dx.doi.org/10.1002/mds.24958] [PMID: 22344717]
[http://dx.doi.org/10.1111/j.1528-1167.2006.00593.x] [PMID: 16886984]
[http://dx.doi.org/10.3238/arztebl.2019.0809] [PMID: 31888794]
[http://dx.doi.org/10.1002/ana.24002] [PMID: 24038210]