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EEG Abnormalities as a Neurophysiological Biomarker of Severity in Autism Spectrum Disorder: A Pilot Cohort Study


To date, the phenotypic significance of EEG abnormalities in patients with ASD is unclear. In a population affected by ASD we aimed to evaluate: the phenotypic characteristics; the prevalence of EEG abnormalities; the potential correlations between EEG abnormalities and behavioral and cognitive variables. Sixty-nine patients with ASD underwent cognitive or developmental testing, language assessment, and adaptive behavior skills evaluation as well as sleep/wake EEG recording. EEG abnormalities were found in 39.13% of patients. EEG abnormalities correlated with autism severity, hyperactivity, anger outbursts, aggression, negative or destructive behavior, motor stereotypies, intellectual disability, language impairment and self-harm. Our findings confirmed that EEG abnormalities are present in the ASD population and correlate with several associated phenotypic features.

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  1. Akshoomoff, N., Farid, N., Courchesne, E., & Haas, R. (2007). Abnormalities on the neurological examination and EEG in young children with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 37(5), 887–893.

  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders firth edition (DSM-5). Washington DC: APA.

  3. Archer, T., & Garcia, D. (2016). Attention-Deficit/hyperactivity disorder: Focus upon aberrant N-methyl-d-aspartate receptors systems. Current Topics in Behavioral Neurosciences, 29, 295–311.

  4. Baglietto, M. G., Battaglia, F. M., Nobili, L., et al. (2001). Neuropsychological disorders related to interictal epileptic discharges during sleep in benign epilepsy of childhood with centrotemporal or Rolandic spikes. Developmental Medicine & Child Neurology, 43(6), 407–412.

  5. Baird, G., Robinson, R. O., Boyd, S., & Charman, T. (2006). Sleep electroencephalograms in young children with autism with and without regression. Developmental Medicine & Child Neurology, 48(7), 604–608.

  6. Bernard, P. B., Castano, A. M., O’Leary, H., Simpson, K., Browning, M. D., & Benke, T. A. (2013). Phosphorylation of FMRP and alterations of FMRP complex underlie enhanced mLTD in adult rats triggered by early life seizures. Neurobiology of Disease, 59, 1–17.

  7. Canitano, R., Luchetti, A., & Zappella, M. (2005). Epilepsy, electroencephalographic abnormalities, and regression in children with autism. Journal of Child Neurology, 20(1), 27–31.

  8. Capal, J. K., Carosella, C., Corbin, E., Horn, P. S., Caine, R., & Manning-Courtney, P. (2018). EEG endophenotypes in autism spectrum disorder. Epilepsy & Behavior, 88, 341–348.

  9. Caselli, M. C., & Casadio, P. (1995). Il primo vocabolario del bambino. Guida all’uso del questionario MacArthur per la valutazione della comunicazione e del linguaggio nei primi anni di vita. Milano: Franco Angeli.

  10. Chez, M. G., Chang, M., Krasne, V., Coughlan, C., Kominsky, M., & Schwartz, A. (2006). Frequency of epileptiform EEG abnormalities in a sequential screening of autistic patients with no known clinical epilepsy from 1996 to 2005. Epilepsy & Behavior, 8(1), 267–271.

  11. Cianchetti, C., & Fancello, G. S. (1997) TVL-Test di Valutazione del Linguaggio. Trento: Erickson.

  12. Deonna, T., & Roulet-Perez, E. (2010). Early-onset acquired epileptic aphasia (Landau-Kleffner syndrome, LKS) and regressive autistic disorders with epileptic EEG abnormalities: the continuing debate. Brain & Development, 32(9), 746–752.

  13. Deonna, T., Zesiger, P., Davidoff, V., Maeder, M., Mayor, C., & Roulet, E. (2000). Benign partial epilepsy of childhood: A longitudinal neuropsychological and EEG study of cognitive function. Developmental Medicine & Child Neurology, 42(9), 595–603.

  14. Dorothy, V., & Bishop, M. (2009). TROG-2 Test for Reception of Grammar-Version 2. Edizione italiana: Silvana Suraniti, Raffaele Ferri, Vincenzo Ferri. OS Giunti Firenze.

  15. Fonseca, L. C., Tedrus, G. M., & Pacheco, E. M. (2007). Epileptiform EEG discharges in benign childhood epilepsy with centrotemporal spikes: Reactivity and transitory cognitive impairment. Epilepsy & Behavior, 11(1), 65–70.

  16. Frye, R. E., Rossignol, D., Casanova, M. F., et al. (2013). A review of traditional and novel treatments for seizures in autism spectrum disorder: Findings from a systematic review and expert panel. Frontiers in Public Health, 1, 31.

