Association of Epileptiform Discharge and Autism Spectrum Disorder Severity in Children Attending the Outpatient Clinics, Child Welfare Teaching Hospital, Baghdad
DOI:
https://doi.org/10.32007/jfacmedbagdad.2131Keywords:
Autism, Childhood Autism, Electroencephalogram, Prevalence, Rating ScaleAbstract
Background: Subjects with Autism Spectrum Disorder (ASD) have a higher prevalence of seizures than the general population, according to a significant body of research. Also, seizure-free patients with ASD have been found to have a higher prevalence of epileptiform discharge abnormalities compared to healthy controls across investigations. Changes in the electroencephalogram (EEG) can manifest as sharp waves or spikes, sharp and slow waves, generally distributed or general area, or focused, and can manifest in various brain regions. There is a necessity to search for a distinctive EEG characteristic in ASD patients.
Objectives: This study used electroencephalography to investigate the relationship between interictal epileptiform discharges and the severity of ASD in children.
Methods: The study involved a total of 65 children. The first group consisted of 30 children (seven females and 23 males, 2-12 years of age) recruited from the autism centre and the paediatric neurology consultancy clinic in the Child Welfare Teaching Hospital / Medical City. The second group consisted of 35 age- and gender-matched normally developed children (10 females and 25 males, 2-12 years of age) recruited from the Paediatrics Consultation Clinics in the Child Welfare Teaching Hospital. The ASD children met the DSM-5 criteria for autism, and the Childhood Autism Rating Scale was utilised to determine the severity of autism. The electroencephalography signals were recorded to detect epileptiform discharge. The data was collected during the period from 5th October 2022 to 1st April 2023.
Result: A statistically significant association was found between the epileptiform discharges and the study group (ASD vs. normally developed children). The EEG records were normal in 20 (66.7%), abnormal in the form of focal epileptiform discharge in 5 (16.7%), and in the form of generalised epileptiform discharge in 5 (16.7%) of ASD children. The EEG findings and the CARS-measured autism severity showed a statistically significant association (P=0.05), as the EEG abnormalities increased with the severity of autism.
Conclusion: The degree of autism was found to be associated with the abnormalities of the electroencephalogram and the degree of autism.
Received: May 2023
Accepted: Sept, 2023
Published: Jan. 2024
Downloads
References
(1) Kodak T, Bergmann S. Autism Spectrum Disorder: Characteristics, Associated Behaviors, and Early Intervention, 2020 Jun;67(3):525-535. https://doi.org/10.1016/j.pcl.2020.02.007.
(2) Kadhum ZIA. Biochemical alteration in some Iraqi children with autistic spectrum disorder (ASD). J Fac Med Baghdad 2016; Vol.58, No .1 https://doi.org/10.32007/jfacmedbagdad.581195.
(3) Lai M, Lombardo MV, Baron-Cohen S. Autism 2014 Mar 8;383(9920):896-910.
https://doi.org/10.1016/S0140-6736(13)61539-1.
(4) Chiarotti F, Venerosi A. Epidemiology of autism spectrum disorders: a review of worldwide prevalence estimates since 2014. Brain Sci.2020;10(5):274. https://doi.org/10.3390/brainsci10050274.
(5) Baio J, Wiggins L, Christensen DL, Maenner MJ, Daniels J, Warren Z, et al. Prevalence of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveill Summ. 2018;67(6):1 https://doi.org/10.15585/mmwr.ss6706a1.
Al-Salehi SM, Al-Hifthy EH, Ghaziuddin M. (2009) "Autism in Saudi Arabia: presentation, clinical correlates, and comorbidity". Transcultural Psychiatry. 46 (2): 340-7https://doi.org/10.1177/1363461509105823.
Al-Mamri W, Idris AB, Dakak S, Al-Shekaili M, Al-Harthi Z, Alnaamani AM, Alhinai FI, et al. Revisiting the Prevalence of Autism Spectrum Disorder among Omani Children: A multicentre study. Sultan Qaboos Univ Med J.
https://doi.org/ 10.18295/squmj.2019.19.04.005.
Alshaban F, Aldosari M, Al-Shammari H, El-Hag S, Ghazal I, Tolefat M, Ali M, et al. (2019) Prevalence and correlates of autism spectrum disorder in Qatar: a national study. J Child Psychol Psychiatry;60(12):1254-1268. https://doi.org/10.1111/jcpp.13066.
Chaaya M, Saab D, Maalouf FT, Boustany RM. Prevalence of Autism Spectrum Disorder in Nurseries in Lebanon: A Cross Sectional Study. J Autism Dev Disord. 2016 Feb;46(2):514-22. https://doi.org/10.1007/s10803-015-2590-7.
Lukmanji S, Manji SA, Kadhim S, Sauro KM, Wirrell EC, Kwon, et al. The co-occurrence of epilepsy and autism: a systematic review. Epilepsy Behav. (2019) 98:238-48. doi: 10.1016/j.yebeh.2019.07.037. https://doi.org/10.1016/j.yebeh.2019.07.037.
(11) Chez MG, Chang M, Krasne V, Coughlan C, Kominsky M, Schwartz A 2006 Frequency of epileptiform EEG abnormalities in a sequential screening of autistic patients with no known clinical epilepsy from 1996 to 2005. Epilepsy Behav 8: 267-271https://doi.org/10.1016/j.yebeh.2005.11.001.
Mulligan CK, Trauner DA. Incidence and behavioral correlates of epileptiform abnormalities in autism spectrum disorders. J. Autism Dev. Disord. 2014;44:452-458. doi: 10.1007/s10803-013-1888-6. https://doi.org/10.1007/s10803-013-1888-6.
