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Review
. 2013 Sep 13;1:31.
doi: 10.3389/fpubh.2013.00031.

A Review of Traditional and Novel Treatments for Seizures in Autism Spectrum Disorder: Findings From a Systematic Review and Expert Panel

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Free PMC article
Review

A Review of Traditional and Novel Treatments for Seizures in Autism Spectrum Disorder: Findings From a Systematic Review and Expert Panel

Richard E Frye et al. Front Public Health. .
Free PMC article

Abstract

Despite the fact that seizures are commonly associated with autism spectrum disorder (ASD), the effectiveness of treatments for seizures has not been well studied in individuals with ASD. This manuscript reviews both traditional and novel treatments for seizures associated with ASD. Studies were selected by systematically searching major electronic databases and by a panel of experts that treat ASD individuals. Only a few anti-epileptic drugs (AEDs) have undergone carefully controlled trials in ASD, but these trials examined outcomes other than seizures. Several lines of evidence point to valproate, lamotrigine, and levetiracetam as the most effective and tolerable AEDs for individuals with ASD. Limited evidence supports the use of traditional non-AED treatments, such as the ketogenic and modified Atkins diet, multiple subpial transections, immunomodulation, and neurofeedback treatments. Although specific treatments may be more appropriate for specific genetic and metabolic syndromes associated with ASD and seizures, there are few studies which have documented the effectiveness of treatments for seizures for specific syndromes. Limited evidence supports l-carnitine, multivitamins, and N-acetyl-l-cysteine in mitochondrial disease and dysfunction, folinic acid in cerebral folate abnormalities and early treatment with vigabatrin in tuberous sclerosis complex. Finally, there is limited evidence for a number of novel treatments, particularly magnesium with pyridoxine, omega-3 fatty acids, the gluten-free casein-free diet, and low-frequency repetitive transcranial magnetic simulation. Zinc and l-carnosine are potential novel treatments supported by basic research but not clinical studies. This review demonstrates the wide variety of treatments used to treat seizures in individuals with ASD as well as the striking lack of clinical trials performed to support the use of these treatments. Additional studies concerning these treatments for controlling seizures in individuals with ASD are warranted.

Keywords: anti-epileptic drugs; autism spectrum disorder; epilepsy; gluten-free casein-free diet; ketogenic diet; seizures; treatment.

Figures

Figure 1
Figure 1
Seizure survey rating for the most favorable rated anti-epileptic drug treatments for clinical seizures. The perceived effect on seizures was not different across the four anti-epileptic drug treatments. Out of the four treatments lamotrigine appeared to worsen several other clinical factors, such as communication, attention, and mood less than valproate.
Figure 2
Figure 2
Seizure survey ratings for the most favorably rated non-anti-epileptic drug treatments for clinical seizures. The ketogenic diet was perceived to improve seizures more than the gluten-free-casein-free diet and hyperbaric oxygen treatment. Other clinical factors were not perceived to differ significantly between these four treatments except for behavior, sleep and mood, which was significantly better for the gluten-free casein-free diet as compared to some other treatments.
Figure 3
Figure 3
The transcranial magnetic stimulator. A block diagram depicting the transcranial magnetic stimulator circuit is depicted on the left. The power supply charges the capacitor. An operator or computer then signals for the charge stored in the capacitor to be released into the stimulation coil through a thyristor switch. The current flowing through the stimulating coil (here depicted as a circular coil) produces a perpendicular magnetic field which transverses the skull and induces electrical currents within the cortex underlying the coil.

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