Autism is a disorder of the nervous system that manifests itself in the form of verbal and non-verbal communication with repetitive behaviors in stereotype.
According to some reports, the prevalence of this disorder is increasing, studies have shown that disorders caused by autism have led to a significant number of children dropping out of school.
A study in the United States found that one in 86 children has autism. Some reports are about 1% and in cases where there is a disorder in social relations, this rate reaches 2%. This disorder causes the child to sink into itself with problems in social relationships. These children avoid looking and engage in repetitive movements. These patients do not communicate with other children when they are in a group of children, and they may relax in a corner and not pay attention to other children, and play with their toys in a corner. When you ask their name, they do not answer and do not pay attention to the fascinating shows that children are interested in: such as flying a toy airplane and seeming to be engrossed. These children are often stubborn and do not have the necessary flexibility. Sick children sometimes become irritable and aggressive. The symptoms of the disease are seen from the beginning of childhood, according to which they can be diagnosed and a suitable solution can be found to cure them. Due to lack of communication and also due to lack of attention, they cause delays in learning and even speaking. Problems in going to school, lack of hygiene and brushing and sometimes in eating are also difficult. Cognitive impairment is one of the most important issues that may be seen in these patients and should be given adequate attention.
There are several factors involved in causing these disorders. Genetic factors are important, but environmental factors may be more important: such as taking some medications, such as pre-pregnancy sodium valproate, which is one of the most widely used medications in the treatment of epilepsy, migraine headaches, and some psychiatric illnesses. There are several conditions that a child with autism may have: autism, other psychiatric disorders, inattention or inattention, and unnecessary hyperactivity. One of the most important comorbidities in children with autism is epilepsy. Epilepsy itself is a common disease in children, so that some studies show that 1% of children suffer from this disease. In cases of mental disability, even in children with an IQ above 70, but less than the average population prevalence Autism is more. Epilepsy is one of the most serious diseases of the central nervous system. This disease recurs due to sudden and severe attacks that are called for no reason. It is very difficult for the patient, especially the family and caregivers of a child with epilepsy, to tolerate it. Epileptic seizures are caused by abnormal discharges (abnormal discharges) of brain cells (neurons). There are different types of epilepsy that may involve the whole brain from the beginning or start a seizure from a specific part of the brain.
In children with autism, any type of epileptic seizure may be seen and is not clearly associated with a particular type of epilepsy. It is important to know the risk factors for epilepsy in patients, some cases may be prevented or at least diagnosed early and better treated. Knowing certain diseases such as metabolic disorders can lead to early diagnosis and reduce the destructive effects of both diseases. Most seizures are frustrating for the family because they are accompanied by a loss of consciousness, especially when accompanied by convulsive movements and paddling and foaming at the mouth. The first question that may come to the mind of any searcher is:
Is the presence of these two patients in a child coincidental? Whether or not these two diseases in this patient may have a common root.
The issue that challenges the patient's family or the treating physician is the simultaneous treatment of these two diseases. Many questions can arise.
1- Should the treatment of two diseases be considered separately from each other and perform two independent treatments for the patient?
2- Does the treatment of one of the two diseases cause the other disease to get better and improve?
3- Does not the treatment of one of the two diseases aggravate the other disease? 4. Is the prognosis worse when the two diseases are together?
These will be simple and basic challenges for the parents and caregivers of these children as well as the attending physician. The challenges of epilepsy itself are many in children. Other issues are sometimes raised in terms of the relationship between epilepsy and autism:
Can epilepsy cause autism? Can autism cause epilepsy? What happens to the patient when there is another illness such as mental disability?
Epilepsy is one of the most common neurological diseases in children. About 70% of epilepsies occur in the first two decades of life, and 75% of epileptic seizures occur in children. Diagnosis of epilepsy is sometimes difficult and a wide range of diseases are subject to differential diagnosis. It is not always easy to categorize a child with epilepsy; in one study, 24% of cases could not be grouped. The drawbacks of not reporting properly are due to the lack of attention from others due to anxiety, or previous epileptic seizures being too short and attributed to behavioral disorders and others. Misdiagnosis of epilepsy is also common, such as tremors, migraines, night terrors, syncope, and prolonged QT. Misdiagnosis of epilepsy is important and common in children and there is a large body of research related to misdiagnosis of epilepsy.
Vodcans are a heterogeneous group of diseases, each of which requires its own diagnosis and treatment. It should be noted that children are more likely to be diagnosed (cause or factors) of the syndrome than adults. Epilepsy in children may lead to an accident and the patient is taken to the emergency room. In one study, 5% of pediatric accidents were due to epilepsy. The first seizure of children is very difficult for the family and they think that their child is dying.
Most children have a fever at the first epileptic seizure, so think about bacterial meningitis or a central nervous system infection and take the necessary precautions. In children, facilitative causes should be found and necessary measures such as measuring blood sugar, examining infections, and if necessary, performing diagnostic radiography.
