Advertisement

European Child & Adolescent Psychiatry

, Volume 16, Issue 1, pp 61–66 | Cite as

Epilepsy in autism spectrum disorders

  • Roberto Canitano
BRIEF REPORT

Abstract

Epilepsy is quite common in autism spectrum disorders, and it is increasingly recognized as an additional clinical problem that must be dealt with. The rate of comorbidity varies, depending upon the age and type of disorder, and currently the conservative estimate of comorbidity cases is 20–25% of the whole spectrum. Major risk factors for seizure occurrence are mental retardation and additional neurological disorders, as well as some specific associated medical conditions. Autism with regression has been reported in one-third of children with previously normal or nearly normal development. In an unknown proportion of these subjects, epileptic disorders are concomitant, leading to so-called autistic epileptiform regression. Furthermore, epileptiform abnormalities without seizures are frequent in this population and their role in the development of the nuclear disturbances of autism is controversial. The therapeutic approaches to epilepsy in autism are conventional treatments, yet when seizures are not evident, there is still controversy. Anticonvulsant medications could also potentially interfere with mood and behavioral disturbances frequently observed in ASD. The current understanding of the association between epilepsy and autism is still limited, but from a clinical point of view this association should not be overlooked, and it should be routinely investigated.

Keywords

epilepsy autism pervasive developmental disorders autistic epileptiform regression 

