Article

Epilepsy in Young Adults with Autism: A Prospective Population-based Follow-up Study of 120 Individuals Diagnosed in Childhood

Department of Pediatrics, Queen Silvia Children's Hospital, Göteborg, Sweden.
Epilepsia (Impact Factor: 4.57). 07/2005; 46(6):918-23. DOI: 10.1111/j.1528-1167.2005.57504.x
Source: PubMed

ABSTRACT

Little is known about the long-term outcome of epilepsy in autism and the epilepsy characteristics of adults with autism. This prospective population-based study was conducted in an attempt to point out differences on a group basis between adults with autism with or without epilepsy, and to describe the occurrence, the seizure characteristics, and the outcome of epilepsy in autism.
One hundred eight of 120 individuals with autism diagnosed in childhood and followed up prospectively for a period of 13-22 years were reevaluated at ages 17-40 years. As adults, the majority had mental retardation and autistic disorder or autistic-like condition. Interviews were performed with the caretakers of 42 of 43 individuals with a history of epilepsy, and their medical records were reviewed.
Adults with autism and mental retardation constituted a severely disabled group. On a group basis, both the cognitive level and the adaptive behavior level were lower in the epilepsy group than in the nonepilepsy group (p<0.05). In all, 38% had epilepsy. One third had epilepsy onset before age 2 years. Remission of epilepsy was seen in 16%. Partial seizures with or without secondarily generalized seizures were the dominating seizure type.
In a community sample of individuals with autism followed up from childhood through to adult age, one of three had epilepsy since childhood/adolescence. Severe mental retardation and autism are significantly associated with epilepsy, especially in female patients. Seizure frequency has a great impact on the individuals' lives. Specialist medical care is needed in this severely communication-disabled population.

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    • "Other conditions, such as an elevated rate of asthma in children with ASD, were dramatically reduced in this adult population. The rate of seizures in this cohort (29%) is comparable to the 22%–38% reported in previous studies (Bolton et al., 2011; Danielsson et al., 2005; Giovanardi et al., 2000). Sleep disorders were seen in a smaller portion of participants (41%) than in two previous studies (75%– 80%), which may reflect the differences in sample size and symptom query (Oyane and Bjorvatn, 2005; Tani et al., 2003). "
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    ABSTRACT: This study describes medical conditions experienced by a population-based cohort of adults with autism spectrum disorder whose significant developmental concerns were apparent during childhood. As part of a 25-year outcome study of autism spectrum disorder in adulthood, medical histories were collected on 92 participants (N = 69 males) who were first ascertained as children in the mid-1980s, 11 of whom were deceased at the time of follow-up. Questionnaires queried medical symptoms, disorders, hospitalizations, surgeries, and medication use. Median age at follow-up was 36 years (range: 23.5-50.5 years), and intellectual disability co-occurred in 62%. The most common medical conditions were seizures, obesity, insomnia, and constipation. The median number of medical conditions per person was 11. Increased medical comorbidity was associated with female gender (p = 0.01) and obesity (p = 0.03), but not intellectual disability (p = 0.79). Adults in this cohort of autism spectrum disorder first ascertained in the 1980s experience a high number of chronic medical conditions, regardless of intellectual ability. Understanding of these conditions commonly experienced should direct community-based and medical primary care for this population. © The Author(s) 2015.
    Full-text · Article · Jul 2015 · Autism
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    • "A number of studies suggest that epilepsy affects a high proportion of individuals with ASD. Indeed, the reported prevalence of epilepsy in ASD ranges from 5% to 38%, which is clearly higher than the 1%–2% prevalence in the general childhood population [8] [9] [10] [11] [12]. In addition, the prevalence of treatmentresistant epilepsy is believed to be higher in children with ASD than in the general childhood population [13]. "
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    ABSTRACT: Autism spectrum disorder (ASD) affects a significant number of individuals in the United States, with the prevalence continuing to grow. A significant proportion of individuals with ASD have comorbid medical conditions such as epilepsy. In fact, treatment-resistant epilepsy appears to have a higher prevalence in children with ASD than in children without ASD, suggesting that current antiepileptic treatments may be suboptimal in controlling seizures in many individuals with ASD. Many individuals with ASD also appear to have underlying metabolic conditions. Metabolic conditions such as mitochondrial disease and dysfunction and abnormalities in cerebral folate metabolism may affect a substantial number of children with ASD, while other metabolic conditions that have been associated with ASD such as disorders of creatine, cholesterol, pyridoxine, biotin, carnitine, γ-aminobutyric acid, purine, pyrimidine, and amino acid metabolism and urea cycle disorders have also been associated with ASD without the prevalence clearly known. Interestingly, all of these metabolic conditions have been associated with epilepsy in children with ASD. The identification and treatment of these disorders could improve the underlying metabolic derangements and potentially improve behavior and seizure frequency and/or severity in these individuals. This paper provides an overview of these metabolic disorders in the context of ASD and discusses their characteristics, diagnostic testing, and treatment with concentration on mitochondrial disorders. To this end, this paper aims to help optimize the diagnosis and treatment of children with ASD and epilepsy. This article is part of a Special Issue entitled "Autism and Epilepsy".
    Full-text · Article · Nov 2014 · Epilepsy & Behavior
    • "Other conditions, such as an elevated rate of asthma in children with ASD, were dramatically reduced in this adult population. The rate of seizures in this cohort (29%) is comparable to the 22%–38% reported in previous studies (Bolton et al., 2011; Danielsson et al., 2005; Giovanardi et al., 2000). Sleep disorders were seen in a smaller portion of participants (41%) than in two previous studies (75%– 80%), which may reflect the differences in sample size and symptom query (Oyane and Bjorvatn, 2005; Tani et al., 2003). "
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    ABSTRACT: Background and objectives: Increased emphasis is being placed on the continuous quality improvement (CQI) education of residents of all specialties. This article describes a resident-led continuous quality improvement (CQI) project, based on a novel curriculum, to improve the immunization rates of children under 2 years old at the Madsen Family Health Center (MHC). Methods: All third-year residents were trained in the FOCUS-PDSA CQI methodology through concurrent didactic lectures and experience leading the CQI team. The CQI team included clinical staff led by a third-year family medicine resident and mentored by a member of the family medicine faculty. Immunization records were distributed to provider-medical assistant teamlets daily for each pediatric patient scheduled in clinic as the intervention. Compliance with the intervention (process measure), as well as immunization rates at 2 and 5 months post-intervention (outcome measure), were monitored. Results: Immunization records were printed on 84% of clinic days from October 24, 2011 to March 31, 2012. The percentage of patients immunized at baseline was 66%. The percentage immunized as of December 31, 2011 was 96% and was 91% as of March 31, 2012. Conclusions: An important educational experience was organized for third-year family medicine residents through learning CQI skills, leading a CQI team, and directing a CQI project to completion. Significant improvement in the percentage of patients under 2 years old immunized at the MHC was achieved by presenting provider-medical assistant teamlets with immunization records of all pediatric patients on the daily clinic schedule.
    No preview · Article · Sep 2014 · Family medicine
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