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The article discusses the clinical management of patients with intellectual disability (ID) and epilepsy in the United Kingdom. Topics explored include the community prevalence of epilepsy in ID patients, the need to consider short term management strategies to improve seizure control in the acute medical setting, and the recognition of longer-term modifying factors such as changes in seizure patterns and value of an epilepsy care plan.

Summary: The aim of this study was to evaluate the efficacy and tolerability of open‐label lacosamide in patients with refractory sleep‐related hypermotor epilepsy. The study was a case review of eight patients with refractory sleep‐related hypermotor epilepsy treated with lacosamide. Seizure diaries compared the mean baseline seizure frequency with the most recent 3 months of follow‐up. Five (62.5%) patients were responders, defined as ≥50% reduction in seizure frequency, over a mean duration of exposure of 21.5 months. The mean maintenance dose of lacosamide was 400 mg/day. No‐one reported worsening of seizures. Lacosamide was well tolerated with initial fatigue being the main side‐effect. Lacosamide is a potentially efficacious adjunctive therapy in patients with refractory sleep‐related hypermotor epilepsy. A double‐blind placebo‐controlled study would determine its efficacy. [ABSTRACT FROM AUTHOR]

Aim This study aimed to assess the relationship between objective measures of cognition and subjective perception of cognitive functioning reported by patients with epilepsy and their caregivers. Methods One hundred patients with epilepsy attending hospital neurology outpatient clinics and their caregivers were enrolled in this study. The EpiTrack® (version 1) brief cognitive screening tool was used to measure objective impairment, the ABNAS questionnaire (A-B Neuropsychological Assessment Schedule) to assess subjective cognitive performance, and a version of the ABNAS designed to be completed by caregivers (C-ABNAS) to document caregivers' views. Patient anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) and considered as covariates. Patients with an uncertain diagnosis of epilepsy or likely severe comorbid mood or anxiety disorders were excluded. Results Data from 82 patients were analyzed after exclusion of patients with uncertain diagnoses or likely severe comorbid mood or anxiety disorders. Fifty-nine (72%) had a degree of objective cognitive impairment. Fifty (84.7%) of these 59 patients had ‘high’ ABNAS scores concordant with the objective assessment, and 43 (72.9%) had high C-ABNAS scores matching the abnormalities detected by objective screening. Of the 23 (28%) patients without objective cognitive impairment, seven (30.4%) had concordantly low ABNAS scores, and 10 (43.4%) had concordantly low C-ABNAS scores. Patient memory impairment was more often reported by patients themselves than by caregivers (p = 0.011). Carers were significantly more likely to rate patients as having impaired motor coordination than patients themselves. A small part of the variance of the EpiTrack score was predicted by the C-ABNAS. Objective cognitive performance did not predict ABNAS or C-ABNAS scores. Conclusions Self-report or caregiver report questionnaires identify patients with epilepsy and objective cognitive impairment more accurately than patients with intact cognition. Those without objective evidence of cognitive impairment may, nevertheless, perceive themselves as having memory dysfunction; it is these patients, therefore, who most require both subjective and objective assessments of cognition, including carers' assessments, in order to establish the nature of their symptoms. None of these assessment measures can be used as a reliable proxy for another, each contributes individually to a comprehensive assessment of cognition, and all must be used in conjunction with measures of mood and anxiety. [ABSTRACT FROM AUTHOR]

• Nonepileptic attacks can coexist with epilepsy in patients with brain tumor. • Focal seizures preceded the diagnosis of NEAD in the majority of patients. • In all patients the residual disease burden was largely due to NEAD. • Timely identification of NEAD improves the chance of effective symptom management. Epileptic seizures are well recognized as a presenting symptom in patients with brain tumors, however much less is known about coexisting nonepileptic attack disorder (NEAD) in this population. Establishing a diagnosis of NEAD can be challenging, especially in those with concomitant epilepsy. Nonepileptic attack disorder is associated with a high rate of morbidity, often due to coexisting psychological factors which may require the input of multiple services. In an era where early aggressive management of tumors is enabling patients to live longer, the associated psychological impact of adjusting to physical disease is increasingly apparent. In this case series, we present a narrative summary of 9 patients referred to neurology with brain tumor-related epilepsy (BTRE) over a five-year period (2015–2020) who also experienced NEAD. We describe their tumor characteristics, treatment course, and factors potentially contributing to their presentation. We conducted a case note review of patients presenting to the epilepsy service with BTRE, in whom NEAD was diagnosed based on clinical features and correlation with their EEG. Patients ranged in age from 26 to 63 years. Two patients were diagnosed with grade 1, three with grade 2 and four with grade 3 tumors. Tumors localized to frontal or temporal regions in seven cases. All patients presented initially with BTRE and developed nonepileptic seizures subsequently. Four patients developed NEAD within 1 month of their tumor diagnosis. One patient developed NEAD 79 months following diagnosis. The diagnosis of NEAD was established in 8 patients by direct visualization of attacks (two during concomitant EEG recording). In the remaining patient, diagnosis was based on history (patient and witness). Six patients were diagnosed with concomitant low mood and/ or anxiety and three were commenced on antidepressant medication. At the time of last review, the predominant attacks were nonepileptic in all but one patient. [ABSTRACT FROM AUTHOR]

• Longer term adjunctive Cannabidiol in modest doses 1–10 mg/kg/day for treatment of seizures associated with LGS. • is well tolerated; 96 % of patients remained on this medication over a median follow up of 24 months. • was associated with significant (≥50 %) reduction of focal seizures in 17 of 28 patients (61 %). • was associated with significant (≥50 %) reduction of tonic-clonic seizures in 35 of 49 patients (71 %). Epileptic encephalopathies are a disabling and life-limiting cause of childhood-onset epilepsy. Lennox Gastaut syndrome (LGS) is a characteristic example. In spite of the development of multiple medical and surgical therapies, many patients with these conditions remain treatment refractory Cannabidiol was licenced by The National Institute for Health and Care Excellence (NICE) in December 2019 for the adjunctive treatment of seizures associated with Lennox Gastaut syndrome [TA 615]. As the largest complex epilepsy centre in the Midlands, we describe our findings from a single centre retrospective study in 50 adults (aged 16 and over) with LGS- associated epilepsy. Our outcome measure was the efficacy of Cannabidiol on seizures of differing types over a 6–24-month period. Patients were treated with adjunctive Cannabidiol (with Clobazam, as per NICE recommendations). Each patient's usual anti-seizure medications (ASMs) were continued. Patients with a Vagal Nerve Stimulator (VNS) in situ remained on this treatment. Gradual titration of Cannabidiol from 1 mg/kg/day up to 10 mg/ kg/ day reduced the frequency of both focal and generalised seizures with ≥ 50 % seizure reduction in 76 % of the cohort. No patients became seizure free. Cannabidiol was well tolerated; 94 % of the cohort remained on the drug at last follow up. [ABSTRACT FROM AUTHOR]