Saturday, 16 April 2011

Autism and epilepsy

I must warn readers that this is probably not the happiest of posts that you will read on this blog. In this post I intend to talk about mortality and a few other not-so-nice things. If you've had a bit of a bad day and really don't want to make it any worse, I won't be offended if you click away now. Might I suggest this link as an alternative?

To quote from the abstract of a recent article appearing in the Journal of Child Neurology: "..there is a higher than expected rate of mortality in individuals with autism and epilepsy than autism alone". Similar studies have confirmed this grim finding related to autism and one of its more frequent co-morbidities. Most people would find it very difficult to say that there are any 'positives' related to having epilepsy or other seizure-type disorder on quality of life either when co-morbid to autism or stand-alone.

Even looking on the Epilepsy Society website there is little to alter such an opinion. Yes, epilepsy can be managed, and managed quite well by things like medication, and yes for the vast majority of people it is not a consistent, on-going problem.

The only thing is that unfortunately people do perish following conditions like status epilepticus and even the anti-epilepsy medications are not without their potential side-effects and developmental effects. [At this point I give a disclaimer on not stopping or altering any medication without seeking medical advice].

Epilepsy and seizure-type disorders have long been associated with autism. The figures are slightly variable as to the extent of the overlap but generally range between 5-40% of people with an autism spectrum condition presenting also with epilepsy at some point in their life. There are lots of different types of epilepsy / seizure-type disorders and quite a few other conditions carrying a higher rate of epilepsy.

With regards to co-morbidity with autism, no-one really knows why there is a heightened risk of epilepsy. There is a correlation, of sorts, between various genetic syndromes presenting with autistic features and epilepsy which could indicate some genetic involvement.

Time of onset of epilepsy in autism might also suggest some variable effect from either environmental or maturational processes. I previously blogged about puberty and autism and a potential relationship there. Other authors have described behavioural regression as being a key correlate with seizure activity onset. I am sure that there are other potential correlates between autism and epilepsy; this article discusses a link between epilepsy and encephalitis following on from the suggestion of a link between autism and viral infection.

Management of epilepsy usually involves medication (as previously discussed) but in some cases can also include things like diet and supplementation of other compounds for certain types of epilepsy. The same kind of diet (ketogenic) has also been suggested for autism without epilepsy; I might come back to this in a future post.

Other, more radical ideas such as the application of vagal nerve stimulation, used for the treatment of epilepsy, to autism remain under investigation.

I apologise again to readers for the grimness of this post. I do stress that epilepsy co-morbid to autism is not an automatic pathway to early mortality - not by any means at all. With the right medicines management, epilepsy can be managed, and managed well.

I suppose the take home message is that epilepsy, in any one of it's many guises, can be common to autism and because of its health implications, really deserves appropriate screening in at-risk groups. Making it a research priority might also be a good idea.