KEEP YOUR EYES OPEN!
Untreated co-morbidities in adults
with Epilepsy and Learning Disability
Authors; Flinton L, Pashley S, Lewington E
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People with learning disabilities are more likely
to have poorer health than the general
population.
Diagnostic overshadowing and the possibility of
unusual presentation of health problems can
delay diagnosis and timely access to appropriate
and effective health interventions.
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Specialist Epilepsy & Learning
Disability Service
Nottinghamshire
SP/LF 2012
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Meet the team
Sarah Pashley
Lisa Flinton
Dr O’Donoghue
Dr Szabo
Dr Singhal
Epilepsy & LD
Consultant Nurse
Epilepsy and LD
Specialist Nurse
Consultant
Neurologist
Consultant
Neurologist
Consultant
Neurologist
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The team provide services to:
Those in whom diagnosis is difficult and
expertise in epilepsy, learning disability, and
associated health conditions is essential in the
differential diagnosis and on-going
management
○ e.g. complex behavioural, sleep, movement,
communication, and psychiatric disorders
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Patients with poorly controlled epilepsy
Patients who have difficulty accessing
mainstream health services and clinical
investigations
Children with epilepsy in transition
Health care professionals and community care
providers requiring specialist advice,
education and training
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 Patients requiring assessment and referral
for Vagal Nerve Stimulation Therapy (VNS)
and adjustment of VNS parameters
Women with learning disabilities who require
preconception advice and management of
epilepsy and antiepilepsy medication through
pregnancy
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Purpose
To determine the prevalence and nature of
undiagnosed and untreated co-morbidities in
new referrals to an epilepsy and learning
disability service.
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Method
Our clinical database identified new referrals
with epilepsy and learning disability over a 12
month period. 93 adults were referred.
Patients with any previous contact with the
service were excluded. 62 met the inclusion
criteria.
All patients were assessed by a Consultant
Nurse with expertise in epilepsy and learning
disability and a Consultant Neurologist.
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Medical records were reviewed to compare
diagnostic and co-morbidity information
provided at the point of referral with that
following detailed assessment. Co morbidities
were treated within our Service or through
appropriate specialist referral (who confirmed
co-morbid diagnoses).
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Results
Previously undiagnosed and untreated comorbidities were identified in 58% of newly
referred patients (36 people). Ages ranged
from 19-64 years.
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The highest prevalence was in the age ranges 20-29 years and 40-49 years
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24 separate health conditions were identified
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23% (14 people) were vitamin D deficient.
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Conclusion
We demonstrate the importance of a holistic
approach to the assessment and treatment of
patients with a learning disability presenting
to an epilepsy clinic.
A learning disability may mask co-morbid
conditions.
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Recommendations
We recommend a proactive and comprehensive
approach to assessment. We find an
integrated Neurology and Learning Disability
Service beneficial.
Further study is required to determine why a
high proportion of adults present with
undiagnosed health needs despite a Primary
Care health screening programme in the UK
for adults with learning disability.
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