Epilepsy/Seizures and AutismIntroduction
Seizures often occur in association with other disorders. This poses a potential challenge for individuals living with multiple disorders. A lack of information about multiple disorders may lead to confusion and uncertainty for these individuals. Therefore, this pamphlet focuses on autism associated with seizures. It presents information about autism and how autism relates to epilepsy. This cross-diagnosis summary was created to assist healthcare providers in providing complete and comprehensive information to the public. For more in-depth information about autism and/or epilepsy, please contact the appropriate association or consult your physician/neurologist.
Dr. Leo Kanner, a Johns Hopkins psychiatrist, first introduced the term autism in 1943, and it was introduced again in 1944 by an Austrian pediatrician, Hans Asperger (1). Kanner applied the term, "autistic" to children who were socially withdrawn and preoccupied with routine, who struggled to acquire spoken language, yet possessed intellectual gifts that ruled out a diagnosis of mental retardation. In addition, Asperger applied the term, "autistic" to children who were socially inept and clumsy, developed bizarre obsessions and seemed highly bright (2). Also, prior to the 1970s, children diagnosed as autistic were often classified as having a type of childhood schizophrenia.
Early theories regarding the origins of autism placed fault with parenting strategies. The mothers of children with autism were labelled as "refrigerator mothers," and were blamed for cold, unfeeling relationships leading to the social withdrawal of their children (1). Interest in the neurological basis of the disorder finally blossomed in the late 1970s, and knowledge of the disorder has grown steadily during the past fifty years (1).
Today, autism is defined as a complex developmental disability, which typically presents during the first three years of life. It is a result of a neurological disorder which affects the functioning of the brain. The latest studies suggest that autism and its associated behaviours have been estimated to occur in as many as 1 in 150 children age ten and younger — a total of nearly 300,000 children in the United States alone (2). If adults are included in the estimation, according to the Autism Society of America, more than one million people in the United States have one of the various autistic disorders (also known as pervasive developmental disorders or PDDs). The problem is five times as common as Down syndrome and three times as common as juvenile diabetes. Autism is also four times more likely to occur in boys than in girls (2).
Autism impacts the typical development of the brain in areas of social interaction and communications skills. Persons with autism typically have difficulty with verbal and non-verbal communication, social interactions, and leisure or play activities. Some people may be aggressive or may induce self-injury. Others may exhibit repeated body movement (hand flapping, rocking), unusual responses to people, unusual attachments to objects and resistance to changes in routines. In addition, people with autism often suffer a bewildering array of problems: sensory disturbances, food allergies, gastrointestinal problems, depression, obsessive compulsiveness, subclinical epilepsy, and Attention Deficit Hyperactivity Disorder (2).
Autism Spectrum Disorders
Autistic Disorder
This diagnosis usually applies to children of less than three years of age who have impairments in social interaction, communication and imaginative play. They tend to show stereotyped behaviours, interests and activities.
Asperger's Disorder
Asperger's was previously considered a variant form of autism, it is now considered to be a related but separate disorder (1). This disorder involves impairments in social interactions and the presence of restricted interests and activities, with no clinically significant general delay in language, self-help skills, adaptive behaviour or in cognitive development.
Pervasive Development Disorder
A diagnosis of PDD may be made when a child does not meet the criteria for a specific diagnosis, but there is a severe impairment in specific behaviours.
Rett's Syndrome
Rett's disorder was identified by Andrea Rett in 1965 (1). To date, Rett's syndrome has occurred in girls only. After a period of normal development, beginning between one and four years of age, previously-acquired skills are lost and the use of the hands is replaced with repetitive movements. This is a progressive disorder, which continues to worsen. As well, children with Rett's disorder often demonstrate respiratory irregularities, and seizures usually appear early on.Usually, the cognitive levels of people with Rett's does not typically surpass that of a one-year-old (1).
Child Disintegrative Disorder (CDD)
This disorder is characterized by normal development for at least the first two years, followed by significant loss of previously-acquired skills. There is regression in bowel and bladder control, language, and social skills, as well as regression in play skills, motor skills, or both. Before the onset of CDD, children can usually speak in full sentences, and after the deterioration, they typically can speak no language (1).
General Information About Epilepsy/Seizures and Autism
Approximately 20% to 35% of individuals with autism have a seizure disorder. About one in four autistic individuals begin to have seizures during puberty. The exact reason for the onset of seizures is not known, but it is likely that the seizure activity may be due to hormonal changes in the body (1). Sometimes these seizures are noticeable, (ie. associated with convulsions); but, for many, they are small, subclinical seizures, and are typically not detected by simple observation. Some possible signs of subclinical activity include the following: exhibiting behaviour problems, such as aggression, self-injury, and severe tantrums; making little or no academic gains after doing well during childhood and pre-teen years; and/or losing some behavioural and/or cognitive gains (4).
People with autism are at a higher risk for seizures if they have certain specific neurologic conditions, such as tuberous sclerosis, neurofibromatosis or untreated phenylketonuria. As well, infantile spasms (sudden generalized muscle contractions, usually beginning between ages 3 and 8 months) do occur in association with autism. Other forms of epilepsy, such as complex partial epilepsy, generalized tonic-clonic epilepsy and absence seizures, may also occur in children with autism. Usually, the seizures can be controlled by anti-convulsants; thus, seizures may decrease or diminish (4). In autistic children, an increase in epilepsy is seen with increasing age, and at the age of twenty about one-fourth to one-third of patients show epilepsy changes (3). Also, it has been shown that, when children with autism are put on a specific diet by their doctor, there is a decrease in epileptic seizures followed by a reduction of medication, but there is also a disastrous relapse when the diet is broken (3).
How can Seizures in People with Autism be Distinguished from Unusual Behaviours?
1. Seizures are sudden and do not require provoking events. However, they are sometimes provoked by certain light frequencies or sounds. Therefore, if an autistic person's seizures are suspected to arise from anger, frustration or fear, these episodes are most likely not epilepsy.
2. Seizures usually follow a set pattern, but only range in duration and intensity. If during seizures, the autistic person's movements and mannerisms are varied, these events are probably not seizures.
3. Generalized seizures can be associated with an aura, and may be followed by a headache, weakness or exhaustion. Therefore, if an autistic person has had a major seizure, it is unlikely that he or she would immediately resume their regular activity.
4. Absence attacks involve staring mannerisms, brief loss of consciousness, often with some eye-blinking or mild facial movements. These behaviours are also associated with certain types of autism, therefore it is important to determine if there is any response to environmental stimuli and whether there are any associated movements with the autistic individual. During a generalized seizure, the person will not respond to you.
Resources
(1) Glennon, Tara, and Heather Miller-Kuhaneck. An Introduction to Autism and the Pervasive Developmental Disorders. New York: 2000.
(2) Nash, Madeleine. "The Secrets of Autism." Time 29 April 2002.
(3) Reichelt, K.L., and Knivsberg A.M. Can the Pathophysiology of Autism be explained by Discovered Urine Peptides? Stravanger, Norway: Institute of Pediatric Research, [2000].
(4) Dalldorf, Joanna. A Review of Seizure Disorders and Landau-Kleffner Syndrome in the Autistic Population. University of North Carolina, [2002].
Thanks to HRDC (Human Resource Development Canada) Summer Career Placement Program, and to Theresa Sargeson for her work in researching and creating this project.
