Evaluation of Antiepileptic for Behavioral Symptoms in Severe Intellectual Disabilities

Antiepileptic, known to manage mood disorders, has been prescribed for behavioral symptoms in severe intellectual disabilities, but often results in multiple prescriptions. Objective: To classify the behavioral symptoms and evaluate the prescription of antiepileptic for the extent of the behavioral symptoms. Method: The extent of the behavioral symptoms was scored using Severe Behavior Disorder Assessment Scale, composed of the 11–items and 4–frequency scale, in 80 hospitalized subjects with severe intellectual disabilities, and analyzed in relation to the number and dose of prescribed antiepileptic. Phenytoin was prescribed for 4 subjects, and their scores were evaluated at baseline and after the prescription. Results: The subjects with organic brain disease or epilepsy showed lower frequency of the behavioral symptoms compared to those without. Factor analysis indicated that the behavioral symptoms were classified into 3 factors; representatively, obsessive⁄hyperactive, aggressive and self–injurious behavior. The extent of the symptoms was inversely correlated to the number of antiepileptic, including valproic acid, carbamazepine and phenytoin. While valproic acid was significantly inversely correlated with the symptoms of obsessive⁄hyperactive and self–injurious behavior, phenytoin was possibly effective for the aggressive behavior. When phenytoin was prescribed in 4 subjects, the score of aggressive behavior was significantly decreased after the prescription of phenytoin, but paroxysmal tonic upgaze was often observed. Conclusion: Valproic acid was effective for the behavioral symptoms, similarly to mood disorders, and phenytoin could stabilize the aggressive behavior. Therefore, among antiepileptic, valproic acid could be the first choice to the symptoms, and prescriptions of antiepileptic could be symptomatically selected.