{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:12:18Z","timestamp":1788437538776,"version":"build-2803163510"},"reference-count":73,"publisher":"Mark Allen Group","issue":"16","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Nurs"],"published-print":{"date-parts":[[2026,9,3]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.12968\/bjon.2025.0427","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:13:13Z","timestamp":1788433993000},"page":"818-825","source":"Crossref","is-referenced-by-count":0,"title":["Individuals with intellectual disability and complex epilepsy: a case study of diagnostic overshadowing"],"prefix":"10.12968","volume":"35","author":[{"given":"Andrew","family":"Boyle","sequence":"first","affiliation":[{"name":"Lecturer, Edinburgh Napier University, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Spassiani","sequence":"additional","affiliation":[{"name":"Associate Professor, University of Toronto; Scientist, Centre for Addiction and Mental Health, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Houghton","sequence":"additional","affiliation":[{"name":"Lecturer, Edinburgh Napier University, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Paterson","sequence":"additional","affiliation":[{"name":"Associate Professor, Edinburgh Napier University, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5130","reference":[{"key":"e_1_3_2_1_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2024.109639"},{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9236(96)90130-7"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/00222194221150230"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2024.45"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/14034948251317243"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.15748"},{"issue":"11","key":"e_1_3_2_7_1","first-page":"36","article-title":"Intellectual disability and psychiatric disorders as exclusion criteria in randomized controlled trials (RCT)","volume":"33","author":"Camanni G","year":"2021","unstructured":"Camanni G, Ciccone O, Lepri A et al. Intellectual disability and psychiatric disorders as exclusion criteria in randomized controlled trials (RCT). Psychiatr Danub. 2021;33(Suppl 11):36\u201339","journal-title":"Psychiatr Danub"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19035"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2024.109646"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/epi4.13024"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2010.10.030"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2023.04.005"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17932"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1352\/1944-7558-129.2.116"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-024-01971-x"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurot.2024.e00344"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13016"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.14581\/jer.21025"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jebm.70015"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-025-13060-6"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNF.0000000000000172"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16856"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192315622"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/epi4.13046"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2468-2667(24)00164-6"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/aur.2972"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2025.1546465"},{"key":"e_1_3_2_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40268-023-00413-x"},{"key":"e_1_3_2_29_1","doi-asserted-by":"publisher","DOI":"10.3390\/gidisord5030026"},{"key":"e_1_3_2_30_1","doi-asserted-by":"publisher","unstructured":"Kanner AM. When thinking of lamotrigine and valproic acid think \u201cpharmacokinetically\u201d! Epilepsy Curr. 2004;4(5):206\u2013207. 10.1111\/j.1535-7597.2004.04515.x","DOI":"10.1111\/j.1535-7597.2004.04515.x"},{"key":"e_1_3_2_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afaf031"},{"key":"e_1_3_2_32_1","doi-asserted-by":"publisher","DOI":"10.12968\/hmed.2023.0357"},{"key":"e_1_3_2_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-090857"},{"key":"e_1_3_2_34_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S505040"},{"key":"e_1_3_2_35_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0256294"},{"key":"e_1_3_2_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bj.2023.100680"},{"key":"e_1_3_2_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/cts.13793"},{"key":"e_1_3_2_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-017-0621-2"},{"key":"e_1_3_2_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/jir.12844"},{"key":"e_1_3_2_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2023.120766"},{"key":"e_1_3_2_41_1","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2024.2393322"},{"key":"e_1_3_2_42_1","doi-asserted-by":"publisher","unstructured":"Morton-Nance S. Drug-induced dysphagia and the high-risk effect on people with intellectual disabilities. Learning Disability Practice. 2019. 10.7748\/ldp.2019.e1955 (accessed 5 August 2026)","DOI":"10.7748\/ldp.2019.e1955"},{"key":"e_1_3_2_43_1","unstructured":"National Institute for Health and Care Excellence. Challenging behaviour and learning disabilities: Prevention and interventions for people with learning disabilities whose behaviour challenges. NICE guideline NG11. 