Medical Comorbidities In Children with Epilepsy and Autism Spectrum Disorders

Background:  While prior research has shown a relationship between sleep disturbance and daytime behavioral problems in autism spectrum disorders (ASD), the relationship of ASD individuals with epilepsy to sleep, behavior, cognition  and medical concerns has not been well characterized.

Objectives:   We examined possible links between epilepsy, sleep, GI symptoms and behavior/cognition in a well characterized population of individuals with ASD.

Methods:  

Children and adolescents with a diagnosis of ASD (autism, Asperger disorder, or PDD-NOS) confirmed by ADOS, age 2 – 18 years were enrolled into the Autism Treatment Network (ATN) Registry which collects data on children with ASD at 14 sites across the US and Canada.  Upon entry into the registry, parents complete a medical history questionnaire, GI Symptom Inventory, Children’s Sleep Habits Questionnaire (CSHQ) and Child Behavior Check List (CBCL).  Subjects also undergo a battery of assessments including cognitive testing, Vineland Adaptive Behavior Scales and detailed neurologic examination.

Results:  Data was available on 2573 children.  Of these, 423 (16%) reported a history of seizures.  For the 1280 children (202 with history of seizures) with a completed CBCL (ages 1 to 5), children with a history of seizures had significantly higher mean scores on the total CBCL and all subscales, when compared to children without seizures. Similarly, for the 1055 children (173 with a history of seizures) with a completed CBCL (ages 6 to 18), children with a history of seizures had significantly higher mean scores on the total CBCL and all subscales.  A total of 2,120 (345 with a history of seizures) had a completed CSHQ evaluating sleep problems.  Children with a history of seizures had significantly higher proportion of parent reported sleep problems (CSHQ) compared to children without a history of seizures (74.2 versus 64.8, p-value = 0.000).  A total of 2,421 (397 with a history of seizures) had a completed GI form.  Children with a history of seizures had a higher proportion of GI problems compared to children without a history of seizures (63.2% compared to 49.8%, p-value = 0.000).  A total of 1921 (302 with a history of seizures) had a completed cognitive battery.  Children with a history of seizures had a higher proportion with lower cognition compared to children without a history of seizures, but this did not reach significance (60% compared to 65.5%; p-value = 0.07). For the 962 children (161 with a history of seizures) with a completed Vineland, children with a history of seizures had significantly lower mean scores for the overall score and its subscales.

Conclusions:  Children with ASD and a history of seizures have increased rates of GI problems, sleep problems, and daytime behavior problems compared to children with ASD and no seizures.  Greater understanding of these relationships could lead to better interventions for this population.

Support from Autism Speaks/Autism Treatment Network and UA3MC11054 (MCHB).