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Published on: September 20, 2024
Clinical features and drug-resistance in pediatric epilepsy with co-occurring autism: A retrospective comparative
Karen Lob1, Tao Hou2, Tzu-Chun Chu3
1The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Insights
Children with autism and epilepsy show distinct seizure types and MRI findings compared to those without autism. Detailed seizure history and EEG are key for predicting drug-resistant epilepsy in this population.
Area of Science:
- Neurology
- Developmental Neuroscience
- Pediatric Epilepsy
Background:
- Epilepsy and autism spectrum disorder (ASD) frequently co-occur in children.
- Understanding the distinct phenotypic and management differences is crucial for optimizing care.
Purpose of the Study:
- To compare phenotypic characteristics and real-world management of epilepsy in children with and without co-occurring autism.
- To identify predictors of drug-resistant epilepsy (DRE) in children with both conditions.
Main Methods:
- Retrospective comparative cohort study involving 156 children with epilepsy and autism, and 156 matched controls with epilepsy only.
- Comparison of clinical variables, EEG, MRI, genetic results, and treatments.
- Logistic regression analysis to identify DRE predictors.
Main Results:
- Children with autism showed a trend towards more generalized motor seizures and fewer electroclinical syndromes.
- Incidental MRI findings were more common, but epilepsy-explanatory MRI findings were less frequent in children with autism.
- While DRE rates were similar, distinct clinical and electrographic correlates for DRE were identified in children with autism.
Conclusions:
- Detailed seizure history and EEG findings are paramount for evaluating and predicting DRE in children with epilepsy and co-occurring autism.
- Further research into epilepsy within specific autism subgroups is warranted.
Objective:
We conducted a retrospective comparative cohort study to determine the phenotypic and real-world management differences in children with epilepsy and co-occurring autism as compared to those without autism.
Methods:
Clinical variables, EEG, brain MRI, genetic results, medical and non-medical treatment were compared between 156 children with both epilepsy and autism, 156 randomly selected and 156 demographically matched children with epilepsy only. Logistic regression analyses were conducted to determine predictors of drug-resistant epilepsy (DRE).
Results:
As compared to the'matched' cohort, more patients with autism had generalized motor seizures although not statistically significant after Benjamini-Hochberg correction (54.5%, vs 42.3%, p = .0314); they had a lower rate of electroclinical syndromes (12.8%, vs 30.1%, p = .0002). There were more incidental MRI findings but less positive MRI findings to explain their epilepsy in children with autism (26.3%, vs 13.8% and 14.3%, vs 34.2%, respectively; p = .0003). In addition, LEV, LTG, and VPA were the most common ASMs prescribed to children with autism, as opposed to LEV, OXC, and LTG in children without autism. No difference in the major EEG abnormalities was observed. Although the rates of DRE were similar (24.8%, vs 26.6%, p = .7203), we identified two clinical and five electrographic correlates with DRE in children with both epilepsy and autism and a final prediction modeling of DRE that included EEG ictal findings, focal onset seizures, generalized motor seizures, abnormal EEG background, age of epilepsy onset, and history of SE, which were distinct from those in children without autism.
Significance:
Our study indicates that detailed seizure history and EEG findings are the most important evaluation and prediction tools for the development of DRE in children with epilepsy and co-occurring autism. Further studies of epilepsy in specific autism subgroups based on their etiology and clinical severity are warranted.
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