2015. https:\/\/www.nice.org.uk\/guidance\/ng11 (accessed 5 August 2026)"},{"key":"e_1_3_2_44_1","unstructured":"National Institute for Health and Care Excellence. Epilepsies in children young people and adults: diagnosis and management. NICE guideline NG217. 2026 (updated version of guideline first published 2022). https:\/\/www.nice.org.uk\/guidance\/ng217 (accessed 5 August 2026)"},{"key":"e_1_3_2_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2666-7568(24)00007-2"},{"key":"e_1_3_2_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2024.12.008"},{"key":"e_1_3_2_47_1","doi-asserted-by":"publisher","DOI":"10.12688\/wellcomeopenres.16749.3"},{"issue":"4","key":"e_1_3_2_48_1","doi-asserted-by":"crossref","first-page":"e010505","DOI":"10.1136\/bmjopen-2015-010505","article-title":"Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study","volume":"6","author":"O\u2019Dwyer M","year":"2016","unstructured":"O\u2019Dwyer M, Peklar J, McCallion P, McCarron M, Henman MC. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open. 2016;6(4):e010505.","journal-title":"BMJ Open"},{"key":"e_1_3_2_49_1","doi-asserted-by":"crossref","unstructured":"Patsalos PN. Antiseizure medication interactions: a clinical guide. Springer Nature; 2022. ISBN: 978-3-030-82789-2","DOI":"10.1007\/978-3-030-82790-8"},{"key":"e_1_3_2_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19011"},{"key":"e_1_3_2_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41999-021-00479-3"},{"key":"e_1_3_2_52_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-023-01060-1"},{"key":"e_1_3_2_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(23)00151-5"},{"key":"e_1_3_2_54_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000206758"},{"key":"e_1_3_2_55_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-023-04256-8"},{"key":"e_1_3_2_56_1","unstructured":"Royal College of Psychiatrists. Management of epilepsy in adults with intellectual disability. Good Psyhciatric Practice. College Report CR203. 2017. https:\/\/www.rcpsych.ac.uk\/improving-care\/campaigning-for-better-mental-health-policy\/college-reports\/2017-college-reports\/management-of-epilepsy-in-adults-with-intellectual-disability-cr203-may-2017 (accessed 5 August 2026)"},{"key":"e_1_3_2_57_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-089962"},{"key":"e_1_3_2_58_1","doi-asserted-by":"publisher","DOI":"10.3390\/pharmacy13010015"},{"key":"e_1_3_2_59_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.65010"},{"key":"e_1_3_2_60_1","doi-asserted-by":"publisher","DOI":"10.1002\/aur.3315"},{"key":"e_1_3_2_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2021.108355"},{"key":"e_1_3_2_62_1","doi-asserted-by":"publisher","DOI":"10.2174\/0118715273275793231030060833"},{"key":"e_1_3_2_63_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-2534-3267"},{"key":"e_1_3_2_64_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-023-03598-x"},{"key":"e_1_3_2_65_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-024-01149-1"},{"key":"e_1_3_2_66_1","doi-asserted-by":"publisher","unstructured":"Watson J Jenkin E Anderson K et al. A human rights framing of the experiences of supporting people with intellectual disability in congregate care: Post-pandemic reflections. J Intellect Dev Disabil. 2025. 10.3109\/13668250.2025.2513336. Epub ahead of print","DOI":"10.3109\/13668250.2025.2513336"},{"key":"e_1_3_2_67_1","unstructured":"World Health Organization. Epilepsy: a public health imperative. 2019. https:\/\/www.who.int\/publications\/i\/item\/epilepsy-a-public-health-imperative (accessed 5 August 2026)"},{"key":"e_1_3_2_68_1","unstructured":"World Health Organization. Global burden of preventable medication-related harm in health care: A systematic review. 2024a. https:\/\/www.who.int\/publications\/i\/item\/9789240088887 (accessed 5 August 2026)"},{"key":"e_1_3_2_69_1","unstructured":"World Health Organization. Medication without harm: Policy brief. 2024b. https:\/\/www.who.int\/publications\/i\/item\/9789240062764 (accessed 5 August 2026)"},{"key":"e_1_3_2_70_1","doi-asserted-by":"publisher","DOI":"10.1248\/bpb.b23-00608"},{"key":"e_1_3_2_71_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-023-06208-y"},{"key":"e_1_3_2_72_1","unstructured":"Yu MKL Ditzel N Bokor L et al. Learning from lives and deaths: People with a learning disability and autistic people. LeDeR report for 2024. LeDeR Autism and learning disability partnership King's College London. July 2026. https:\/\/www.kcl.ac.uk\/research\/leder (accessed 5 August 2026)"},{"key":"e_1_3_2_73_1","doi-asserted-by":"publisher","DOI":"10.1684\/epd.2014.0714"}],"container-title":["British Journal of Nursing"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.magonlinelibrary.com\/doi\/pdf\/10.12968\/bjon.2025.0427","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:13:16Z","timestamp":1788433996000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.magonlinelibrary.com\/doi\/10.12968\/bjon.2025.0427"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":73,"journal-issue":{"issue":"16","published-print":{"date-parts":[[2026,9,3]]}},"alternative-id":["10.12968\/bjon.2025.0427"],"URL":"https:\/\/doi.org\/10.12968\/bjon.2025.0427","relation":{},"ISSN":["0966-0461","2052-2819"],"issn-type":[{"value":"0966-0461","type":"print"},{"value":"2052-2819","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]}}}