Epilepsy, Autism Spectrum Disorders and Behavior
Report on conference by Gerald Bloomfield 

A meeting, jointly sponsored by the Epilepsy Foundation of Michigan and the Autism Society of Michigan, was held in the Sheraton Detroit Novi hotel on 18 March 2005. The focus of the meeting was on the features of epilepsy that affect children with autism.

Epilepsy is a general term for a variety of disorders characterized by recurring, unprovoked seizures. A seizure is a brief disturbance in the electrical activity of the brain, which causes temporary changes in movement, awareness, feelings or behaviour. There are over 20 different types of seizure. About 20-30 percent of people with classic, Kanner-type autism have epilepsy for some part of their lives. Some develop seizures in the early months of life, others begin in adolescence, some in adulthood. Overall, it is estimated about 14 percent of children with Autism Spectrum Disorders have epilepsy.

The morning program featured three speakers:

  • Harry Chugani (Chief of Pediatric Neurology at Michigan Children’s Hospital and Professor, Wayne State University, Detroit) on “The relationship between epilepsy and autism.”
  • Catherine Lord (Professor of Psychology and Psychiatry at the University of Michigan, Ann Arbor, and Senior Scientist at the Center for Human Growth and Development) on “Epilepsy and behavior in children with autism spectrum disorders.”
  • Luke Y. Tsai (Professor of Psychiatry and Pediatrics, University of Michigan Medical School, Ann Arbor) on “The link between sleep, seizure disorders and behavioral abnormalities.”

All the speakers explained the general types of seizures but noted that we are still in the very early stages of understanding the precise relationships between epilepsy and autism. Some types of bizarre behavior or “acting out” may well be related to mild forms of seizure activity. The causes of seizure activity are very varied: some cases may be triggered by sleep deprivation. Each speaker stressed the importance of accurate diagnosis, but this is not always possible, given the common aversion to hospitals and medical personnel. Seizure control is most commonly achieved by medication (70 per cent of cases), although three trials may be needed before a successful medication is found. Surgery is advocated in 15 per cent of cases, while in the remaining 15 per cent no control is possible. In all cases, quality of life for the individual is critical. The speakers all emphasized the importance of reducing stress while one noted that Sensory Integration Therapy is one of the few medical treatments that really works.

The afternoon program featured four concurrent sessions focused on solutions for families with a child who has both ASD and seizure disorder. These sessions included:

  • Sleep disorders and ASD
  • Optimizing outcomes for individuals with neurodevelopmental disabilities and seizures
  • Challenging behavior
  • Issues in the school, community and family with ASD and seizures.

In the second of these sessions, Jules Constantinou (Senior Staff {Pediatric Epileptologist at the Comprehensive Epilepsy Program in the Henry Ford Health Centre, Detroit) made several important points. Getting away from the seizure-counting mentality is particularly important. Occasional seizures should be accepted if the person is not at risk from injury. The adverse effects of drugs could be worse than the seizures. “Polypharmacy” should be avoided. With any drug therapies, his advice was “Go low, go slow.”

The conference was very much a work in progress, showing more of the relationships in the complex of autism spectrum disorders. The importance of neurology was apparent in new developments in our knowledge of ASD. Inevitably, those attending the conference in the search for specific treatments would be disappointed. Simple answers are not possible. All the presenters emphasized the great importance of caution, limited intrusion, caring, and quality of life. The focus on children, however, left answered the common questions of how to support adults with ASD and seizures.

All conferences should provide opportunities for networking and comparisons. I learned, for example, that special education in Michigan extends to age 26. The impressive array of expertise on ASD and epilepsy in the Detroit-Ann Arbor area left some of the audience from other parts of the state concerned about the quality of diagnosis and services in their regions.

This was an innovative meeting in bringing together the interests of epilepsy and autism. Many developments in fostering new knowledge about autism are stimulated by such cross-disciplinary connections. Presenting these relationships is a real challenge for the organizers and speakers, especially in avoiding repetition. All four speakers I heard at this conference spent a good deal of their time outlining the various types of seizure. Given the complexity of relationships, the meeting also needed a concluding plenary sessions to help delegates gather up the multiple images and ideas expressed throughout the day.

Further links suggested by the conference:
http://www.epilepsyfoundation.org/ Epilepsy Foundation Michigan

http://www.epilepsyontario.org/ Epilepsy Ontario has a Waterloo-Wellington branch at 301 Frederick Street, Kitchener (519-745-2112). There are adult awareness groups in Kitchener and Guelph.
 
http://www.autism-mi.org/ Autism Society of Michigan

http://www.umaccweb.com/ University of Michigan Autism & Communication Disorders Centers

http://www.ncbi.nlm.nih.gov/  National Center for Biotechnology Information US National Library of Medicine databases: PubMed produced 430 citations on epilepsy and autism.