Epilepsy and Autism: Is There a Relationship?

What is Epilepsy?

• Seizures: abnormal electrical firing from the brain
• Epilepsy: recurrent seizures
• Approximately 1-2% of children are diagnosed with epilepsy

What is Autism Spectrum Disorders?

• Autism Spectrum Disorders (ASD): developmental dysfunction involving social, speech, cognition and behavioral disabilities
• About 0.1% of children have ASD worldwide
• In the United States, about 1.5% of children have ASD

Is there a connection?

• Yes, there is an association between epilepsy and autism.
• Children with autism are (a little) more likely to have epilepsy.
• Children with epilepsy are (a little) more likely to have autism.
• Seizures are the most common neurologic complication in ASD.

Do all children with autism have seizures?

• No. Not all autistic children will develop seizures. In fact, only a minority will.
• Similarly, not all children with epilepsy will have autism. Only a small minority.
• Approximately a third of the autistic spectrum also have epilepsy.

Are some people with ASD more prone to seizures than others?

• Yes, some genetic disorders are associated with both seizures and autism, including Rett’s, Fragile X, Angelman, Prader-Willi and many other syndromes.
• Children with characteristics that suggest these disorders should undergo genetic testing.

Is there a specific type of seizure associated with ASD?

• No, there is no one type of seizure in ASD.
• Seizures can be focal or generalized.
• Includes focal onset impaired awareness (complex partial), absence, tonic-clonic, and atonic just to name a few.

Are seizures in people with ASD more severe?

• Generally no, but it is variable.
• Some seizures are easily controlled and others are intractable.
• There is higher mortality and morbidity (rate of disease) associated with seizures in ASD.

What should parents look for?

• It may be difficult to recognize seizure activity in ASD, because of the communication barriers and overlap of symptoms with frequent abnormal behaviors.
• For example, repetitive purposeless behaviors of autism can resemble automatisms seen in seizures.
• Cognitive delay, impaired social interactions, and aggressive and irritable behavior seen in children with epilepsy can also be seen with ASD, thus it is difficult to discern the cause.
• Red flags to note for seizures:
  • Staring episodes (which could be signs of absence or atypical absence seizures)
  • Stiffening (which could be a sign of tonic seizures)
  • Rhythmic shaking or twitching (which could be a sign of focal aware/simple partial seizures)
  • Loss of attention (which could be a sign of absence or focal impaired awareness/complex partial seizures)

What can be done?

Epilepsy associated with ASD does not change the evaluation or management of seizures.

• Medical evaluation with brain imaging and EEG (electroencephalogram)
• Anti-epileptic drugs for treatment
• Adjunctive non-pharmacologic therapy can be considered if medications fail (ketogenic diet, vagus nerve stimulation)
• Safety measures by caregivers: avoid restraining child, move large objects from area to avoid injury, turn child on his or her side, ensure nothing in mouth to avoid choking. Learn more care and comfort first aid.