M. Scheepers | University of Stellenbosch (original) (raw)

Papers by M. Scheepers

Current Opinion in Neurology, 2003

Whilst behaviour disorder is so commonly a challenge to physicians in the field of epilepsy, comp... more Whilst behaviour disorder is so commonly a challenge to physicians in the field of epilepsy, comparatively little is known of its exact association with the epilepsies. This review highlights advances in knowledge, focussing on a broad definition of behaviour to include psychiatric pathology. Differential rates of disturbance appear to be associated with concurrent intellectual disability. Advances in imaging, in particular, suggest that structural brain changes may underlie the increased susceptibility in some epilepsy patients. Clinical practice should recognize that, with the possible exception of seizure freedom in postictal behavioural disturbance, epilepsy treatment alone is unlikely to treat the associated psychological and behavioural disturbance. Research continues to focus on assessing the correlates of epilepsy and psychopathology whilst the association between epilepsy and behaviour disorder in people with an intellectual disability remains largely unknown.

Seizure, 2020

People with Intellectual Disability (ID) and epilepsy are more likely to experience psychiatric c... more People with Intellectual Disability (ID) and epilepsy are more likely to experience psychiatric conditions, challenging behaviour (CB), treatment resistance and adverse effects of anti-seizure medications (ASM) than those without. This population receives care from various professionals, depending on local care pathways. This study evaluates the training status, confidence, reported assessment and management practices of different professional groups involved in caring for people with ID, epilepsy and CB. Methods: A cross sectional survey using a questionnaire developed by expert consensus which measured selfreported training status, confidence, and approaches to assessment and management of CB in people with ID and epilepsy was distributed to practitioners involved in epilepsy and/or ID. Results: Of the 83 respondents, the majority had either a psychiatry/ID (n = 39), or Neurology/epileptology background (n = 31). Psychiatry/ID and Neurology/epileptology had similar confidence in assessing CB in IDepilepsy cases, but Psychiatry/ID exhibited higher self-rated confidence in the management of these cases. While assessing and managing CB, Psychiatry/ID appeared more likely to consider mental health aspects, while Neurology/epileptology typically focused on ASM. Conclusion: Psychiatry/ID and Neurology/epileptology professionals had varying training levels in epilepsy, ID and CB, had differing confidence levels in managing this patient population, and considered different factors

Expert Opinion on Pharmacotherapy, 2019

Changes made as a result of publishing processes such as copy-editing, formatting and page number... more Changes made as a result of publishing processes such as copy-editing, formatting and page numbers may not be reflected in this version. For the definitive version of this publication, please refer to the published source. You are advised to consult the publisher's version if you wish to cite this paper.

British Medical Journal, 2000

EDITOR—Leonard et al's editorial concerns heart and heart-lung transplantation in Down's ... more EDITOR—Leonard et al's editorial concerns heart and heart-lung transplantation in Down's syndrome.1 Possible bias and discrimination towards people with a learning disability having access to a range of health screening and intervention programmes are increasingly being recognised.2 Rationing or prioritisation should be open. Criteria should be agreed by all stakeholders, with no code of silence among the healthcare professionals and with evidence based decision making. We believe that the root of the problem for people with a learning disability lies in …

Journal of Neurology, Neurosurgery & Psychiatry, 2003

BJPsych Open, 2020

Background Rapid spread of coronavirus disease 2019 (COVID-19) has affected people with intellect... more Background Rapid spread of coronavirus disease 2019 (COVID-19) has affected people with intellectual disability disproportionately. Existing data does not provide enough information to understand factors associated with increased deaths in those with intellectual disability. Establishing who is at high risk is important in developing prevention strategies, given risk factors or comorbidities in people with intellectual disability may be different to those in the general population. Aims To identify comorbidities, demographic and clinical factors of those individuals with intellectual disability who have died from COVID-19. Method An observational descriptive case series looking at deaths because of COVID-19 in people with intellectual disability was conducted. Along with established risk factors observed in the general population, possible specific risk factors and comorbidities in people with intellectual disability for deaths related to COVID-19 were examined. Comparisons between ...

