Abstracts

Pediatric epilepsy patients with intellectual and developmental disabilities (IDD) are challenging both in terms of epilepsy treatment and behavioral comorbidity. Behavioral and psychiatric characteristics in this population are also difficult to isolate given the potential masking of psychiatric symptoms by intrinsic characteristics of IDD. IDD patients have been perceived to have limited ability to swallow pills and thus have restricted treatment options. Our goal was to characterize behavioral problems in a study population with epilepsy and moderate-severe IDD and to assess behavioral outcomes through the clinical trial., Pediatric epilepsy patients with IDD were recruited to participate in a clinical trial involving transition from Depakote[reg] sprinkle medication to extended release tablets. A clinical evaluation, CBCL, and adaptive behavior rating scales were completed initially and at the conclusion of the eight week trial. Patients underwent a protocol to instruct them on swallowing pills. Parents completed CBCLs and category scores were deemed clinically significant for t scores of 65 or greater., Ten patients with pediatric epilepsy and IDD were recruited (average age 11.1; 6 male) for the dosage conversion study. Adaptive functioning scales and/or documented IQ levels revealed all participants to be well within the moderately mentally retarded range (IQ approx. 40-60). Two patients were nonverbal, but could accomplish many activities of daily living with assistance. At the initial visit, 8/10 subjects had at least one CBCL narrow band category score in the clinically significant range. Seven subjects had completed behavioral measures and one subject had dropped out at the time of this analysis. Of the seven completers, five had at least one category score that improved, and three had at least one category score that worsened. Three patients had improvement in thought problems, two had improved attention, and none of the sample worsened in these two categories. Two patients had worse scores in somatic concerns., We did not expect significant behavior change in this study that focused upon medication dosage form conversion; however, some specific aspects of behavior improved with the transition to once daily Depakote[reg] extended release tablets. Thought processing and attention were improved in some subjects and did not worsen for any subject. Somatic concerns increased in two subjects and may be related to preoccupation with pill swallowing. It is notable that in this severely impaired population, once daily medication was successfully used and may have benefits for behavior function in addition to facilitating easier adherence to treatment., (Supported by Abbott Laboratories, Inc. provided unrestricted research support.)