Role of medications in Intellectual Disability

There is no single medicine available to cure Intellectual disability or Mental Retardation. Associated conditions need to be treated efficiently to enhance the cognitive capacity of the child.

Convulsion (Seizure disorders/ Epilepsy) Management
A few children with ID also suffer from epilepsy or convulsion disorder

Anticonvulsants help stop these seizures in ID children. There are different types of anticonvulsant medications available. These anticonvulsants tend to limit the excessive electrical activity that occurs in ID related seizures. There have been many successes in treating these seizures with anticonvulsants. 

Conventional antiepileptic drugs: 
Phenytoin, Phenobarbitone, Carbamazipine, Valporic acid.

Newer antiepileptic drugs: 

Oxcarbazepine, Gabapentine, Lamotrizine, Clobazam, Topramate, Levitiracetam, Zonisamide, Pregabalin, Tiagabine, Vigabatrin. 

Side effects of anticonvulsant medication include drowsiness, dizziness, irritability, confusion, vomiting, uncontrolled eye movements, gingivitis, and itching or a rash. Anticonvulsants may also interact negatively with other medications that you may be taking. 

Discontinuation of antiepileptic drugs (AED) in children with ID can and should be practiced when possible after patients have been seizure free for at least 2 years. AED
It is often difficult to control seizures particularly if the child has mental retardation as an associated factor. 

Neurological deficits and mental retardation are poor prognostic factors for seizure relapse after AED discontinuation. 

Before starting medicines for epilepsy, it is necessary to diagnose the kind and severity of the seizures as some other common condition can mimic as seizures. Such as: breathe holding spell, gastro esophageal reflux, syncope, movement disorders, behavioral events and parasomnias. 

Drooling

Drooling is unintentional involuntary spillage of saliva from the mouth. A major morbidity associated with ID. It is considered as psycho-social consequences such as social stigmatization and emotional devastation for the patients and their families. 

Causes: It is commonly caused by poor oral facial and bulbar muscles control. The major contributing factors are: hyper secretion of saliva, dental malocclusion, postural problems, and inability to recognize salivary spill, mouth breathing, excitement and impaired concentration, lack of sensation around the mouth. 

Complications: A lot of complications is caused due to drooling: Peri-oral chapping, dehydration, odor, social stigmatization. 

Medication: There are only a few medicines which helps reducing drooling. Anticholinergic medicines such as Glycopyrrolate and scopolamine help a little bit. 

Side effects: These medicines have lot of side effects.

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