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Evidence

Query: Is there a possible link between having fits [seizures] and autistic spectrum disorder (ASD)?

Response posted: March 2015

To answer this question, we searched a number of electronic databases which are accessible to the public (NICE, NHSEvidence, Cochrane Library, TRIP and PubMed) and the websites of organisations working in this field. ‘Fits’ are also known as ‘seizures’, and epilepsy is a condition which involves having seizures, so we searched using the terms "epilepsy” OR “seizures” AND “autism” OR “ASD” OR “autism spectrum disorder”.

There is increasing recognition that the changes to neurodevelopmental genes can predispose to both epilepsy and autism.  Epilepsy is more common in individuals with ASD, however rates of co-occurrence of these two conditions vary greatly and depend on other factors, such as the presence of intellectual disability. 1, 2 While the links between these two conditions are being better understood, only a few studies have looked at how epilepsy and ASD impact each other and the reported results have not been consistent.3 

Both conditions have broad diagnostic categories and can also occur with other conditions, such as ADHD and learning disability.  This makes it challenging for studies looking at effective treatments to measure developmental outcomes, and the evidence is limited. While early and aggressive medical and surgical treatments can be advocated to treat seizures, there is no clear evidence that this intervention improves ASD symptoms.4

Some of the drugs prescribed to treat epilepsy are sometimes also given to children with ASD without epilepsy to treat mood and behaviour.  At present, no randomized controlled trials or large clinical trials have tested the effects of these drugs in well-defined populations of children with ASD and epilepsy. Research has begun to look at developing medication which could target both conditions, including trials with mice, but there is currently no definitive evidence for a clinical intervention for individuals with both ASD and epilepsy. 4 It is important to note that even if specific therapies become available, a combined comprehensive treatment approach designed to suit each individual is likely to be recommended.

The National Autistic Society has a useful information guide that discusses the link between these two conditions and suggests further information sources: http://www.autism.org.uk/about-autism/related-conditions/epilepsy.aspx

The organisation Research Autism brings together research evidence relevant to autism. They too have a list of research studies relevant to this topic: http://www.researchautism.net/medical-issues/epilepsy-and-autism/epilepsy-and-autism-publications

References

1 Woolfenden S. et al. (2012) A systematic review of two outcomes in autism spectrum disorder - epilepsy and mortality. Developmental Medicine and Child Neurology. 54(4), pp. 306-312.

2 Cantiano R. (2014) Autism with epilepsy: A neurodevelopmental association. OA Autism Apr 08; 2 (1): 7.

3 El Achkar CM et al (2015) Clinical characteristics of children and young adults with co-occurring autism spectrum disorder and epliepsy. Epilepsy Behav (2015) doi:10.1016/j.yebeh.2014.12.022

4 Tuchman R et al (2010). Autism spectrum disorders and epilepsy: Moving towards a comprehensive approach to treatment. Brain & Development 32, pp, 718073.

Signposting to further information:

NHS Choices website provides information on treatments for ASD: http://www.nhs.uk/Conditions/Autistic-spectrum-disorder/Pages/Treatment.aspx

NICE Clinical Guideline 137 provides advice on treatment for epilepsy http://www.nice.org.uk/guidance/cg137/chapter/introduction

Young Epilepsy also has resources for parents, children and professionals: http://youngepilepsy.org.uk/all-about-epilepsy/what-is-epilepsy/diagnosing-epilepsy/autistic-spectrum-disorder-and-epilepsy