Children with autism spectrum disorder (ASD), a developmental dysfunction that affects communication and behavior, are more likely to have epilepsy, a brain disorder that causes seizures. And vice versa: Children with epilepsy are slightly more likely to have ASD. Seizures are more likely in ASD people who also have a genetic disorder associated with both conditions, such as Rett syndrome, fragile X syndrome, and Prader-Willi syndrome.
Parents and caregivers of ASD children should be informed of the possibility of seizures, especially during adolescence and the young adult years, so they can look for anything unusual happening with them. If someone with ASD does have a seizure, neurologists will order magnetic resonance imaging (MRI) to rule out any other possible cause, such as a brain tumor, and an electroencephalogram (EEG) to identify the location of the seizure.
Seizures can manifest in different ways. During some, the muscles are stiff; during others, the muscles relax. Still others may cause jerking or shaking in parts of the body or just decreased responsiveness and staring. No one seizure type is associated with ASD, but parents and caregivers should become familiar with all types in order to identify them, know how to handle them, and be able to report them to a neurologist.
Some ASD children who can't communicate effectively may exhibit behaviors similar to seizure behaviors. For example, they might flap their hands or fidget, which can resemble movements known as automatisms—repetitive motor activities like lip smacking, chewing, or swallowing—that often occur during a seizure. In addition, both ASD and epilepsy can be associated with cognitive delay, impaired social interactions, and aggressive and irritable behavior. While symptoms such as staring, rhythmic shaking, and inattention can indicate epilepsy, they also may be part of the way an ASD child behaves.
Having both conditions doesn't change how seizures are managed. Keep the person safe by moving large objects out of the way, turning the person on his or her side, and making sure nothing is in or blocking the mouth. This helps avoid choking if the person vomits during the seizure. The same medications to control seizures are used whether the person has epilepsy only or ASD and epilepsy, but for those with ASD who also have trouble swallowing or are sensitive to textures, the medication could be formulated differently—say, as a liquid solution instead of a pill.
Once seizures (which can affect how someone interacts and engages with others) are under control, ASD symptoms may lessen in severity. In rare cases, it may turn out that the person did not have ASD but was guarded and antisocial because of the seizures or some other aspect of epilepsy. Surgery to eliminate or reduce seizures, if warranted, may also reduce symptoms of ASD.
Adequate sleep and a healthy diet are especially key for people with epilepsy because lack of sleep can provoke some seizures. It's also important that children stay current with immunizations, since some vaccine-preventable diseases (such as meningitis) have the potential to further damage the brain.
Dr. Wiznitzer is interim chief of child neurology at the Rainbow Babies and Children’s Hospital in Cleveland and professor of pediatric neurology at Case Western Reserve School of Medicine.
