Autism spectrum disorders and epilepsy: dual diagnosis and therapeutic strategies (literature review)

Abstract

Autism spectrum disorders (ASD) are characterized by significant genetic and clinical polymorphism, comorbidity with neurological and mental disorders. In children with ASD, hotbeds of epileptiform and specific epileptic activity are often registered on the electroencephalogram (EEG), which have a causal relationship with behavioral and emotional disorders. The presence of specific epileptic activity on the EEG, impaired social reciprocity and repetitive behavior may be manifestations of a single pathological process, that results in developmental disorder. The course of ASD can be complicated by epileptic seizures, in particular with the use of neurometabolic drugs. According to the results of some controlled studies, antiepileptic drugs (AED) have shown their effectiveness in the treatment of mental disorders in ASD, including emotional instability, irritability, inhibition of movement. AED which stimulate neurotransmission of γ-aminobutyric acid, are more effective in ASD than blockers of the glutamatergic system. Thymoisoleptic properties of some AED, in particular carbamazepine, valproate acid, lamotrigine in some controlled studies have shown efficacy in the regulation of mood disorders in both children with ASD and children with epilepsy. With the use of carbamazepine, topiramate in children with ASD, there may be impaired attention and cognitive activity; deterioration of attention may be accompanied by increased hyperactivity, impulsivity, motor deceleration. The use of AEDs should be expected to increase the frequency and severity of side effects, including cognitive impairment, motor development, which may lead to impaired general functioning and premature disability, even with seizure control. Specific data on alternative treatments for ASD with seizures such as diet (ketogenic, modified Atkins) are discussed.