Swatzyna RJ, Tarnow JD, Turner RP, Roark AJ, MacInerney EK, Kozlowski GP. Integration of EEG Into Psychiatric Practice: A Step Toward Precision Medicine for Autism Spectrum Disorder. J. Clin. Neurophysiol. 2017;34:230-235. https://doi.org/10.1097/WNP.0000000000000365.
Hernan AE, Holmes GL, Isaev D, Scott RC, Isaeva E. (2013). Altered short-term plasticity in the prefrontal cortex after early life seizures. Neurobiol Dis. 2013 doi: 10.1016/j.nbd.2012.10.007. https://doi.org/10.1016/j.nbd.2012.10.007.
(15) Chlebowski C, Green JA, Barton ML, Fein D. (2010) Using the Childhood Autism Rating Scale to Diagnose Autism Spectrum Disorders. J Autism Dev Disord.; 40(7): 787-799 https://doi.org/10.1007/s10803-009-0926-x.
(16) Acharya JN, Hani A, Cheek J, Thirumala P, Tsuchida TN. American Clinical Neurophysiology Society Guideline 2: Guidelines for Standard Electrode Position Nomenclature. J. Clin. Neurophysiol. 2016, 33, 308-311. https://doi.org/10.1097/WNP.0000000000000316.
(17) Fong CY, Tay CG, Ong LC, Lai NM. Chloral hydrate as a sedating agent for neurodiagnostic procedures in children. The Cochrane Database of Systematic Reviews, 2017(11). https://doi.org/10.1002/14651858.CD011786.pub2.
(18) Spence SJ & Schneider MT. (2009). The Role of Epilepsy and Epileptiform EEGs in Autism Spectrum Disorders. Pediatric Research, 65(6), 599-606. https://doi.org/10.1203/PDR.0b013e31819e7168.
(19) Akshoomoff N, Farid N, Courchesne E, Haas R. (2007). Abnormalities on the neurological examination and EEG in young children with pervasive developmental disorders. J Autism Dev Disord 37: 887-893. https://doi.org/10.1007/s10803-006-0216-9.
(20) Al-Beltagi M. (2021) Autism medical comorbidities. World Journal of Clinical Pediatrics. 10 (3) p 15-28.) https://doi.org/10.5409/wjcp.v10.i3.15.
(21) Amiet C, Gourfinkel-An I, Laurent C, Carayol JR, Génin BR, Leguern E, et al. Epilepsy in simplex autism pedigrees is much lower than the rate in multiplex autism pedigrees. Biological Psychiatry, 74(3), e3-e4. https://doi.org/10.1016/j.biopsych.2013.01.037.
(22) Anukirthiga B, Mishra D, Pandey S, Juneja M, Sharma N. (2019). Prevalence of epilepsy and inter-ictal epileptiform discharges in children with autism and attention-deficit hyperactivity disorder. Indian Journal of Pediatrics, 86, 897-902. https://doi.org/10.1007/s12098-019-02977-6.
(23) Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, et al. Prevalence and incidence of epilepsy: a systematic review and meta-analysis of international studies. Neurology 2017; 88:296-303. https://doi.org/10.1212/WNL.0000000000003509.
(24) Forsgren L, Beghi E, Oun A, Sillanpaa M. The epidemiology of epilepsy in Europe-a systematic review. Eur J Neurol. 2005; 12:245-253 https://doi.org/10.1111/j.1468-1331.2004.00992.x.
(25) Ben-Ari Y, Holmes GL. Effects of seizures on developmental processes in the immature brain. Lancet Neurol. 2006;5(12):1055-1063 https://doi.org/10.1016/S1474-4422(06)70626-3.
(26) Lee H, Kang HC, Kim SW, Kim YK, Chung HJ (2011) Characteristics of late onset epilepsy and EEG findings in children with autism spectrum disorders. Kor J Ped 54: 22-28 doi: 10.3345/kjp.2011.54.1.22 https://doi.org/10.3345/kjp.2011.54.1.22.
(27) Yousef AM, Youssef UM, El-Shabrawy A, Abdel Fattah NR, Khedr H, Khedr H. (2017) EEG abnormalities and severity of symptoms in non-epileptic autistic children. Egyptian Journal of Psychiatry. 38 p 59-64. https://doi.org/10.4103/1110-1105.209676.
(28) Ewen JB, Marvin AR, Law K, Lipkin PH. (2019) Epilepsy and autism severity: A study of 6,975 children. Autism Research. 12 (8) p 1251-1259. https://doi.org/10.1002/aur.2132.
(29) Parisi L, Lanzara V, Vetri L, Operto FF, Pastorino GMG, Ruberto M, et al. (2020) Electroencephalographic Abnormalities in Autism Spectrum Disorder: Characteristics and Therapeutic Implications https://doi.org/10.3390/medicina56090419.
(30) Akhter S. (2021) Epilepsy: A common co-morbidity in ASD. In: Autism Spectrum Disorder. Fitzgerald, M. (Edi.) Chapt. 2, IntechOpen, Rijeka. https://doi.org/10.5772/intechopen.96484
(31) Samra NM, Ghaffar HMA, El-Awady HA, Soltan MR, Moktader RMA. (2017) Epilepsy and EEG findings in children with autism spectrum disorders. Autism Open Access. 7 p 211. https://www.longdom.org/open-access/epilepsy-and-eeg-findings-in-children-with-autism-spectrum-disorders-36495.html. https://doi.org/10.4172/2165-7890.1000211.
(32) Elkholy N, Ezedin A, Hamdy M, El Wafa H. (2015). Electroencephalographic pattern among autistic children and their relatives. Egyptian Journal of Psychiatry. 36 (3) p 150. https://doi.org/10.4103/1110-1105.166359.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Esraa E. Abdulrazzaq, Ghasan T. Saeed
This work is licensed under a Creative Commons Attribution 4.0 International License.