Seizures in fetal alcohol spectrum disorders: Evaluation of clinical, electroencephalographic, and neuroradiologic features in a pediatric case series

Abstract

SUMMARYSeizures are observed with a frequency of 3-21% in children with fetal alcohol spectrum disorders (FASD). However, clinical, neuroradiologic, and electroencephalography (EEG) features are poorly described. In this study, 13 patients with FASD and epilepsy or seizures were identified retrospectively from the databases of seven Italian pediatric neurology divisions. Eleven children were affected by epilepsy, and two had at least one documented seizure. Both generalized and focal seizures were observed. EEG showed diffuse or focal epileptic activity; two children developed electric status epilepticus during sleep (ESES). Structural brain anomalies, including polymicrogyria, nodular heterotopia, atrophy, and Arnold-Chiari type 1 malformation, were discovered in almost 50% of patients. Control of seizures was not difficult to obtain in 11 cases; one patient showed pharmacoresistant epilepsy. EEG and clinical follow-up are recommended in children with FASD and epilepsy, since severe conditions requiring aggressive treatment, such as in ESES, may develop. Neuroradiological evaluation is warranted because several types of brain anomalies could be associated with maternal alcohol consumption during pregnancy.

Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders

“…This modification was prompted by a growing body of research that indicates that epilepsy is a frequent accompaniment of FASD. 86,87 More commonly observed in children with FASD, a small head circumference is a reliable, easily obtained proxy for decreased brain volume. 88,89 Finally, a number of structural brain anomalies have been observed in imaging studies in animals and human subjects with FASD.…”

FASD: folic acid and formic acid — an unholy alliance in the alcohol abusing mother

“…Alcoholics have low folate levels, owing to reduced absorption, and following alcohol consumption, formic acid levels rise and can be neurotoxic. FASD is associated with significant neurological problems such as behavioural, cognitive, and motor impairment (Chokroborty-Hoque et al 2014) depression (Pei et al 2011), and epileptic seizures (Bell et al 2010;Nicita et al 2014). Women who consume alcohol during pregnancy may also have low folic acid and higher formic acid levels that can be teratogenic to the fetus.…”

Proceedings of the 2016 annual meeting of the Fetal Alcohol Spectrum Disorders Study Group

“…Dr. Rotenberg called attention to animal studies that showed decreased myelination after developmental alcohol exposure (David & Subramaniam, 2017), and noted that it would be interesting to use the non-invasive sTMS approach to evaluate the state of the maturation of excitability and nerve conductivity in subjects with FASD. Another alteration of cortical excitability that is common in subjects with FASD is epileptic seizures (Bell et al, 2010; Nicita et al, 2014). Dr. Rotenberg presented data demonstrating the feasibility and efficacy of low frequency repetitive stimulation (0.5–1 Hz) in decreasing cortical excitability and in turn reducing seizures in different conditions (Gersner, Oberman, et al, 2016; Rotenberg et al, 2008, 2009).…”

“…A decrease in the number of PV neurons would decrease inhibition, resulting in tissue that is more excitable and prone to seizures (Hsieh et al, 2016). A parallel can be drawn to FASD, since it has been reported that developmental alcohol exposure can lead to an increase in oxidative stress (Brocardo, Gil-Mohapel, & Christie, 2011), a decrease in PV neurons (Smiley et al, 2015), and the development of seizures (Bell et al, 2010; Nicita et al, 2014). …”