autism

Morrison-Levy N, Go C, Ochi A, Otsubo H, Drake J, Rutka J, Weiss SK. Epilepsy & Behavior, 85 (2018) 200-204.

Epilepsy is common in children diagnosed with autism spectrum disorder (ASD). About 1 out of 3 children with ASD also have a diagnosis of epilepsy. In addition, 1 out of 3 children with ASD and epilepsy have drug resistant epilepsy. This means their seizures are not well controlled by anti-seizure medications.

Prior studies in children with drug resistant epilepsy who are candidates for resective epilepsy surgery (removal of a lesion or an area of brain where seizures begin) have shown that surgery can provide significant benefit for many. If a child has a lesion that is responsible for causing seizures and the lesion is removed, up to 70% of these children can become seizure-free. When a lesion is not found, but an area of the brain is identified as causing seizures, resective surgery can result in seizure freedom for 45% of these children.

Studies have also shown that children who are not good candidates for resective epilepsy surgery may be helped by other options, such as corpus callosotomy or the placement of a vagus nerve stimulator (VNS).

Purpose

The goal of this study was to evaluate a group of children with both ASD and drug resistant epilepsy after epilepsy surgery to determine what factors may predict the best outcome.

Description of Study

  • The medical charts of 29 children who had undergone epilepsy surgery or VNS device for seizure management were reviewed.
  • All children had a diagnosis of drug resistant epilepsy and ASD.
  • Children were between 2 and 18 years of age.
  • The study included children who were seen over a 15 year time period (2000-2015) at a tertiary care hospital.
  • All children had at least one year of follow up after resective surgery, VNS placement, or corpus callosotomy. The range of follow up was 1-6 years.
  • Information looked at included
  • Seizure control classified as
    • Seizure free
    • Rare disabling seizures
    • Worthwhile improvement
    • No improvement

Summary of Study Findings

  • 15 children had resective surgery; 14 children had a VNS placed; 1 child had corpus callosotomy surgery
  • 35% of children who had resective surgery had the best possible outcome and were seizure-free
  • In addition, the average number of anti-seizure medications used after post surgical resection decreased.
  • Of the total group of 29 children, 66% benefited from epilepsy surgery or a VNS device with outcomes ranging from becoming seizure-free to having worthwhile improvement.
  • Seizure-free outcomes occurred more frequently in younger children.
  • In the group of children who had a VNS placed, half had worthwhile improvement in their seizure outcome. No children were seizure free after VNS placement.

What does this mean?

  • It is important to screen children with ASD and drug resistant epilepsy for epilepsy surgery or treatment with a device.
  • This study suggests children with ASD and drug resistant seizures can benefit from resective surgery.
  • This study supports that children who have good surgical results can decrease the amount of seizure medication needed to control their seizures.
  • Placement of VNS in children with ASD and drug resistant epilepsy may be helpful for seizure control.
  • While more research is needed, parents of children with autism and drug resistant epilepsy should talk to their epilepsy team to learn about all options for treatment.

Article published in Epilepsy & Behavior, August 2018.

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Authored By: 
Elaine Kiriakopoulos MD, MSc
Authored Date: 
09/2018
Reviewed By: 
Joseph I. Sirven MD
on: 
Sunday, September 16, 2018