References

  1. 1.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV). Washington, DC: American Psychiatric AssociationGoogle Scholar
  2. 2.
    Asato MR, Hardan AY (2004) Neuropsychiatric problems in tuberous sclerosis complex. J Child Neurol 19:241–249PubMedGoogle Scholar
  3. 3.
    Askalan R, Mackay M, Brian J, Otsubo H, McDermott C, Bryson S, Boyd J, Snead C 3rd, Roberts W, Weiss S (2003) Prospective preliminary analysis of the development of autism and epilepsy in children with infantile spasms. J Child Neurol 18:165–170PubMedGoogle Scholar
  4. 4.
    Azmitia Whitaker PM (2001) Serotonin and brain development: Role in human developmental disease. Brain Res Bull 56: 479–485CrossRefGoogle Scholar
  5. 5.
    Ballaban-Gil K, Tuchman R (2000) Epilepsy and epileptiform EEG: association with autism and language disorders. Ment Retard Dev Disabil Res Rev 6:300–308PubMedCrossRefGoogle Scholar
  6. 6.
    Belsito K, Law P. Kirk K, et al. (2001) Lamotrigine therapy for autistic disorder: a randomized double-blind , placebo controlled trial. J Autism Dev Disord 31:175–181PubMedCrossRefGoogle Scholar
  7. 7.
    Besag FM (2004) Behavioral aspects of pediatric epilepsy syndromes. Epilepsy Behav 5(S1):3–13CrossRefGoogle Scholar
  8. 8.
    Binnie CD (2003) Cognitive impairment during epileptiform discharges: is it ever justifiable to treat EEG? Lancet Neurol 2:735B–730BGoogle Scholar
  9. 9.
    Binnie CD (1993) Significance and management of transitory cognitive impairment due to subclinical EEG discharges in children. Brain Dev 15:25–30CrossRefGoogle Scholar
  10. 10.
    Bolton PF, Park RJ, Higgins JN, Griffiths PD, Pickles A (2002) Neuro-epileptic determinants of autism spectrum disorders in tuberous sclerosis complex. Brain. 125(Pt 6):1247–1255PubMedCrossRefGoogle Scholar
  11. 11.
    Bolton PF (2004) Neuroepileptic correlates of autistic symptomatology in tuberous sclerosis. Ment Retard Dev Disabil Res Rev 10:126–131PubMedCrossRefGoogle Scholar
  12. 12.
    Canitano R, Luchetti A, Zappella M (2005) Epilepsy, EEG abnormalities and regression in children with autism. J Child Neurol 20:27–31PubMedGoogle Scholar
  13. 13.
    Canitano R (2004) Epilepsy in pervasive developmental disorders. In: Remschmidt H, Belfer M (eds) Book of the Abstracts of the 16th Congress of the IACAPAP. Steinkopff Darmstadt, Springer, Berlin, p 231Google Scholar
  14. 14.
    Chez MG, Buchanan T, Aimonovitch M, Mrazek S, Krasne V, Langburt W, Memon S (2004) Frequency of EEG abnormalities in age-matched siblings of autistic children with abnormal sleep EEG patterns. Epilepsy Behav 5:159–162PubMedCrossRefGoogle Scholar
  15. 15.
    Chugani DC (2004) Serotonin in autism and pediatric epilepsies. Ment Retard Dev Disabil Res Rev 10:112–116PubMedCrossRefGoogle Scholar
  16. 16.
    De Martino A, Tuchman R (2001) Antiepilepic drugs: affective use in autism spectrum disorders. Pediatric Neurol 25:199–207CrossRefGoogle Scholar
  17. 17.
    Deonna T (1991) Acquired epileptiform aphasia in children (Landau–Kleffner syndrome). J Clin Neurophysiol 8:263–268Google Scholar
  18. 18.
    Deykin EY, Mac Mahon B (1979) The incidence of seizures among children with autistic symptoms. Am J Psychiatry 136:1310–1312PubMedGoogle Scholar
  19. 19.
    Elia M, Musumeci SA, Ferri R, Bergonzi P (1995) Clinical and neurophysiological aspects of epilepsy in subjects with autism and mental retardation. Am J Ment Retard 100:6–16PubMedGoogle Scholar
  20. 20.
    Fombonne E (2003) Epidemiological surveys of autism and other pervasive developmental disorders: an update. J Autism Dev Disord 4:365–382CrossRefGoogle Scholar
  21. 21.
    Galanopoulou AS, Bojko A, Lado F, Moshe SL (2000) The spectrum of neuropsychiatric abnormalities associated with electrical status epilepticus in sleep. Brain Dev 22:279–295PubMedCrossRefGoogle Scholar
  22. 22.
    Gillberg C (1991) The treatment of epilepsy in autism. J Autism Dev Disord 21:61–77PubMedCrossRefGoogle Scholar
  23. 23.
    Giovanardi Rossi P, Parmeggiani A, Bach V, Santucci M, Visconti P (1995) EEG features and epilepsy in patients with autism. Brain Dev 17:169–174CrossRefGoogle Scholar
  24. 24.
    Giovanardi Rossi P, Posar A, Parmeggiani A (2000) Epilepsy in adolescents and young adults with autistic disorder. Brain Dev 22:102–106PubMedCrossRefGoogle Scholar
  25. 25.
    Glaze DG (2004) Rett syndrome: of girls and mice–lessons for regression in autism. Ment Retard Dev Disabil Res Rev 10:154–158PubMedCrossRefGoogle Scholar
  26. 26.
    Hering E, Epstein R, Elroy S, Iancu DR, Zelnik N (1999) Sleep patterns in autistic children. J Autism Dev Disord 29: 143–147PubMedCrossRefGoogle Scholar
  27. 27.
    Hollander E, Dolgoff-Kaspar R, Cartwright C, Rawitt R, Novotny S (2001) An open trial of divalproex sodium in autism spectrum disorders. J Clin Psychiatry 62:530–534PubMedCrossRefGoogle Scholar
  28. 28.
    Hrdlicka M, Komarek V, Propper L, Zumrova A, et al. (2004) Not EEG abnormalities but epilepsy is associated with autistic regression and mental functioning in autism. Eur Child Adolesc Psychiatry 13:209–213PubMedCrossRefGoogle Scholar
  29. 29.
    Hughes JR, Melyn M (2005) EEG and seizures in autistic children and adolescents: further findings with therapeutic implications. Clin EEG Neurosci 36:15–20PubMedGoogle Scholar
  30. 30.
    Kanner A (2000) Commentary: the treatment of seizure disorders and EEG abnormalities in children with autistic spectrum disorders: are we getting ahead of ourselves? J Autism Dev Disord 20:491–495CrossRefGoogle Scholar
  31. 31.
