Epilepsy surgery in patients with autism

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The purpose of this study was to report outcomes of epilepsy surgery in 56 consecutive patients with autism spectrum disorder.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Medical records of 56 consecutive patients with autism who underwent epilepsy surgery were reviewed with regard to clinical characteristics, surgical management, postoperative seizure control, and behavioral changes.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Of the 56 patients with autism, 39 were male, 45 were severely autistic, 27 had a history of clinically significant levels of aggression and other disruptive behaviors, and 30 were considered nonverbal at baseline. Etiology of the epilepsy was known in 32 cases, and included structural lesions, medical history, and developmental and genetic factors. Twenty-nine patients underwent resective treatments (in 8 cases combined with palliative procedures), 24 patients had only palliative treatments, and 3 patients had only subdural electroencephalography. Eighteen of the 56 patients had more than one operation. The mean age at surgery was 11 ± 6.5 years (range 1.5–35 years). At a mean follow-up of 47 ± 30 months (range 2–117 months), seizure outcomes included 20 Engel Class I, 12 Engel Class II, 18 Engel Class III, and 3 Engel Class IV cases. The age and follow-up times are stated as the mean ± SD. Three patients were able to discontinue all antiepileptic drugs (AEDs). Aggression and other aberrant behaviors observed in the clinical setting improved in 24 patients. According to caregivers, most patients also experienced some degree of improvement in daily social and cognitive function. Three patients had no functional or behavioral changes associated with seizure reduction, and 2 patients experienced worsening of seizures and behavioral symptoms.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Epilepsy surgery in patients with autism is feasible, with no indication that the comorbidity of autism should preclude a good outcome. Resective and palliative treatments brought seizure freedom or seizure reduction to the majority of patients, although one-third of the patients in this study required more than one procedure to achieve worthwhile improvement in the long term, and few patients were able to discontinue all AEDs. The number of palliative procedures performed, the need for multiple interventions, and continued use of AEDs highlight the complex etiology of epilepsy in patients with autism spectrum disorder. These considerations underscore the need for continued analysis, review, and reporting of surgical outcomes in patients with autism, which may aid in better identification and management of surgical candidates. The reduction in aberrant behaviors observed in this series suggests that some behaviors previously attributed to autism may be associated with intractable epilepsy, and further highlights the need for systematic evaluation of the relationship between the symptoms of autism and refractory seizures.</jats:p></jats:sec>

Centromedian thalamic responsive neurostimulation for Lennox‐Gastaut epilepsy and autism

“…6 Our group has previously shown the feasibility and safety of epilepsy surgery in children with ASD, emphasizing the potential for better seizure control and associated gains in cognition with reductions in violent behavior. 12 Not surprisingly, children with ASD and MRI-negative epilepsy, similar to the two presented here, appeared to have worse outcomes than their lesional counterparts after an irreversible ablative treatment. 12 We chose a modulatory approach in the current patients for several reasons.…”

“…12 Not surprisingly, children with ASD and MRI-negative epilepsy, similar to the two presented here, appeared to have worse outcomes than their lesional counterparts after an irreversible ablative treatment. 12 We chose a modulatory approach in the current patients for several reasons. Novel treatments such as RNS have added to our armamentarium in treating epilepsy in adults.…”

“…The burden of DRE coupled with ASD is high. 12 Epilepsy surgery yields significantly greater life expectancy compared to medical treatment in children with DRE, yet it is underutilized. 6 Our group has previously shown the feasibility and safety of epilepsy surgery in children with ASD, emphasizing the potential for better seizure control and associated gains in cognition with reductions in violent behavior.…”

Rates and predictors of seizure outcome after corpus callosotomy for drug-resistant epilepsy: a meta-analysis

“…Overall, 1742 patients were included from 58 unique studies (Table 1). 1,3–10, 18–21, 23–26, 29, 32–34, 36, 37, 39–47, 49–57,59–62, 66, 69–76, 79–82 All studies were retrospective or prospective case series, and no controlled studies were identified. Overall, the rates of complete seizure freedom and freedom from drop attacks were 18.8% and 55.3%, respectively, at last follow-up.…”

<p>Bridging the Gap Between Physical Health and Autism Spectrum Disorder</p>

“…164 For those individuals who have failed prior psychopharmacology attempts, and those who exhibit unusual and challenging behaviours-for example, sudden and unprovoked outbursts of aggression, irritability, crying, screaming or self-harming, unusual facial and body movements and postures, staring spells, covering of ears-an EEG could be helpful for differentiating between seizures and non-epileptic paroxysmal behaviours. 165,166 Metabolic Irregularities, Acquired Mitochondrial Dysfunction and Oxidative Stress in ASD Children and adults with ASD are at significantly greater risk for weight issues and obesity than the general population. 167 Compared with those presenting with milder impairments, individuals with severe ASD also show an increased likelihood of obesity alongside various other metabolic disorders including hypertension, diabetes and dyslipidemia.…”