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Unprovoked Seizures in First Year of Life May Signal Autism Spectrum Disorder

Marlene Busko

May 27, 2008 (London, United Kingdom) In a population-based study of close to 100 children from Iceland who had unprovoked seizures in the first year of life, 13.7% went on to have an autism spectrum disorder (ASD).

Having symptomatic seizures (with a known cause) as opposed to nonsymptomatic or cryptogenic seizures (with an unknown cause) was associated with an almost 9-fold higher risk of subsequent autism.

Evald Saemundsen, PhD, from the division of autism and communication disorders, State Diagnostic and Counseling Center, in Kopavogur, Iceland, reported these findings in an oral presentation at the 7th Annual International Meeting for Autism Research.

"A history of seizure in the first year of life should attract attention to the possibility of subsequent ASD, particularly in cases where seizures are of symptomatic origin," he said.

Epilepsy and ASD

Epilepsy (recurrent, unprovoked seizures) was 1 of the first biological factors associated with autism, Dr. Saemundsen noted. Cases studies have reported a high prevalence of autism in children with previous infantile spasms, a type of epilepsy. But it was unknown whether other unprovoked seizures in the first year of life present a risk of ASD.

The researchers aimed to determine whether there was a link between unprovoked seizures in the first year of life and ASD.

They examined hospital records from 1982 to 1998 to identify all pediatric patients in Iceland who had been diagnosed with seizures during their first year of life.

Of the 121 children they identified, 5 had died and 1 lived abroad. The parents of the remaining 115 children were contacted, and 95 parents consented to allow their children 61 girls and 34 boys, with a mean age of 11 years to participate in the study.

The parents replied to the social communication questionnaire, which was used as an initial test of the children's autistic behaviors. The children were then assessed using the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) and/or the Childhood Autism Rating Scale (CARS).

Of the 95 children, 17 had infantile spasms and 78 had other types of seizures.

A total of 13 children 8 girls and 5 boys had ASD. All but 1 had intellectual disability, and 6 had profound intellectual disability (IQ < 20).

Of the 13 children with ASD, 6 had infantile spasms, and 7 had other types of epilepsy. The children with infantile spasms were more likely to have subsequent ASD than were children with other types of epilepsy (odds ratio, 1.55; 95% CI, 0.33 7.37).

Symptomatic Seizures Strongly Predicted ASD

Children with seizures of symptomatic origin, irrespective of type, were nearly 9 times more likely to develop ASD than were those who had nonsymptomatic seizures (OR, 8.73; 95% CI, 1.88 40.54).

The high prevalence of ASD (13.7%) in children with unprovoked seizures in the first year of life that was found in this study warrants further investigation, said Dr. Saemundsen.

The article about the current study is about to be published, he told Medscape Psychiatry.

7th Annual International Meeting for Autism Research: Oral Presentation 113.7. May 15-17, 2008.