    Kosinovsky B, Hermon S, Yoran-Hegesh R, Golomb A, Senecky Y, Goez H, Kramer U (2005) The yield of laboratory investigations in children with infantile autism. J Neural Transm 112:587–596PubMedCrossRefGoogle Scholar
  32. 32.
    Levisohn PM (2004) Electroencephalography findings in autism: similarities and differences from Landau–Kleffner syndrome. Semin Pediatr Neurol 11:218–224PubMedCrossRefGoogle Scholar
  33. 33.
    Lewine JD, Andrews R, Chez M, Patil AA, Devinsky O, Smith M, Kanner A, Davis JT, Funke M, et al. (1999) Magnetoencephalographic patterns of epileptiform activity in children with regressive autistic spectrum disorders. Pediatrics 104: 405–418PubMedCrossRefGoogle Scholar
  34. 34.
    Malow BA (2004) Sleep disorders, epilepsy, and autism. Ment Retard Dev Disabil Res Rev 10:122–125PubMedCrossRefGoogle Scholar
  35. 35.
    Mantovani JF (2000) Autistic regression and Landau–Kleffner syndrome: progress or confusion? Dev Med Child Neurol 42:349–353PubMedCrossRefGoogle Scholar
  36. 36.
    McDougle C, Price L, Volkmar F, Goodman W, et al. (1992) Clorimipramine in autism: preliminary evidence of efficacy. J Am Acad Child Adolesc Psychiatry 31:746–750PubMedCrossRefGoogle Scholar
  37. 37.
    McDougle C, Stigler K, Posey D (2003) Treatment of aggression in children and adolescents with autism and conduct disorders. J Clin Psychiatry 64(S4):16–25PubMedGoogle Scholar
  38. 38.
    Mount RH, Charman T, Hastings RP, et al. (2003) Features of autism in Rett syndrome and severe mental retardation. J Autism Dev Disord 33:435–442PubMedCrossRefGoogle Scholar
  39. 39.
    Mourisden SE, Rich B, Isager T (1999) Epilepsy in disintegrative psychosis and infantile autism: a long term validation study. Dev Med Child Neurol 41:110–114CrossRefGoogle Scholar
  40. 40.
    Muhle R, Trentacoste SV, Rapin I (2004) The genetics of autism. Pediatrics 113:e472–e486PubMedCrossRefGoogle Scholar
  41. 41.
    Nass R, Devinsky O (1999) Autistic regression with rolandic spikes. Neuropsychiatry Neuropsychol Behav Neurol 12:193–197PubMedGoogle Scholar
  42. 42.
    Nass R, Gross A, Devinsky O (1998) Autism and autistic epileptiform regression with occipital spikes. Dev Med Child Neurol 40:453–458PubMedCrossRefGoogle Scholar
  43. 43.
    Nass R, Gross A, Wisoff J, Devinsky O (1999) Outcome of multiple subpial transections for autistic epileptiform regression. Pediatr Neurol 21:464–470PubMedCrossRefGoogle Scholar
  44. 44.
    Neville BG (1999) Magnetoencephalographic patterns of epileptiform activity in children with regressive autism spectrum disorders. Pediatrics 104:558–559PubMedCrossRefGoogle Scholar
  45. 45.
    Olsson I, Steffenburg S, Gillberg C (1988) Epilepsy in autism and autistic-like conditions. A population based study. Arch Neurol 45:666–668PubMedGoogle Scholar
  46. 46.
    Pavone P, Incorpora G, Fiumara A, Parano E, Trifiletti RR, Ruggieri M (2004) Epilepsy is not a prominent feature of primary autism. Neuropediatrics 35:207–210PubMedCrossRefGoogle Scholar
  47. 47.
    Pellock JM (2004) Understanding co-morbidities affecting children with epilepsy. Neurology 62:S17–S23PubMedGoogle Scholar
  48. 48.
    Rapin I (1995) Autistic regression and disintegrative disorder: how important the role of epilepsy? Semin Pediatr Neurol 2:278–285PubMedCrossRefGoogle Scholar
  49. 49.
    Skinnar S, Rapin I, Arnold S, Tuchman RF, Shulman L, Ballaban-Gil K, Maw M, Deuel RK, Volkmar F (2001) Language regression in childhood. Pediatr Neurol 24: 183–189Google Scholar
  50. 50.
    Stefanatos GA, Kinsbourne M, Wasserstein J (2002) Acquired epileptiform aphasia: a dimensional view of Landau–Kleffner syndrome and the relation to regressive autistic spectrum disorders. Neuropsychol Dev Cogn C Child Neuropsychol 8:195–228CrossRefGoogle Scholar
  51. 51.
    Steffenburg S, Steffenburg U, Gillberg C (2003) Autism spectrum disorders in children with active epilepsy and learning disability: comorbidity, pre- and perinatal background, and seizure characteristics. Dev Med Child Neurol 45:724–730PubMedCrossRefGoogle Scholar
  52. 52.
    Tharp BR (2004) Epileptic encephalopathies, their relationship to developmental disorders: do spikes cause autism?. Ment Retard Dev Disabil Res Rev 10:132–134PubMedCrossRefGoogle Scholar
  53. 53.
    Trevathan E (2004) Seizures and epilepsy among children with language regression and autistic spectrum disorders. J Child Neurol 19(Suppl 1):S49–S57PubMedGoogle Scholar
  54. 54.
    Tuchman R, Rapin I (2002) Epilepsy in autism. Lancet Neurol 1:352–358PubMedCrossRefGoogle Scholar
  55. 55.
    Tuchman R, Rapin I (1997) Regression in pervasive developmental disorders: seizures and epileptiform electroencephalogram correlates. Pediatrics 99:560–566PubMedCrossRefGoogle Scholar
  56. 56.
    Tuchman R (2004) AEDs and psychotropic drugs in children with autism and epilepsy. Ment Retard Dev Disabil Res Rev 10:135–138PubMedCrossRefGoogle Scholar
  57. 57.
    Tuchman R (2000) Treatment of seizures disorders and EEG abnormalities in children with autism spectrum disorders. J Autism Dev Disord 20:485–489CrossRefGoogle Scholar
  58. 58.
    Tuchman R, Rapin I, Shinnar S (1991) Autistic and dysphasic children. II. Epilepsy. Pediatrics 6:1219–1225Google Scholar
  59. 59.
    Volkmar F, Nelson D (1990) Seizure disorders in autism. J Amer Acad Child Adolesc Psychiatry 29:127–129CrossRefGoogle Scholar
  60. 60.
    Wong V (1993) Epilepsy in children with autistic spectrum disorder. J Child Neurol 8:313–322Google Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  1. 1.Division of Child NeuropsychiatryGeneral University Hospital of SienaSienaItaly

Personalised recommendations