Commentary on Iinuma

First of all, Dr. Iinuma is to be congratulated for studying this population of patients. Patients with mental disabilities represent one of the largest populations in pediatric epilepsy. However, researchers generally tend to either not address this population as a special group, or to avoid such studies because of the behavior difficulties and other challenges. The differences in the frequency of monotherapy in this study illustrate the difficulty in treating these patients. While monotherapy was used in 60% of the normally intelligent patients in this study, only 12% of those with intellectual disabilities were treated with single agents. The mean number of antiepileptic drugs (AEDs) was 1.6 for the first group versus 2.94 for the disabled group. Regardless of the seizure type, better overall control was attainable in the normally intelligent versus the intellectually disabled persons. The incidence of adverse events was interesting, with 21% of the normal group experiencing side effects, 28% of the disabled, and 24% overall. Usually, adverse events are reported in the mentally disabled population at about 20–40%. This is due to the excess of behavioral abnormalities seen with so many of our current drugs. Zonisamide appears to be an effective AED in both normal and intellectually deficient children. No special adverse effects were worsened in the intellectually challenged group. Overall, we need more double-blind, placebo-controlled, or comparative studies to determine which patients will respond most favorably to treatment. This study