Epilepsy affects 20- 33% of people with autism, compared to an estimated 1-2% of the general population.

Epilepsy, or seizure disorder, was the first medical condition clearly connected to autism. (Gubbay 1970) Emotionally cold parenting and autism is a false theory because there’s evidence that autism is a neurodevelopmental condition (affecting the brain development).

The overlap of autism and epilepsy appears to be most common in people who also have intellectual disability. (Amiet 2008)

Intellectual disability is defined as an IQ score below 70, along with challenges or difficulties performing everyday functions.  Intellectual disability affects an estimate 32% of people with autism. (Christensen 2016)

Diagnosis and treating epilepsy effectively with autism is important, to prevent the potential for brain damage and death from uncontrolled seizures.  A review of 21 studies in 2012 found out that death due to epilepsy was 7-30% among people with autism. (Woolfenden 2012)  There are a few studies on children with autism, epilepsy and sleep disorders – researchers suggest that it’s a vicious cycle – uncontrolled seizures affect sleep and disrupted sleep increases seizures. (Malow 2004)

How to recognize epilepsy in someone with autism

The association between epilepsy and autism is well known. The most challenging part is the diagnosis because seizures are not always outwardly evident, which makes it even more challenging to identify.

Seizures begin at any age, though researchers have identified them in two peaks, onset among children with autism – preschool and in adolescence.  (Rossi 2000)

Characteristic symptoms include:

  • Unexplained staring spells
  • Stiffening of muscles
  • Involuntary jerking of limbs

 

Other less-specific symptoms can include:

  • Sleepiness or sleep disturbances
  • Marked and unexplained irritability or aggressiveness
  • Regression in normal development

Severity of autism with epilepsy varies widely. It is important for experts to identify seizures and its affects by pinpointing where they begin in the brain.  This helps experts choose seizure medication, potential benefits of epilepsy surgery, outlook and possible causes. (Fisher 2017)

 

Diagnosing and treating epilepsy in those affected by autism

A neurologist’s evaluation for any suspicion of seizures is crucial. He/she may order an Electroencephalogram (EEG), a non-invasive process that involves placing electrodes on the head to monitor activity in the brain.  An analysis of the EEG patterns will help them identify altered brain activities of concern.  For people with autism, sensory and communication is often challenging, hence EEG protocols address these issues.  (Katz 2015)

Treatment principles for people with autism is similar to the treatment of epilepsy.  Depending on the severity, type of seizure and EEG patterns health care professionals prescribe anti-epileptic medications.

Anti-epileptic medication does not cure epilepsy.  The treatment goal is to minimize seizure episodes. Once the medication course is initiated, the neurologist works closely with the patient and his family to understand its effectiveness and side effects.  They also try and minimize side effects by prescribing a low dose and slowly increasing as per the requirement.  Common side effects include dizziness, mild to moderate fatigue, abdominal discomfort.  The titration of the medication is customized to arrive at an optimal dose and to take control of seizures over time.

It is found that anti-epileptic drugs eliminate seizures in around two-thirds of patients.  Sometimes a combination of two or more medications is prescribed to control seizures.  If the patient fails to respond, then other options are discussed.  Including the vagus nerve stimulation, a technique that prevents seizures by sending pules of electrical energy to the brain through a device that acts like a “pacemaker” for the brain.  The other option is the surgical removal of seizure-producing areas of the brain. (Morris 1999)

Research on epilepsy and autism

Certain gene mutations, or changes in the DNA, increase the occurrence of both epilepsy and autism.  These genes cause rare syndromes whose symptoms frequently include both conditions.  The syndromes include tuberous sclerosis and fragile X syndrome and cortical dysplasia-focal epilepsy. (Garcia – Nonell 2008, Huang 2015, Poot 2015) The treatment can be potential, by personalizing and specifically targeting the affected brain networks of the patient.

 

Sri Lakshmi H A  (Senior Nutritionist)