  17. Frye, R. E., Sreenivasula, S., & Adams, J. B. (2011). Traditional and non-traditional treatments for autism spectrum disorder with seizures: An on-line survey. BMC Pediatrics, 11, 37.

  18. Gabis, L., Pomeroy, J., & Andriola, M. R. (2005). Autism and epilepsy: Cause, consequence, comorbidity, or coincidence? Epilepsy & Behavior, 7(4), 652–656.

  19. Giovanardi Rossi, P., Posar, A., & Parmeggiani, A. (2000). Epilepsy in adolescents and young adults with autistic disorder. Brain & Development, 22(2), 102–106.

  20. Griffiths, R. (1996). GMDS-ER, Griffiths Mental Development Scales-Extended Revised. Giunti OS-Firenze.

  21. Hagerman, R. J. (2013). Epilepsy drives autism in neurodevelopmental disorders. Developmental Medicine & Child Neurology, 55(2), 101–102.

  22. Hagerman, R. J., Berry-Kravis, E., Hazlett, H. C., et al. (2017). Fragile X syndrome. Nature Reviews Disease Primers, 3, 17065.

  23. Hancock, E. C., & Cross, J. H. (2013). Treatment of Lennox–Gastaut syndrome. Cochrane Database of Systematic Reviews, 2, CD003277.

  24. Hartley-McAndrew, M., & Weinstock, A. (2010). Autism spectrum disorder: Correlation between aberrant behaviors, EEG abnormalities and seizures. Surgical Neurology International, 2(1), e10.

  25. Hernan, A. E., Alexander, A., Jenks, K. R., et al. (2014). Focal epileptiform activity in the prefrontal cortex is associated with long-term attention and sociability deficits. Neurobiology of Disease, 63, 25–34.

  26. Hrdlicka, M., Komarek, V., Propper, L., et al. (2004). Not EEG abnormalities but epilepsy is associated with autistic regression and mental functioning in childhood autism. Eur Child and Adolescent Psychiatry, 13(4), 209–213.

  27. Hughes, J. R., & Melyn, M. (2005). EEG and seizures in autistic children and adolescents: Further findings with therapeutic implications. Clinical EEG Neuroscience, 36(1), 15–20.

  28. Kawasaki, Y., Yokota, K., Shinomiya, M., Shimizu, Y., & Niwa, S. (1997). Brief report: Electroencephalographic paroxysmal activities in the frontal area emerged in middle childhood and during adolescence in a follow-up study of autism. Journal of Autism and Developmental Disorders, 27(5), 605–620.

  29. Kim, H. L., Donnelly, J. H., Tournay, A. E., Book, T. M., & Filipek, P. (2006). Absence of seizures despite high prevalence of epileptiform EEG abnormalities in children with autism monitored in a tertiary care center. Epilepsia, 47(2), 394–398.

  30. Lee, C. H., Lim, S. N., Lien, F., & Wu, T. (2013). Duration of electroencephalographic recordings in patients with epilepsy. Seizure, 22(6), 438–442.

  31. Lesch, K. P. (2016). Maturing insights into the genetic architecture of neurodevelopmental disorders—from common and rare variant interplay to precision psychiatry. J Child Psychology Psychiatry, 57(6), 659–661.

  32. Lloyd, M. D. (2000). Peabody-Test di vocabolario recettivo. Edizione italiana: G. Stella, C. Pizzioli, Patrizio E. Tressoldi.

  33. Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2013). Autism diagnostic observation schedule (Second edn.). Los Angeles: Western Psychological Services. Edizione Italiana Colombi, Tancredi, Persico e Faggioli, Hogrefe Editore Firenze.

  34. LoRusso, M. P. (2009). Abilità Pragmatiche nel Linguaggio. Giunti OS: APL Medea.

  35. Losey, T. E., & Uber-Zak, L. (2008). Time to first interictal epileptiform discharge in extended recording EEGs. Journal of Clinical Neurophysiology, 25(6), 357–360.

  36. McVicar, K. A., Ballaban-Gil, K., Rapin, I., Moshé, S. L., & Shinnar, S. (2005). Epileptiform EEG abnormalities in children with language regression. Neurology, 65(1), 129–131.

  37. Millichap, J. G., & Millichap, J. J. (2015). Indications for an EEG in a Child with ADHD. Pediatric Neurology Briefs, 29(5), 39.

  38. Mulligan, C. K., & Trauner, D. A. (2014). Incidence and behavioral correlates of epileptiform abnormalities in autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(2), 452–458.

