Individuals with intellectual disability and complex epilepsy: a case study of diagnostic overshadowing

People with intellectual disability have a higher prevalence of epilepsy, care complexity, comorbidity and polypharmacy than the general population. These patients are often found to be on multiple medications without a clear rationale for ongoing prescriptions. Recent evidence has highlighted the ongoing exposure to avoidable health inequalities and premature death in this population group, in which medicines management can play an influential role. This article aims to identify practical interventions to mitigate the risk of diagnostic overshadowing and health inequalities in individuals with intellectual disability and complex epilepsy. The discussion centres on a comprehensive retrospective analysis of the care outcomes experienced by an individual with a diagnosed epilepsy syndrome (Lennox-Gastaut syndrome). Rationalising medication is complex but can reduce the risk of drug interactions and adverse outcomes. Iatrogenic effects can be mistaken for physical health symptoms and confound care pathways. Systematic assessment and collaboration with appropriately experienced clinicians improves outcomes. Prospective therapeutic drug monitoring may have a role to play in mitigating adverse outcomes and diagnostic overshadowing in individuals with intellectual disability and complex epilepsy.