Behavioral assessment in mentally retarded and developmentally disabled patients with epilepsy

Behavioral disturbance is common in many individuals with mental retardation. Its presence in those with coexisting epilepsy provides a further challenge to the individual, caretakers, and family members. In particular, concerns that antiepileptic medication is causing such behavioral disturbances are often raised. For the clinician, assessment is crucial to minimize morbidity by appropriately identifying the cause of the behavioral disturbance. The assessment should aim to delineate whether the disturbance is due to a direct effect of epilepsy, its treatment, social impact, or factors unrelated to the epilepsy. However, before being able to make this differentiation, the clinician needs to understand the behavior itself. Assessing behavior in people with mental retardation requires a multifactorial approach. These factors include an objective and reliable description of the behavior and an assessment of its function. Detailed description requires a functional analysis of behavior. Such analysis may indicate the behavior is associated with epilepsy treatment or represents a seizure disorder in itself. In the majority of cases, though, it is likely that any disturbance seen is independent of epilepsy or its management.