Treatment of epilepsy in the multiply handicapped

The medical management of epilepsy in the multi-handicapped patient require s careful evaluation, classification, and pharmacologic treatment. it is es timated that 20-40% of patients with mental retardation and cerebral palsy have epilepsy. This review reports the clinical trial data and personal exp erience related to the use of newer AEDs in the chronic management of epile psy syndromes in children and adults, as well as information available on t he treatment of seizures in individuals with mental retardation and associa ted handicaps. Furthermore, clusters of seizures, prolonged seizures and st atus epilepticus are more commonly seen in the multiply handicapped and men tally retarded population and require special attention. The new antiepilep tic drugs felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, vigabatrin and zonisamide show specific advantage i n some multiply handicapped patients, be it for seizure control or medicati on tolerance. Furthermore, new modalities of treatment for prolonged seizur es allow better efficacy both outside of hospital and within hospital facil ities. The treatment of epilepsy in multihandicapped and retarded adults an d children has significantly advanced in the past few years, and much of th is improvement can be attributed to improved knowledge and monitoring of ne w antiepileptic drugs. Conventional anticonvulsants remain first line thera py for most clinicians, but newer AEDs must broaden the therapeutic option and do allow improved therapy for some multiply handicapped patients. (C) 2 000 Wiley-Liss, Inc.