Autistic spectrum disorders in childhood epilepsy surgery candidates

One third of children with autistic spectrum disorders (or pervasive developmental disorders) enter that state by regression from a more normal prior development at the onset of epilepsy or epileptiform abnormality in the electroencephalogram. In a very small proportion structural lesions of the temporal lobes are discovered. These form part of the sample of children coming to a surgical treatment programme. Ninety-eight child candidates for epilepsy surgery were seen by one neuropsychiatrist. Their psychiatric diagnoses were coded on DSM IV schedules. Other variables of interest were the age at onset of epilepsy; the nature, the side, and time of acquisition of the lesion; intelligence, and sex. There were 19 children with autistic spectrum disorders including eight with Asperger's syndrome. Ten of the children in the autistic group had right brain lesions; six were dysembryoplastic neuroepithelial tumours (DNETs); two were cortical dysplasias; one tuberous sclerosis; one hemi-cortical defect; and 1 mesial temporal sclerosis. Nine started epilepsy in their first year; nine had IQs in the retarded range; nine of the 11 were male. Six of eight Asperger's children had right brain lesions; two DNETs; four mesial temporal sclerosis; one Rasmussen encephalitis. Four started epilepsy in their first year; one was retarded; five were female. Children who had no, or other, psychiatric disorder also showed "mass" lesions, or temporal sclerosis but with different biases as to side, sex, and very early onset of epilepsy from the autistic spectrum group. Very early onset of epilepsy, with lesions of embryonal origin, in the right temporal lobe, strongly predisposed males towards autistic regression. Such patients should be referred very early for consideration of urgent surgical treatment.