Note: Normally, blood, calcium, and magnesium blood count tests are not available for everyone and should be checked in case of suspicion. There is no need for hospitalization after epileptic seizures improve and symptoms resolve. Epilepsy may be associated with another neurological disorder. Children with learning disabilities are more likely to have epilepsy, 15% of children with mild learning disabilities and 30% of children with severe learning disabilities. Epilepsy and autism are more common in people with reduced IQ, which was mentioned. Brain growth disorders can cause epilepsy and autism, so having two diseases in one person may be caused by a single cause. Brain growth disorders can be different and cause different signs and symptoms of malfunctioning brain cells and neurons, or damage to the brain in processing information, and signals can not be transmitted properly. These disorders can be the source of epilepsy or autism, and in significant cases both.
Epilepsy is common in children with cerebral palsy, especially children with quadriplegia. 20% of children with hemiplegia also have active epilepsy. There is a rare syndrome called Landau-Kleffner syndrome, which in 75% of cases has epileptic seizures and in significant cases also autism.
There is a strong relationship between cognitive impairment and epilepsy.
Between 38-3% of children with autism have epilepsy. When epilepsy is associated with learning disabilities, the risk of autism by age 10 is three times that of normal people. Recent studies have reported that about 20% of children with epilepsy may have autism.
Prenatal, postpartum, and postpartum factors and environmental factors have been implicated in both epilepsy and autism.
The role of genetics in the co-occurrence of autism and epilepsy:
There have been many advances in genetics in recent years, with the possibility of recording small chromosomal changes, which is a great help in this regard. Some studies have suggested that autism is associated with corpus callosum abnormalities, 20% of which are due to genetic mutations. More than 100 genes are known to play a role in autism. Some of these genetic disorders are associated with epilepsy and may be associated with mental retardation. In an interesting and unusual study conducted in Sweden, which considered the relationship between family relationships, they found significant findings. Relatives and children of people with epilepsy also found that the chances of developing autism were higher. The rate of autism is also higher in people who had childhood epilepsy. One of the most well-known genetic diseases is Tuberosclerosis, in which certain drugs have been used and have had considerable success. It is common in other neurogenetic diseases such as Down syndrome, Angleman syndrome, Rett syndrome, and fragile epilepsy syndrome X, and has been linked to autism. Genetic testing is required in patients with autism. Diagnosis of epilepsy in children with autism is not easily associated with patients without the disease. Children with autism do not cooperate, some symptoms of autism can be confused with the symptoms of epilepsy. Epileptic behaviors similar to autism are more common, especially in children. Repetitive movements can be seen in both autism and automatism. Cognitive disorders, social interactions, restless and aggressive behaviors can be seen in autism as well as in children with epilepsy. In a child with autism, epilepsy should be suspected and a neurologist should be suspected if conditions such as glare, fainting, stiffness, loss of attention, or regular movements are seen as jumping and grabbing. Sometimes epileptic seizures, especially persistent epilepsy, can mimic autistic conditions, in which timely and appropriate treatment can improve these conditions. It is very helpful to know these brain scans and sometimes long-term brain scans when accompanied by a video image. In cases of illness with some degree of mental disability, these conditions may be seen, making diagnosis more difficult. In cases associated with tuberculosis, certain medications are available that can be helpful. It is important to know what causes epilepsy and autism together in terms of treatment and medications needed. Some antiepileptic drugs may worsen autism, and some medications, while controlling epileptic seizures, can also reduce autism. In any case, epilepsy should be treated independently and autism should be treated and cared for. Recently, it has been recognized that conditions caused by the effect of neuronal autoantibodies, in which genetics also play a role, can bring relief to these patients with prompt and timely treatment.
The role of environmental factors:
Many environmental factors are also blamed for autism, some of which are associated with an increased incidence of epilepsy. Air pollution is one of the most important and it is necessary to pay more attention in this regard due to our climatic conditions. Insecticide use is considered, although there is not much substantiated evidence. The protective effects of folate are also present in pregnant mothers. In general, it should be said that an increase in the incidence of these diseases is seen with the interaction of genetic factors with the environment. If children are genetically predisposed and exposed to environmental toxins, they may develop autism and epilepsy.
The role of intrauterine factors:
There are also known intrauterine relationships, such as maternal rubella during pregnancy, which can even cause mental retardation. Taking certain medications, such as sodium valproate, during pregnancy and even before pregnancy can lead to autism, especially in a mother who has used this medication for epilepsy, which can increase the chances of developing autism.
Treatment issues:
Treatment of epilepsy requires sufficient information about the type of epilepsy, comorbidities and other socio-financial conditions, the presence of drugs in the market, the possibility of proper use of drugs and especially the side effects of drugs that the doctor should consider the best decision for the patient To take. Epilepsy in children is often easily controlled, but sometimes it is not possible easily and without tolerating some side effects of medication, especially in cases where it is accompanied by another problem. Epilepsy may have a higher mortality rate when associated with another condition, such as autism. Children with epilepsy with autism sometimes suffer from sleep, behavioral, and cognitive disorders. Importantly, the treatment of epilepsy itself should be done independently, and the treatment of a patient with autism usually does not significantly interfere with the treatment of the patient's epilepsy.
Conclusion:
1 - The risk of developing epilepsy in autism is high (about 20%). The risk of developing autism in epilepsy is also high (about 20%).
2 - In most cases, there is a common relationship between epilepsy and autism in a child and we must be sure that the autistic manifestations are not due to a defect in the treatment of epilepsy.
3 - Good management of autism and epilepsy as well as comorbid disorders can improve the quality of life in the child and family.
Dr. Hossein Ali Ebrahimi Meymand
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