Evaluation and treatment of epilepsy in multiply handicapped individuals

The evaluation and treatment of patients with seizures and multiple handicaps are challenging. An orderly approach to these patients, however, can be especially rewarding. As in other patient populations, evaluation rests on the clinical cornerstones of history, examination, imaging, and electroencephalography. Several disease entities are overrepresented in the multiply handicapped population. Here, we review the principles of evaluation and some of the most common etiologies of recurrent seizures afflicting handicapped individuals. Practical issues that arise in institutional settings are highlighted, and basic treatment principles are discussed.