  39. Narayanan, J. T., Labar, D. R., & Schaul, N. (2008). Latency to first spike in the EEG of epilepsy patients. Seizure, 17(1), 34–41.

  40. Parmeggiani, A., Posar, A., Antolini, C., Scaduto, M. C., Santucci, M., & Giovanardi-Rossi, P. (2007). Epilepsy in patients with pervasive developmental disorder not otherwise specified. J Child Neurol, 22(10), 1198–1203.

  41. Roid, H. G., & Miller, J. (1997) Leiter international performance scale-revised. Giunti OS: Firenze.

  42. Rossi, P. G., Parmeggiani, A., Bach, V., Santucci, M., & Visconti, P. (1995). EEG features and epilepsy in patients with autism. Brain & Development, 17(3), 169–174.

  43. Rutter, M., Bailey, A., & Lord, C. (2003). ADI-R: The autism diagnostic interview-revied. Los Angeles, CA: Western Psychological Services. Edizione italiana a cura di Faggioli, Saccani, Persico, Tancredi, Parrini e Igliozzi. Organizzazioni Speciali-Firenze.

  44. Saemundsen, E., Ludvigsson, P., & Rafnsson, V. (2007). Autism spectrum disorders in children with a history of infantile spasms: A population-based study. Journal of Child Neurology, 22(9), 1102–1107.

  45. Schopler, E., VanBourgondien, M. E., Wellman, G., & Love, S. R. (2014). CARS2. Childhood autism rating scale. Giunti, OS: Firenze.

  46. Sidenvall, R., & Eeg-Olofsson, O. (1995). Epidemiology of infantile spasms in Sweden. Epilepsia, 36(6), 572–574.

  47. Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (2003). Vineland adaptive behavior scales. Giunti, OS: Firenze.

  48. Spence, S. J., & Schneider, M. T. (2009). The role of epilepsy and epileptiform EEGs in autism spectrum disorders. Pediatric Research, 65(6), 599–606.

  49. Stefanatos, G. (2011). Changing perspectives on Landau-Kleffner syndrome. The Clinical Neuropsychologist, 25(6), 963–988.

  50. Trauner, D. A. (2015). Behavioral correlates of epileptiform abnormalities in autism. Epilepsy & Behavior, 47, 163–166.

  51. Tuchman, R., & Rapin, I. (2002). Epilepsy in autism. The Lancet Neurology, 1(6), 352–358.

  52. van Eeghen, A. M., Pulsifer, M. B., Merker, V. L., et al. (2013). Understanding relationships between autism, intelligence, and epilepsy: a cross-disorder approach. Developmental Medicine & Child Neurology, 55(2), 146–153.

  53. Veerappan, V. D., Sweetha, B., Kavitha, H. R., Sivalingam, B., Nambi, S., & Pauline, L. (2018). Two-Year follow-up of isolated epileptiform discharges in autism: An endophenotypic biomarker? Indian Journal of Psychological Medicine, 40, 219–224.

  54. Volkmar, F. R., & Nelson, D. S. (1990). Seizure disorders in autism. Journal of the American Academy of Child and Adolescent Psychiatry, 29(1), 127–129.

  55. Wechsler, D. (2008). WAIS-IV: Administration and scoring manual. New York: The Psychological Corporation.

  56. Wechsler, D. (2008). WPPSI-III, Wechsler preschool and primary scale of intelligence-III. Giunti OS: Firenze.

  57. Wechsler, D. (2012). WISC-IV, Wechsler intelligence scale for children. Giunti OS: Firenze .

  58. Yasuhara, A. (2010). Correlation between EEG abnormalities and symptoms of autism spectrum disorder (ASD). Brain & Development, 32(10), 791–798.

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This research did not receive any specific Grant from any funding agency in the public, commercial or not-for-profit sector. The authors have no financial relationship relevant to this article to disclose.

Author information

AGN and SAM conceived and planned the study. AGN wrote the manuscript. SAM and RJH supervised the project. SDN was involved in statistical analyses. AGN, MVC and SAM contributed to interpretation data. SB, ES, SG, GDV, and EML contributed to acquisition data. All authors read and approved the final manuscript.

Correspondence to Antonio Gennaro Nicotera.

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Nicotera, A.G., Hagerman, R.J., Catania, M.V. et al. EEG Abnormalities as a Neurophysiological Biomarker of Severity in Autism Spectrum Disorder: A Pilot Cohort Study. J Autism Dev Disord 49, 2337–2347 (2019).

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  • Autism spectrum disorder
  • Biomarker
  • Epileptiform abnormalities
  • Hyperactivity
  • Phenotype