The Psychiatrist, 2012

... Mark Scheepers is a consultant psychiatrist and clinical director for services to people with... more ... Mark Scheepers is a consultant psychiatrist and clinical director for services to people with learning disability, Martin Ansell is a ... part of an externally funded research project in collaboration with Queen Margaret University, Edinburgh, using the Flight Gate practice development ...

The British journal of general practice : the journal of the Royal College of General Practitioners, 2000

Those with a learning disability previously cared for in institutions have now been discharged in... more Those with a learning disability previously cared for in institutions have now been discharged into smaller community homes. This has meant that an increased burden has been placed on general practitioners (GPs) to evaluate and treat those who have symptoms that may be difficult to interpret. This report presents the prevalence of Helicobacter pylori in those still awaiting discharge and discusses the possible symptoms that GPs may encounter.

Seizure, 2000

The aim of this study was to determine whether intranasal midazolam is a safe and effective rescu... more The aim of this study was to determine whether intranasal midazolam is a safe and effective rescue medication in adolescent and adult patients with severe epilepsy. This field trial was designed to test the feasibility of the use of intranasal midazolam as an alternative to rectal diazepam in a cohort of patients with severe epilepsy who require rescue medication as part of their treatment. A dose of intranasal midazolam (5 mg if the patient weighed less than 50 kg and 10 mg if the patient weighed over 50 kilograms) was prescribed for those who had previously responded to other rescue medication. Midazolam was prescribed buccally if excessive head movement accompanied seizures. The protocol reverted to the usual rescue medication if there was no response to midazolam within 10 minutes. Vital signs were monitored for half an hour following the administration of the treatment. Twenty-two patients received 84 treatment episodes and 79 of these were considered clinically effective. Five treatment failures were recorded, three due to poor technique in delivering the midazolam. Two patients were successfully retried on midazolam and a third is awaiting a retrial of this drug. The two other treatment failures received the drug buccally. In the first patient the clinical opinion was that this was possibly a psychogenic non-epileptic seizure. The other patient responded initially, but within an hour had another seizure requiring further rescue treatment. No significant adverse effects were reported. Our study shows that intranasal midazolam, when used appropriately, is an effective treatment in those who require rescue treatment. There are clear advantages in the use of midazolam over diazepam in the treatment of acute seizures. These include the favourable pharmacokinetic and pharmacodynamic properties of midazolam as well as the potential of a more acceptable and dignified administration route.

Seizure, 1998

People with a learning disability are often disadvantaged due to the nature of their disability. ... more People with a learning disability are often disadvantaged due to the nature of their disability. Up to a third are likely to have concomitant epilepsy which adds to the health loss experienced by this group. It is important to manage their epjlepsy in such a way as to limit the debilitating effects of both the illness and the medication. Rectal diazepam remains the gold standard rescue medication for prolonged, recurrent seizures or seizures associated with hypoxia. Some of the drawbacks are highlighted in this paper and we go on to explore a novel means of treating these seizures. Midazolam, via the intranasal route, has been used extensively in children, mostly as a sedative but also in the treatment of epilepsy. We present two cases, both are adults with a learning disability, who have benefited significantly from the use of intranasal midazolam. Ongoing research into the safe use of this form of treatment, training of staff and carers and the impact on the individual is being conducted.

Journal of Policy and Practice in Intellectual Disabilities, 2005

to identify domains of health disparity and examples of evidence-based or good practice and from ... more to identify domains of health disparity and examples of evidence-based or good practice and from them define statements and recommendations that would form the basis of an agenda for change. This multiprofessional international workgroup included healthcare providers, policy makers, researchers, and others involved in the field of intellectual disabilities. This report has been designed to provide a framework for addressing the disparity in health that exists for people with intellectual disabilities. The intent is to influence the direction of research, interventions, service provision, and the thinking of policy makers in order to minimize disparity. While this document reflects a population-based approach, some of the recommendations may be applied to individuals. The recommendations represent a consensus view based on currently available evidence from appropriate specialist knowledge and a review of the literature.

