Unrecognised autism in epilepsy

"All children with epilepsy, particularly those with IQ ≤ [less than or equal to] 50, irrespective of age of onset of epilepsy, seizure type, frequency of seizures, or intractability of epilepsy, should be screened for ASD [autism spectrum disorder]."

So said the findings reported by Monica Juneja and colleagues [1] continuing an important research theme on how autism and epilepsy seem to be very, very closely linked (see here and see here).

Researchers "randomly selected" over 100 children with epilepsy "(defined as two or more epileptic seizures unprovoked by any immediate identifiable cause...)" who were first screened for using Social Communication Questionnaire (SCQ) for autism and then for some, given a more detailed diagnostic work-up. They reported that about 8% of their cohort (9/106) 'screened positive' on the SCQ - "had [a] SCQ score of ≥15" - and 8 of those 9 subsequently went on to meet the criteria for an ASD based on the DSM-IV. They conclude that: "The prevalence of unrecognized ASD was 7.5/100."

This is important work. It adds to an increasing body of peer-reviewed research literature that sees both autism as a risk factor for epilepsy (see here) and epilepsy as a risk factor for autism. The authors also make reference in their findings that they: "add to the growing body of evidence that epilepsy, autism, and ID [intellectual disability] are different clinical manifestations of neurological damage that disrupts the normal neuronal pathways in the developing brain." Accepting that 'neurological damage' is perhaps rather too sweeping a term to apply to the entire autism spectrum (see here), I do think such a conclusion by Juneja et al is worthy of further investigation. I say that from the point of view that the term 'epileptogenic brain lesions' is no stranger to the research literature [2] and that the use of the term 'comorbidity' referencing epilepsy appearing alongside autism, might not always be entirely accurate (see here)...

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[1] Juneja M. et al. Prevalence of Unrecognized Autism Spectrum Disorders in Epilepsy: A Clinic-Based Study. Journal of Pediatric Neurosciences. 2018;13(3):308-312.

[2] Kreilkamp BAK. et al. Neuroradiological findings in patients with "non-lesional" focal epilepsy revealed by research protocol. Clin Radiol. 2018 Sep 28. pii: S0009-9260(18)30519-1.

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