The Incidence of Epileptic Seizures and/ or Epileptiform EEG Abnormaliti es in Children with Childhood and Atypical Autism


Authors: H. Ošlejšková 1;  L. Dušek 2;  Z. Makovská 1;  E. Dujíčková 1;  R. Autrata 3;  I. Šlapák 4
Authors‘ workplace: Klinika dětské ne urologi e LF MU a FN Brno, Centrum pro epileptologii a epileptochirurgii MU Brno 1;  Centrum bi ostatistiky a analýz LF MU 2;  Dětská oční klinika LF MU a FN Brno 3;  Klinika dětské ORL LF MU a FN Brno 4
Published in: Cesk Slov Neurol N 2008; 71/104(4): 435-444
Category: Original Paper

Overview

In more than 40% of a utistic spectrum disorders (ASD) cases are associ ated with epileptic seizures and, in up to 20%, with epileptiform abnormaliti es in EEG witho ut clinical epileptic seizures. Our study is a retrospective evaluati on of 205 children (145 boys, 60 girls) with ASD aged 10 (and also 5 and 15) years. Signs of an epileptic process (epileptic seizures and/ or epileptiform activity in EEG) were seen in 103 cases (50.2%), epileptic seizures with/ witho ut epileptiform abnormaliti es in the EEG occurred in 64 children (31.2%), and epileptic seizures witho ut epileptiform EEG abnormaliti es occurred in 5 cases (2.4%). Coincidence of signs of an epileptic process and an ASD increased most typically in a subgro up of pati ents with childhood a utism (CA 66.0%) and atypical a utism (AA 30.1%). It was rare in children with Asperger’s syndrome (AS) (N = 4, i.e. 3.9% o ut of total set N = 103 and 19.1% within AS) and above average in a utism with regressi on (41.8%). The most frequent forms of epileptic activity were parti al seizures (46.6%), of these 27.2% were complex parti al seizures and 19.4% simple parti al seizures. Generalized seizures appeared in 29.1%. Of these atonic generalized seizures were present in 11.7%, and infantile spasms in 10.8%. Among the epileptic syndromes (epilepsi es), the most frequently occurring type were parti al seizures –  30.1%, and generalized seizures –  23.3%. Speci al epileptic syndromes (continuo us discharges in slow sleep „CSWS“ and Landa u- Kleffner syndrome) occurred in 3.9%. In o ur study gro up, epilepsy was significantly associ ated with multiple other pathological findings such as abnormal ne urological clinical examinati ons, EEG abnormaliti es (abnormal backgro und, non- specific abnormaliti es), pathological findings on CT and/ or MRI, decreased frequency of right- handed children in the family history. It significantly decreases IQ. The most common types of seizures and epilepsi es and the significant associ ati on between them and abnormal ne urological findings, pathological CT and MRI findings, and abnormal basic activity in ECG points to the fact that o ur study gro up included mainly children with encephalopathy and secondary a utism. In pati ents with epileptic seizures the occurrence of seizures substanti ally predates the age of onset of the first symptoms of a utism recognized by the parents. This informati on concerns a utism with low and mean functi onality, on the contrary, the opposite trend is evident in pati ents with high functi onality. This result does not, however, mean that low and mean functi onality a utism is a result of epilepsy in children.

Key words:
a utism –  secondary a utism –  epileptic seizures –  epileptiform abnormaliti es on EEG –  a utism with regressi on –  Asperger‘s syndrome –  Intelligence Quoti ent –  Childhood Autism Rating Scale


Sources

1. Brimacombe M, Xue Ming, Parikh A. Famili al risk factors in a utism. J Child Ne urol 2007; 22(5): 593−597.

2. Muhle R, Trentacoste SV, Rapin I. The genetics of a utism. Pedi atrics 2004; 113(5): 472−486.

3. Tuchman R, Rapin I. Epilepsy in a utism. Lancet Ne urol 2002; 1(6): 352−358.

4. Besag FM. Behavi oral aspects of pedi atric epilepsy syndromes. Epilepsy Behav. 2004; 5(Suppl 1): S3−13.

5. Deonna T, Ro ulet-Perez E. Cognitive and Behavi o ural Disorders of Epileptic Origin in Children. Clinics in Developmental Medicine No. 168. London: Mac Keith Press 2005.

6. McVicar KA, Ballaban-Gil K, Rapin I, Moshé SL, Shinnar S. Epileptiform EEG abnormaliti es in children with language regressi on. Ne urology 2005; 65(1): 129−131.

7. Baird G, Robinson RO, Boyd S, Charman T. Sleep electroencephalograms in yo ung children with a utism with and witho ut regressi on. Dev Med Child Ne urol 2006; 48(7): 604−608.

8. Canitano R, Luchetti A, Zappella M. Epilepsy, electroencephalographic abnormaliti es, and regressi on in children with a utism. J Child Ne urol 2005; 20(1): 27−31.

