Skip to main content Accessibility help
×
Home

Epilepsy in autism: features and correlates

  • Patrick F. Bolton (a1), Iris Carcani-Rathwell (a2), Jane Hutton (a3), Sue Goode (a4), Patricia Howlin (a3) and Michael Rutter (a5)...

Abstract

Background

Epilepsy occurs in a significant minority of individuals with autism, but few long-term follow-up studies have been reported, so the prevalence, features (type of seizures, age at onset and severity, etc.) and correlates (IQ history of regression, family history) have only partially been identified.

Aims

To undertake a long-term follow-up study of individuals with autism in order to better characterise the features and correlates of epilepsy in individuals with autism.

Method

One hundred and fifty individuals diagnosed with autism in childhood were followed up when they were 21+ years of age. All individuals were screened for a history of possible seizures by parental/informant questionnaire. An epilepsy interview was undertaken and medical notes reviewed for individuals with a history of possible seizures. The features and correlates of epilepsy were examined using survival and regression analysis.

Results

Epilepsy developed in 22% of participants. In the majority, seizures began after 10 years of age. Generalised tonic–clonic seizures predominated (88%). In over a half (19/33), seizures occurred weekly or less frequently and in the majority of individuals (28/31) they were controlled with the prescription of one to two anticonvulsants. Epilepsy was associated with gender (female), intellectual disability and poorer verbal abilities. Although the presence of epilepsy in the probands was not associated with an increased risk of epilepsy in their relatives, it was associated with the presence of the broader autism phenotype in relatives. This indicates that the familial liability to autism was associated with the risk for epilepsy in the proband.

Conclusions

Epilepsy is an important medical complication that develops in individuals with autism. Seizures may first begin in adolescence or adulthood. Putative risk factors for epilepsy in autism were identified and these will require further investigation in future studies.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Epilepsy in autism: features and correlates
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Epilepsy in autism: features and correlates
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Epilepsy in autism: features and correlates
      Available formats
      ×

Copyright

Corresponding author

Patrick F. Bolton, Departments of Child & Adolescent Psychiatry & Social Genetic & Developmental Psychiatry Centre, Box PO 46, Institute of Psychiatry, Kings College London, SE5 8AF, UK. Email: Patrick.Bolton@kcl.ac.uk

Footnotes

Hide All

P.F.B. was supported by the National Institute of Health Research, Biomedical Research Centre in Mental Health. The study was supported by grants from the UK Medical Research Council.

Declaration of interest

None.