Journal of Policy and Practice in Intellectual Disabilities, 2004

This paper reviews the epidemiology of Helicobacter pylori (H. Pylori) in adults with intellectua... more This paper reviews the epidemiology of Helicobacter pylori (H. Pylori) in adults with intellectual disability (ID) including clinical presentation, risk factors for infection and diseases, and assesses the best options for testing and treatment. It was observed that particular groups of adults with ID have significantly higher rates of H. pylori infection, and possibly disease consequences including peptic ulcer disease and gastric cancer, when compared to the general population, although the presentation with typical dyspepsia in people with ID is rare. Identified independent risk factors for infection include a history of institutionalization, lower ability, higher levels of behavior problems, and living with flatmates with oral hypersalivation or fecal incontinence. The presence of ID and the associated biopsychosocial factors necessitate development of adaptations to the usual testing and treatment methods as part of a preventive health strategy in order to relieve occult symptoms, and prevent disease development. Among the available tests, the fecal antigen or serology tests are equally acceptable to adults with ID regardless of their level of disability or behaviors, although only those who function more normally can perform the urea breath test. The H. pylori eradication rate is lower, with treatment side-effect and recurrence rates higher, compared to the general population; but, given the evidence that patients with ID carry the infection and associated pathology for long periods, testing and treating those with at-risk is recommended. While not recommending screening all adults with ID for H. pylori infection, the authors provide an overall evidence-based position statement on whom to test and treat, and how to diagnose and manage this infection, an important cause of preventable disease.

Journal of Intellectual Disability Research, 2009

Background Epilepsy has a pervasive impact on the lives of people with intellectual disability an... more Background Epilepsy has a pervasive impact on the lives of people with intellectual disability and their carers. The delivery of high-quality care is impacted on by the complexity and diversity of epilepsy in this population. This article presents the results of a consensus clinical guideline process. Results A Delphi process identified a list of priority areas for the development of evidence-based guidelines. All guidelines were graded and consensus on scoring was achieved across the guideline group. Conclusion There is a dearth of high-quality evidence from well-constructed studies on which to base guidance. However, the development of internationally derived consensus guidelines may further support the management of epilepsy in adults with an intellectual disability.

Journal of Intellectual Disability Research, 2001

Advancing knowledge of the existence of Helicobacter pylori and its association with gastrointest... more Advancing knowledge of the existence of Helicobacter pylori and its association with gastrointestinal tract malignancy, and previous research showing higher-than-expected gastrointestinal tract malignancy in institutionalized adults with intellectual disability (ID) prompted a review of all deaths as a result of cancer in the Stoke Park group of hospitals for people with ID between  and . A year, retrospective case note analysis of all deaths from cancer in an institution for people with ID was undertaken. Death from stomach cancer accounted for up to % of all cancer deaths. A further  residents had died of perforated stomach ulcers. The higher proportion of deaths specifically caused by stomach cancer in a population with ID has not been noted previously. It is postulated that the high levels of H. pylori infection found in institutionalized populations may be instrumental in this higher mortality rate and that the closure of the institutions without evaluation of H. pylori status transfers the problem unresolved to the community. Existing guidelines for the screening and eradication of H. pylori developed for the general population are inadequate when applied to people with ID, and therefore, the value of population screening and mass eradication programmes is explored. Journal of Intellectual Disability Research       M. Duff et al. • Helicobacter pylori and stomach cancer Journal of Intellectual Disability Research       M. Duff et al. • Helicobacter pylori and stomach cancer 221 ©  Journal of Intellectual Disability Research       M. Duff et al. • Helicobacter pylori and stomach cancer

BMJ (Clinical research ed.), Jan 5, 2000