9. Zappella M. The questi on of reversible a utistic behavi or in a utism. In: Coleman M (ed). The Ne urology of Autism. Oxford: Oxford University Press 2005: 157−172.

10. World Health Organizati on. ICD-10 Classificati on of Mental and Behavi o ural Disorders. Clinical Descripti ons and Di agnostic Guidelines, Nonseri al Publicati on. Geneva: World Health Organizati on 1992.

11. Mezinárodní klasifikace nemocí, 10. revize. Duševní poruchy a poruchy chování. Popisy klinických příznaků a di agnostická vodítka. Praha: Psychi atrické centrum 1992.

12. Schopler E, Reichler RJ, DeVellis RF, Daly K. Toward objective classificati on of childhood a utism: Childhood Autism Rating Scale (CARS). J Autism Dev Disord 1980; 10(1): 91−103.

13. Scott FJ, Baron-Cohen S, Bolton P, Brayne C. The CAST (Childhood Asperger Syndrome Test): preliminary development of a UK screen for mainstream primary-school-age children. Autism 2002; 6(1): 9−31.

14. DeMyer M, Hingtgen JN, Jackson RK. Infantile a utism revi ewed: a decade of research. Schizophreni a Bull 1981; 7(3): 388−451.

15. Commisi on on Classificati on and terminology of the Internati onal League Against Epilepsy. Proposal for revised clinical and electroencephalographic classificati on of epileptic seizures. Epilepsi a 1981; 22(4): 489−501.

16. Commisi on on Classificati on and terminology of the Internati onal League Against Epilepsy. Proposal for revised classificati on of epilepsi es and epileptic syndromes. Epilepsi a 1989; 30(4): 389−399.

17. Altman DG. Practical Statistics for Medical Research. London: Chapman and Hall 1991.

18. Zar JH. Bi ostatistical Methods. 2nd ed. London: Prentice Hall 1984.

19. Canitano R. Epilepsy in a utism spectrum disorders. Eur Child Adolesc Psychi atry. 2007; 16(1): 61−66.

20. Ming-X, Brimacombe M,Wagner GC. Prevalence of motor impairment in a utism spectrum disorders. Brain Dev 2007; 29(9): 565−570.

21. Volkmar FR, Nelson DS. Seizure disorders in a utism. J Am Acad Child Adolesc Psychi atry 1990; 29(1): 127−129.

22. Clarke DF, Roberts W, Daraksan M, Dupuis A, McCabe J, Wood H et al. The prevalence of a utistic spectrum disorder in children surveyed in a terti ary care epilepsy clinic. Epilepsi a 2005; 46(12): 1970−1977.

23. Riikonen R, Amnell G. Psychi atric disorders in children with earli er infantile spasms. Dev Med Child Ne urol 1981; 23(6): 747−760.

24. Gabis L, Pomeroy J, Andri ola MR. Autism and epilepsy: ca use, consequence, comorbidity, or coincidence? Epilepsy Behav 2005; 7(4): 652−656.

25. Tuchman RF, Rapin I, Shinnar S. Autistic and dysphasic children. II: Epilepsy. Pedi atrics 1991; 88(6): 1219−1225.

26. Tuchman RF, Rapin I. Regressi on in pervasive developmental disorders: seizures and epileptiform electroencephalogram correlates. Pedi atrics 1997; 99(4): 560−566.

27. Hughes JR, Melyn M. EEG and seizures in a utistic children and adolescents: further findings with therape utic implicati ons. Clin EEG Ne urosci 2005; 36(1): 15−20.

28. Wrong V. Epilepsy in childreen with a utistic spectrum disorder. J Child Ne urol 1993; 8(4): 316−322.

29. Steffenburg S, Gillberg C, Steffenburg U. Psychi atric disorders in children and adolescents with mental retardati on and active epilepsy. Arch Ne urol 1996; 53(9): 904−912.

30. Curatalo P, Cusmai R. Autism and infantile spasms in children with tubero us sclerosis. Dev Med Child Ne urol 1987; 29(4): 551.

31. Dani elsson S, Gillberg IC, Bill­stedt E, Gillberg C, Olsson I. Epilepsy in yo ung adults with a utism: a prospective populati on- based follow-up study of 120 individuals di agnosed in childhood. Epilepsi a 2005; 46(6): 918−923.

32. Coleman M. The Ne urology of Autism. New York: Oxford University Press 2005.

33. Pavone P, Incorpora G, Fi umara A, Parano E, Trifiletti RR, Ruggi eri M. Epilepsy is not a prominent feature of primary a utism. Ne uropedi atrics 2004; 35(4): 207−210.

34. Saemundsen E, Ludvigsson P, Hilmarsdottir I, Rafnsson V. Autism spectrum disorders in children with seizures in the first year of life –  a populati on-based study. Epilepsi a 2007; 48(9): 1724−1730.

35. Hara H. Autism and epilepsy: a retrospective follow-up study. Brain Dev 2007; 29(8): 486−490.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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