Footnotes

References

Hide All
1 World Health Organization. The ICD–10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. WHO, 1993.
2 Kawasaki, Y, Yokota, K, Shinomiya, M, Shimizu, Y, Niwa, S. Brief report: electroencephalographic paroxysmal activities in the frontal area emerged in middle childhood and during adolescence in a follow-up study of autism. J Autism Dev Disord 1997; 27: 605–20.
3 Olsson, I, Steffenburg, S, Gillberg, C. Epilepsy in autism and autisticlike conditions. A population-based study. Arch Neurol 1988; 45: 666–8.
4 Tuchman, RF, Rapin, I. Regression in pervasive developmental disorders: seizures and epileptiform electroencephalogram correlates. Pediatrics 1997; 99: 560–6.
5 Tuchman, R, Rapin, I. Epilepsy in autism. Lancet Neurol 2002; 1: 352–8.
6 Amiet, C, Gourfinkel-An, I, Bouzamondo, A, Tordjman, S, Baulac, M, Lechat, P, et al. Epilepsy in autism is associated with intellectual disability and gender: evidence from a meta-analysis. Biol Psychiatry 2008; 64: 577–82.
7 Tuchman, R, Moshe, SL, Rapin, I. Convulsing toward the pathophysiology of autism. Brain Dev 2009; 31: 95103.
8 Kurtz, Z, Tookey, P, Ross, E. Epilepsy in young people: 23 year follow up of the British national child development study. BMJ 1998; 316: 339–42.
9 Goulden, KJ, Shinnar, S, Koller, H, Katz, M, Richardson, ST. Epilepsy in children with mental retardation: a cohort study. Epilepsia 1991; 32: 690–7.
10 Matthews, T, Weston, N, Baxter, H, Felce, D, Kerr, M. A general practice-based prevalence study of epilepsy among adults with intellectual disabilities and of its association with psychiatric disorder, behaviour disturbance and carer stress. J Intellect Disabil Res 2008; 52: 163–73.
11 Danielsson, S, Gillberg, IC, Billstedt, E, Gillberg, C, Olsson, I. Epilepsy in young adults with autism: a prospective population-based follow-up study of 120 individuals diagnosed in childhood. Epilepsia 2005; 46: 918–23.
12 Hara, H. Autism and epilepsy: a retrospective follow-up study. Brain Dev 2007; 29: 486–90.
13 Bolton, P, Macdonald, H, Pickles, A, Rios, P, Goode, S, Crowson, M, et al. A case-control family history study of autism. J Child Psychol Psychiatry 1994; 35: 877900.
14 Howlin, P, Goode, S, Hutton, J, Rutter, M. Adult outcome for children with autism. J Child Psychol Psychiatry 2004; 45: 212–29.
15 Hutton, J, Goode, S, Murphy, M, Le Couter, A, Rutter, M. New-onset psychiatric disorders in individuals with autism. Autism 2008; 12: 373–90.
16 Lord, C, Rutter, M, Le Couteur, A. Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. J Autism Dev Disord 1994; 24: 659–85.
17 Lord, C, Rutter, M, Goode, S, Heemsbergen, J, Jordan, H, Mawhood, L, et al, Autism diagnostic observation schedule: a standardized observation of communicative and social behaviour. J Autism Dev Disord 1989; 19: 185212.
18 Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Epilepsia 1993; 34: 592–6.
19 Raven, JC, Court, JH, Raven, J. Raven's Progressive Matrices and Raven's Coloured Matrices. H. K. Lewis, 1986.
20 Dunn, LM, Whetton, C, Pintillie, D. The British Picture Vocabulary Scale. nferNelson, 1982.
21 Zax, M, Sameroff, AJ, Babigian, HM. Birth outcomes in the offspring of mentally disordered women. Am J Orthopsychiatry 1977; 47: 218–30.
22 Gillberg, C, Gillberg, IC. Infantile autism: a total population study of reduced optimality in the pre-, peri-, and neonatal period. J Autism Dev Disord 1983; 13: 153–66.
23 Bolton, PF, Murphy, M, Macdonald, H, Whitlock, B, Pickles, A, Rutter, M. Obstetric complications in autism: consequences or causes of the condition? J Am Acad Child Adolesc Psychiatry 1997; 36: 272–81.
24 Waldrop, MF, Pedersen, FA, Bell, RQ. Minor physical anomalies and behavior in preschool children. Child Dev 1968; 39: 391400.
25 Bradley, E,. Bolton, P. Episodic psychiatric disorders in teenagers with learning disabilities with and without autism. Br J Psychiatry 2006; 189: 361–6.
26 Saemundsen, E, Ludvigsson, P, Hilmarsdottir, I, Rafnsson, V. Autism spectrum disorders in children with seizures in the first year of life – a population-based study. Epilepsia 2007; 48: 1724–30.
27 Aman, MG, Lam, KS, Van Bourgondien, ME. Medication patterns in patients with autism: temporal, regional, and demographic influences. J Child Adolesc Psychopharmacol 2005; 15: 116–26.
28 Parmeggiani, A, Posar, A, Giovanardi-Rossi, P, Andermann, F, Zifkin, B. Autism, macrocrania and epilepsy: how are they linked? Brain Dev 2002; 24: 296–9.
29 Baird, G, Charman, T, Pickles, A, Chandler, S, Loucas, T, Meldrum, D, et al, Regression, developmental trajectory and associated problems in disorders in the autism spectrum: the SNAP study. J Autism Dev Disord 2008; 38: 1827–36.
30 Bartak, L, Rutter, M. Differences between mentally retarded and normally intelligent autistic children. J Autism Child Schizophr 1976; 6: 109–20.
31 Hrdlicka, M, Komarek, V, Propper, L, Kulisek, R, Zumrova, A, Faladova, L, et al, Not EEG abnormalities but epilepsy is associated with autistic regression and mental functioning in childhood autism. Eur Child Adolesc Psychiatry 2004; 13: 209–13.
32 Spence, SJ, Schneider, MT. The role of epilepsy and epileptiform EEGs in autism spectrum disorders. Pediatr Res 2009; 65: 599606.
33 Helbig, I, Scheffer, IE, Mulley, JC, Berkovic, SF. Navigating the channels and beyond: unravelling the genetics of the epilepsies. Lancet Neurol 2008; 7: 231–45.
34 Raznahan, A, Toro, R, Daly, E, Robertson, D, Murphy, C, Deeley, Q, et al. Cortical anatomy in autism spectrum disorder: an in vivo MRI study on the effect of age. Cereb Cortex 2009; 20: 1332–40.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Epilepsy in autism: features and correlates

  • Patrick F. Bolton (a1), Iris Carcani-Rathwell (a2), Jane Hutton (a3), Sue Goode (a4), Patricia Howlin (a3) and Michael Rutter (a5)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *