The prevalence of epilepsy is high in people with intellectual disability (ID) and increases with growing severity of the ID. People with epilepsy and ID are not only at risk of different types of seizure-related complications (such as injuries and sudden unexpected death) but also of different types of physical impairments and of psychiatric, cognitive and behavioral comorbidities. ID is also associated with drug-resistant epilepsy (OR 3.38). Polytherapy is frequent in this population and leads to (among others) psycho-behavioral and bone health adverse events. All these factors together complicate the care for these persons and cause a great deal of social dependency. They function at a lower level than the severity of the ID alone would predict. Due to the common intractability of the epilepsy, alternative treatments are needed such as ketogenic diet and in specific cases neurosurgery and neuromodulation. The behavioral disorder is mostly multifactorial and the treatment may be complex. The family burden and stress should be taken into account, as well as the transition from child to adult neurologist and the possibility of admission to institutes.