Comparison of community and institutional prescription of antiepileptic drugs for individuals with learning disabilities.
Community programs once gave people with ID more brain-dulling seizure drugs than hospitals did, and later evidence says that was the wrong direction.
01Research in Context
What this study did
Pierce et al. (1994) looked at drug sheets for adults with learning disabilities. They compared prescriptions in large state hospitals with those in small community homes.
The team counted how many people took older seizure drugs like phenytoin, phenobarbitone, and primidone.
What they found
People living in the community were more likely to receive the older drugs. These same drugs can dull thinking and spark behavior problems.
The finding was a red flag: the setting meant to offer a better life was handing out more risky medicine.
How this fits with other research
Later reviews say stop using those very drugs. Alvarez et al. (1998), Iivanainen (1998), and Alvarez (1998) all warn that phenytoin and phenobarbital can slow memory, worsen balance, and increase irritability in people with ID. Their advice supersedes the 1994 practice.
Faja et al. (2015) followed people who moved from institutions to the community. Anticonvulsant use rose after the move, showing the gap never closed.
Agiovlasitis et al. (2025) found the same pattern with antipsychotics: community services still lean on heavy drugs instead of behavior plans. The problem D et al. spotted in 1994 has simply shifted to a new drug class.
Why it matters
If you support adults with ID, pull the med sheet at every team meeting. Ask the doctor if any old-school antiepileptics remain. Point to the newer reviews and request a switch to valproate, lamotrigine, or oxcarbazepine. Pair the change with a functional assessment and skill-teaching program so behavior gains come from learning, not sedation.
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Join Free →Check each client's antiepileptic name; if you see phenytoin, phenobarbital, or primidone, flag it for the prescriber and request a review.
02At a glance
03Original abstract
The use of antiepileptic agents for individuals with learning disabilities (mental handicap) resident both within National Health Service facilities and the community was surveyed in the UK. There was no difference in rates of polypharmacy, but there were significant differences in choice of antiepileptic agent. In particular, individuals resident in the community were more likely to be in receipt of phenytoin, primidone and phenobarbitone, which are particularly recognized as producing adverse effects on cognition and behaviour.
Journal of intellectual disability research : JIDR, 1994 · doi:10.1111/j.1365-2788.1994.tb00457.x