Department of Residential Care, Kempenhaeghe Epilepsy Centre, Heeze, The Netherlands.
Department of Neurology, Academic Center for Epileptology Kempenhaeghe, Heeze, The Netherlands.
J Intellect Disabil Res. 2019 Jan;63(1):40-48. doi: 10.1111/jir.12556. Epub 2018 Oct 14.
In the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5), the diagnostic criteria of intellectual disability (ID) include three domains of adaptive deficits: the conceptual, social and practical. Substantial intra-individual differences between domains can be considered an ID domain discrepancy.
We explored the associations between ID domains, discrepancies and epilepsy in 189 adults (mean age = 47.9; SD = 15.6). Each DSM-5 ID domain was assessed separately, using subscales of the Vineland II for the social and practical domains, and psychological instruments, including intelligence tests, for the conceptual domain. A set of standardised criteria is proposed to identify an ID domain discrepancy.
An ID domain discrepancy seemed to be present in about one-third of subjects and was particularly present in subjects with moderate ID (53.4%). Impairment in the social domain was most often the reason for the discrepancy. The presence of a discrepancy was significantly related to a focal (localised) epilepsy type (OR = 2.3, P = .028) and a mixed seizure type (OR = 1.4, P = .009). Epilepsy characteristics that are indicative of a more severe and refractory epilepsy, including various seizure types, a high seizure frequency, a combined epilepsy type (both focal and generalised epilepsy) and an early age at onset, were significantly related to more severe impairments in conceptual, social and practical adaptive behaviour (all P values <.01).
With a substantial proportion of the subjects who had both ID and epilepsy with an ID discrepancy, professionals should be aware of this and take all domains of ID into account when studying or working with this vulnerable population.
在《精神障碍诊断与统计手册》第五版（DSM-5）中，智力障碍（ID）的诊断标准包括三个适应缺陷领域：概念、社会和实践。领域内个体间存在显著差异，可以认为是 ID 领域差异。
我们探讨了 189 名成年人（平均年龄 47.9；标准差 15.6）中 ID 领域、差异和癫痫之间的关联。分别使用 Vineland II 量表的社会和实践领域分量表以及心理工具（包括智力测验）评估每个 DSM-5 ID 领域。提出了一套标准来确定 ID 领域差异。
大约三分之一的受试者似乎存在 ID 领域差异，特别是中度 ID 受试者（53.4%）。社会领域的障碍是差异的主要原因。差异的存在与局灶性（局限性）癫痫类型（OR=2.3，P=0.028）和混合性癫痫类型（OR=1.4，P=0.009）显著相关。表明癫痫更严重和难治的特征，包括各种癫痫类型、高癫痫发作频率、混合性癫痫类型（局灶性和全面性癫痫）和早期发病，与概念、社会和实践适应行为的更严重障碍显著相关（所有 P 值均<.01）。
由于相当一部分 ID 患者同时伴有 ID 差异的癫痫，专业人员应意识到这一点，并在研究或与这一弱势群体合作时考虑 ID 的所有领域。
