Document Type : original article
Authors
1 Associated Professor of Pediatric Neurology, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
2 Assistant Professor of Psychiatry (Child and Adolescent), Research Center of Psychiatry and Behavioral Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
3 Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Abstract
Background: The need for early detection and supportive therapy of Autism Spectrum Disorder (ASD) underlined the influence of screening for ASD in children with epilepsy as well as screening for epilepsy in ASD. This study aimed to explore the prevalence of autism in epileptic children in the northwest of Iran.
Methods: A case-control study was performed on 80 children aged 16 to 30 months, consisting of 40 with epilepsy as the case group and 40 with febrile seizure as a control group. The case group included children diagnosed with epilepsy, and the control group comprised children with recurrent febrile seizures who were matched by age and sex. Two questionnaires, Ages and Stages Questionnaire (ASQ) and Modified Checklist for Autism in Toddlers (m-CHAT), were utilized for developmental assessment and ASD screening, respectively. An experienced child and adolescent psychiatrist clinically diagnosed autism through relevant DSM-5 criteria.
Results: The studied children comprised 22 (55%) males and 18 (45%) females. Based on the M-CHAT screening questionnaire, 19 (47.5%) patients in the case group were positive for ASD. M-CHAT-positive patients were referred to the comprehensive autism center, and of whom, 4 (10%) patients met DSM-5 diagnostic criteria for ASD (definite ASD). In epileptic children with developmental delay, the overall prevalence of definite ASD was 18.2%.
Conclusion: The present study showed a high prevalence of autism among epileptic children, especially in developmentally delayed children; this demonstrated the need for autism screening in epileptic patients.
Keywords
- Lord C, Brugha TS, Charman T, Cusack J, Dumas G, Frazier T, et al. Autism spectrum disorder. Nature reviews Disease primers. 2020 Jan 16;6(1):1-23.
- Sabaie H, Dehghani H, Shiva S, Asadi MR, Rezaei O, Taheri M, et al. Mechanistic insight into the regulation of immune-related genes expression in autism spectrum disorder. Frontiers in Molecular Biosciences. 2021 Oct 21;8:754296.
- Lukmanji S, Manji SA, Kadhim S, Sauro KM, Wirrell EC, Kwon CS, et al. The co-occurrence of epilepsy and autism: A systematic review. Epilepsy & Behavior. 2019 Sep 1;98:238-48.
- Besag FM, Vasey MJ. Seizures and epilepsy in autism spectrum disorder. Child and Adolescent Psychiatric Clinics. 2020 Jul 1;29(3):483-500.
- Holmes H, Sawer F, Clark M. Autism spectrum disorders and epilepsy in children: A commentary on the occurrence of autism in epilepsy; how it can present differently and the challenges associated with diagnosis. Epilepsy & Behavior. 2021 Apr 1;117:107813.
- Nadkarni S, LaJoie J, Devinsky O. Current treatments of epilepsy. Neurology. 2005 Jun 28;64(12_suppl_3):S2-11.
- Shiva S, Gharesouran J, Sabaie H, Asadi MR, Arsang-Jang S, Taheri M, et al. Expression analysis of Ermin and listerin E3 ubiquitin protein ligase 1 genes in autistic patients. Frontiers in Molecular Neuroscience. 2021 Jul 19;14:701977.
- Jeste SS, Tuchman R. Autism spectrum disorder and epilepsy: two sides of the same coin?. Journal of child neurology. 2015 Dec;30(14):1963-71.
- Matos MB, Liberalesso PB, Bara TD, Gomes PC, Zeigelboim BS, Marques JM, et al. Risk of autism spectrum disorder in children with infantile epileptic spasms syndrome: a retrospective study in a single center in Brazil. Jornal de Pediatria. 2024 Sep 23;100(5):552-6.
- Loughman A, Bowden SC, D'souza W. Cognitive functioning in idiopathic generalised epilepsies: a systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews. 2014 Jun 1;43:20-34.
- Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies.
- Frazier TW, Youngstrom EA, Speer L, Embacher R, Law P, Constantino J, et al. Validation of proposed DSM-5 criteria for autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 2012 Jan 1;51(1):28-40.
- Tuchman R. What is the relationship between autism spectrum disorders and epilepsy?. InSeminars in pediatric neurology 2017 Nov 1 (Vol. 24, No. 4, pp. 292-300). WB Saunders.
- Besag F. The relationship between epilepsy and autism: a continuing debate. Acta Paediatrica. 2009 Apr 1;98(4).
- Reilly C, Atkinson P, Memon A, Jones C, Dabydeen L, Cross JH, et al. Autism, ADHD and parent-reported behavioural difficulties in young children with epilepsy. Seizure. 2019 Oct 1;71:233-9.
- Berg AT, Plioplys S, Tuchman R. Risk and correlates of autism spectrum disorder in children with epilepsy: a community-based study. Journal of child neurology. 2011 May;26(5):540-7.
- Jokiranta E, Sourander A, Suominen A, Timonen-Soivio L, Brown AS, Sillanpää M. Epilepsy among children and adolescents with autism spectrum disorders: a population-based study. Journal of autism and developmental disorders. 2014 Oct;44:2547-57.
- Fisher B, Dezort C, Nordli DR, Berg AT. Routine developmental and autism screening in an epilepsy care setting. Epilepsy & Behavior. 2012 Aug 1;24(4):488-92.
- Catarino CB, Liu JY, Liagkouras I, Gibbons VS, Labrum RW, Ellis R, et al. Dravet syndrome as epileptic encephalopathy: evidence from long-term course and neuropathology. Brain. 2011 Oct 1;134(10):2982-3010.
- Chu‐Shore CJ, Major P, Camposano S, Muzykewicz D, Thiele EA. The natural history of epilepsy in tuberous sclerosis complex. Epilepsia. 2010 Jul;51(7):1236-41.
- El Achkar CM, Spence SJ. Clinical characteristics of children and young adults with co-occurring autism spectrum disorder and epilepsy. Epilepsy & Behavior. 2015 Jun 1;47:183-90.
- Berg AT, Plioplys S. Epilepsy and autism: is there a special relationship?. Epilepsy & Behavior. 2012 Mar 1;23(3):193-8.
- Werling DM, Geschwind DH. Sex differences in autism spectrum disorders. Current opinion in neurology. 2013 Apr 1;26(2):146-53.
- Viscidi EW, Johnson AL, Spence SJ, Buka SL, Morrow EM, Triche EW. The association between epilepsy and autism symptoms and maladaptive behaviors in children with autism spectrum disorder. Autism. 2014 Nov;18(8):996-1006.
- Strasser L, Downes M, Kung J, Cross JH, De Haan M. Prevalence and risk factors for autism spectrum disorder in epilepsy: a systematic review and meta‐analysis. Developmental Medicine & Child Neurology. 2018 Jan;60(1):19-29.
- Parmeggiani A, Barcia G, Posar A, Raimondi E, Santucci M, Scaduto MC. Epilepsy and EEG paroxysmal abnormalities in autism spectrum disorders. Brain and Development. 2010 Oct 1;32(9):783-9.