I recently had a patient present to the office for a neurological consultation regarding a learning disability, ADHD or an issue relating to the autism spectrum. It appears that the little girl was spacing out and had difficulty concentrating. In my seminars, I always speak about patients on the autism spectrum not having any hard lesions. That is to say, their MRI is normal in regards to not having any tumors, infections, malformations etc. For example if the child has a tumor, then his diagnosis is not autism but would be whatever type of tumor was found. It is only when all these hard lesions are ruled out that the diagnosis of autism is considered. This type of screening ensures that we are then dealing with a functional lesion. This means that all the structures in the brain are present. It then becomes a question of the function of the brain, its connections and coherence. Another fairly common test that is performed on a child suspected of being on the autism spectrum is an EEG. In this case, we would be looking for seizures. In the case above we would be concerned with absent seizures in which the patient seems to space out or be “absent” consciously even though they are present physically. In my practice ,we have quite a few patients that have both a history of an autism diagnosis as well as a seizure disorder. Please be aware that a patient can have an autism spectrum disorder, a seizure disorder or they may have both. The patient’s treatment will of course be affected by the category into which they fall. for example functional neurologist often use light as a technique to introduce a stimulus into the visual system. If the patient recently had an EEG in which the flashing of lights triggered a seizure, then that information certainly needs to be considered when developing a treatment plan for that particular patient. In any case, many patients being evaluated for these types of conditions will have an MRI and an EEG performed as part of their work up. Those tests should exclude other conditions being a cause of your child’s issues and your child not being part of the autism spectrum. A recent study in the Journal of Brain Development found that 24.6% individuals in the study with infantile autism had at least one epilepsy diagnosis versus 1.5% in the comparison group. The take-home of this article is make sure your basics are covered so that the most appropriate treatment plan can be instituted for your child.
Brain Dev. 2010 Jul 22. [Epub ahead of print]
A longitudinal study of epilepsy and other central nervous system diseases in individuals with and without a history of infantile autism.
Centre for Child and Adolescent Psychiatry, Bispebjerg University Hospital, Copenhagen, Denmark.
Objective: To compare the prevalence and types of epilepsy and other central nervous system (CNS) diseases in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with 336 matched controls from the general population. Methods: All participants were screened through the nationwide Danish National Hospital Register (DNHR). The average observation time was 30.3years (range 27-30years), and mean age at follow-up was 42.7years (range 27-57years). Results: Of the 118 individuals with IA, 29 (24.6%) were registered with at least one epilepsy diagnosis against 5 (1.5%) in the comparison group (p<0.0001; OR=21.6; 95% CI 8.1-57.3). Other CNS diseases occurred with low frequency in both groups and only cerebral palsy, unspecified (p=0.02) was significantly more frequent among participants with a history of IA. Conclusions: Our study lends further support to the notion that epilepsy, but not other CNS diseases, is a common comorbid condition in IA. Low intelligence, but not gender, was a risk factor for epilepsy in IA. Copyright © 2010 Elsevier B.V. All rights reserved.
PMID: 20655678 [PubMed - as supplied by publisher]