Children with autism spectrum disorders and drug-resistant epilepsy can benefit from epilepsy surgery

Epilepsy Behav. 2018 Aug;85:200-204. doi: 10.1016/j.yebeh.2018.06.023. Epub 2018 Jul 4.

Abstract

Objective: The objective of this research was to evaluate a cohort of children with both autism spectrum disorder (ASD) and drug-resistant epilepsy (DRE) after epilepsy surgery to determine predictors of best outcome.

Methods: Retrospective chart review was done for 29 children ages 2 to 18 years with ASD and DRE who had neurosurgical intervention for seizure management over 15 years at one institution. All subjects had at least 1 year of follow-up. Data abstraction included demographic information, seizure diagnosis, treatment, investigations, surgical intervention, neuropsychological assessment, and outcome. Statistical analysis software (SAS) was used for statistical analysis. Engel classification was used to assess seizure outcome.

Results: Fifteen subjects had resective surgery. Fourteen had palliative surgery with vagal nerve stimulator (VNS) insertion (13) and corpus callosotomy (1). Of the 29 subjects, 35% had class I outcome (all in the resective group). When combining all subjects (resective and palliative), 66% of subjects benefited with class I-III outcomes. In the total cohort, age at time of surgery was significant, with class I outcome more frequently seen in the younger age group when compared with classes II-IV (p = 0.01).

Conclusion: A subset of children with ASD can benefit from resective surgery, and for those who are not candidates, a VNS can offer significant improvements in seizure control.

Keywords: Autism spectrum disorder; Drug-resistant epilepsy; Epilepsy; Epilepsy surgery; Vagal nerve stimulator.

MeSH terms

  • Adolescent
  • Autism Spectrum Disorder / diagnostic imaging
  • Autism Spectrum Disorder / epidemiology*
  • Autism Spectrum Disorder / surgery*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Drug Resistant Epilepsy / diagnostic imaging
  • Drug Resistant Epilepsy / epidemiology*
  • Drug Resistant Epilepsy / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Neurosurgical Procedures / methods*
  • Neurosurgical Procedures / trends
  • Psychosurgery / methods
  • Psychosurgery / trends
  • Retrospective Studies
  • Treatment Outcome
  • Vagus Nerve Stimulation / methods*
  • Vagus Nerve Stimulation / trends