Epilepsy is a neurological disorder. It is characterized by recurrent seizures caused by abnormal electrical activity in the brain. The factors for its occurrence vary: these include genetic causes, brain injuries, brain infections, and more. Each case of epilepsy is unique and may depend on a combination of several factors.
Epilepsy is more common in children and adults with autism spectrum disorder than in the general population. The risk percentage ranges from 10% to 40%. And the degree of risk depends on additional factors that accompany autism. For example, when autism is combined with mental retardation, the risk of epilepsy is 50%, which tells us that autism and epilepsy are often linked. Clinical evidence also shows that children with Rett syndrome, tuberous sclerosis, Landau-Kleffner syndrome and several other genetic disorders are most susceptible.
Who is at greatest risk of developing epilepsy?
Various studies have shown that intellectual disability (“mental retardation”) is the main risk factor for epilepsy in autism. The risk of epilepsy for autistic children without intellectual disabilities is 8%. However, for children with autism and intellectual disabilities, it is 20%. With severe intellectual disabilities, this risk can be as high as 40%. At the same time, among autistic children with above-average intelligence, about 4% develop epilepsy.
Another risk factor is adolescence. When children with autism reach adolescence, their risk of seizures increases, and it continues to increase into adulthood. Factors such as gender, regression of speech skills and level of social skills have not shown an association with the likelihood of developing epilepsy.
How is epilepsy diagnosed?
A neurologist (or pediatric neurologist) diagnoses seizures or epilepsy. The criteria for diagnosis do not depend on whether the patient has autism. However, with autism, diagnosis may be complicated by the fact that some signs of seizures, such as prolonged staring at one point or repetitive movements, may be manifestations of autism.
If an autistic person stares at a single point and does not react to anything for any length of time or makes rhythmic repetitive movements that are not normally characteristic of autism, a specialist should be consulted to check for epileptic seizures. Any suspicion of possible epilepsy indicates the need to see a doctor.
Before making a diagnosis, a neurologist must determine the cause of the seizures. This may require such examinations as:
- sleep electroencephalogram;
- magnetic resonance imaging;
- genetic testing.
After diagnosis, a neurologist may prescribe anticonvulsant medication to prevent new seizures.
Drug treatment of epilepsy
In severe cases, when the patient suffers so much that drug therapy does not help stabilize the condition, other therapies such as ketogenic diet and surgery are used.
Unfortunately, some anticonvulsant drugs have undesirable effects on the behavior of epileptic patients. In particular, irritability may increase, aggression may appear or, conversely, the child becomes lethargic and drowsy. Therefore, the administration of such drugs should be carefully monitored by a neurologist or psychiatrist, and in parallel, behavioral interventions to correct problem behavior should be carried out. Pills and syrups may also be difficult to take, and in such cases, appropriate behavioral protocols may need to be implemented to teach the child to swallow pills.
How can we help the person communicate that a seizure is coming?
Some children and adults with autism can talk about how they feel, but if the person does not speak and uses alternative communication, it is important to develop specific strategies and teach the person to report their experiences.
For example, body drawing or pictures of specific body parts can be used so that the person can show where they are experiencing pain or unusual sensations. Some people may use sign language to show that they are not feeling well.
How to recognize an impending seizure of epilepsy
Many aspects of support for autistic people with epilepsy are the same as when supporting neurotypical people with epilepsy. For example, this includes first aid skills for seizures.
However, autism may make it more difficult for a person to explain their internal experiences and sensations, which means it is more difficult for them to report an impending seizure and get timely help.
For example, people with epilepsy may experience strange sensations before a seizure, such as a strange taste in the mouth or visual distortions. Often these signs are not noticeable from the outside, and a person with autism may have difficulty communicating what they are experiencing.
There is also a risk that signs of an impending seizure will be interpreted as sensory problems associated with autism. Therefore, it is very important to watch for the slightest changes in behavior that may indicate that something is not right. For example, this could be:
- motor excitement;
- looking at his fingers;
- smacking his lips;
- an unusual need to follow and be close to other people.
The key here is to determine what signs indicate an impending seizure in a particular person and what in the environment usually triggers seizures.
How can parents create a safe environment for their child?
An important strategy is to avoid factors that increase the risk of seizures. This includes bright lights, flashing screens, loud noises, and fall hazards. An important strategy is also an adequate learning load that takes into account the needs and abilities of the individual child. With appropriate rules and adequate therapy, in most cases the child’s condition can be stabilized.
The role of therapies and educational programs
When parents are faced with epilepsy and autism in their children, they have to deal with two serious diagnoses that, as we have found, are often interrelated. In addition to anticonvulsant therapy aimed at controlling epileptic seizures, it is necessary to find a child with developmental delays additional therapies to help him to live as independent life as possible, to develop self-care and socialization skills. A peculiarity of autism is a violation of social interaction. Together with epilepsy, social isolation can be exacerbated. Appropriately selected therapies, including behavioral therapies, as well as educational programs play a key role in the treatment of epilepsy, complementing medication and helping to improve patients’ quality of life. They help patients and their families better understand the disease, cope with its challenges, and lead more fulfilling lives.
Conclusion
Epilepsy is more common in autistic individuals, making early diagnosis and personalized support essential. Since communication difficulties can make it hard to recognize seizures, caregivers must watch for subtle behavioral signs. A combination of medical treatment, behavioral therapy, and a safe environment helps improve quality of life. With the right approach, individuals with autism and epilepsy can live safer and more independent lives.
