Treatment of behavioral problems in intellectually disabled adult patients with epilepsy *Michael Kerr, † 1 Antonio Gil-Nagel, ‡Michael Glynn, §Marco Mula, *Rose Thompson, and ¶Sameer M. Zuberi *Welsh Centre for Learning Disabilities, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom; †Neurology Department, Hospital Ruber Internacional, Madrid, Spain; ‡Epilepsy Practice, IBE, Brainwave The Irish Epilepsy Association, Dublin, Ireland; §Amedeo Avogadro University, Novara, Italy; and ¶Paediatric Neurosciences Research Group, Royal Hospital for Sick Children, Yorkhill, Glasgow, United Kingdom SUMMARY Behavioral disorders are common in people with epilepsy and intellectual disability. Although in some genetic disorders behavioral problems are part of the established phenotype, they may also be a manifestation of underlying physical or men- tal illness, or may be unrecognized seizure activity. In light of this, assessment of behavioral disorders should take into account person factors such as the physical health and mental state of the person and environmental factors such as the quality of their interactions with carers and their living con- ditions. Video–electroencephalography ( EEG) is recommended where possible. We review poten- tial pharmacologic and behavioral management strategies for behavioral disorders in people with intellectual disability. KEY WORDS: Epilepsy, Intellectual disabilities, Mental retardation, Antipsychotic drugs. People with intellectual disabilities frequently have some forms of behavioral disorders that may manifest as stereotypies, difficult or disruptive behavior, aggressive behaviors toward other people, behaviors that lead to injury of the self or others, and destruction of property (Lowe et al., 2007; Smith & Matson, 2010a). These lead to difficulties for the individual themselves and are often problematic for those who work with and care for them. A joint report by the Royal College of Psychiatrists, British Psychological Society & Royal College of Speech and Language Therapists (2007) defined behavior as challenging when: …it is of such an intensity, frequency or duration as to threaten the quality of life and/or the physical safety of the individual or others and is likely to lead to responses that are restrictive, aversive or result in exclusion. A large study conducted in South Wales (United Kingdom) found that 10% of the intellectual disability population manifested some form of serious challenging behavior, with disruptive behavior being the most preva- lent. Multiple forms of challenging behavior in the same person were common (Lowe et al., 2007). These figures were convergent with earlier studies that also found self- injury, destructiveness, aggression, and disruptive behav- ior to be prevalent in 10% of the intellectual disability population (Emerson et al., 2001). Earlier studies of a broader range of behavioral problems, including problems such as verbal aggression and temper tantrums, in the intellectual disability population have suggested preva- lence between 22.5% and 55% (Deb & Joyce, 1999; Cooper et al., 2007). Recent community studies of epilepsy in the intellec- tual disability population have suggested prevalence between 26% and 40% (McGrother et al., 2006), and it is widely accepted that even higher rates of epilepsy are found in individuals with more severe intellectual dis- ability (Bowley & Kerr, 2000). Although challenging behaviors are commonly observed in people who have both epilepsy and intellectual disability, there is some disagreement within the scientific literature as to whether the presence of epilepsy in a person with intellectual Address correspondence to Michael Kerr, Welsh Centre for Learning Disabilities, Institute of Psychological Medicine and Clinical Neuro- sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 1YS, U.K. E-mail: kerrmp@Cardiff.ac.uk 1 Supported in part by Fundacion INCE, Madrid Spain. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy 34 Epilepsia, 54(Suppl. 1):34–40, 2013 doi: 10.1111/epi.12103 PSYCHIATRIC DISORDERS IN EPILEPSY