Abstract
BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder believed to be strongly associated with epilepsy. The prevalence of epilepsy among children with ASD ranges widely, and an increased prevalence is observed in low-resource countries. Besides, individuals with ASD have an increased chance of abnormal epileptiform activity on EEG, irrespective of the presence of epilepsy. There is a lack of understanding of their intricate relationship and possible associations. Hence, we conducted this study to evaluate the prevalence and types of epilepsy and its association with abnormal EEG findings in children with ASD. MATERIALS AND METHODS: This cross-sectional observational study was conducted at the autism clinic in the Department of Pediatric Neurology at the National Institute of Neurosciences and Hospital, Dhaka, from July 2020 to December 2020. Following informed written consent from parents or legal guardians, 100 children with ASD aged 1-17 years were included in this study, irrespective of sex, race, or ethnicity, after meeting the inclusion and exclusion criteria. Ethical clearance was obtained from the Bangladesh Medical Research Council before the commencement of the study. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was used to confirm the diagnosis of ASD. Then, data were collected using a structured questionnaire. EEG was performed on each study patient using a digital EEG machine. After collection, the data were analyzed using SPSS Statistics version 24.0 (IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.). RESULTS: The mean age of the participants was 4.47 ± 2.35 years, with a male predominance. Among them, 20 (20%) patients had epilepsy. Out of these children having epilepsy, 12 (12%) had a focal seizure, and the rest had other types of seizures. The average age at seizure onset was 25.14 ± 26.09 months. Among comorbidities, hyperactivity was at the top, followed by sleep disturbance, intellectual disability, and attention-deficit/hyperactivity disorder. EEG revealed that 62 (62%) patients had abnormal electrographic changes, where focal epileptiform discharges were documented in 35 (35%) patients. Additionally, 42 (42%) children with abnormal EEG findings had no clinical seizure. A significant association was found between clinical seizures and EEG abnormalities (p < 0.05). ASD children with epilepsy showed a significant association (p < 0.05) with hyperactivity in this study. CONCLUSIONS: We found that one-fifth of children with ASD had clinical epilepsy, where the focal seizure was the predominant seizure type. Although EEG abnormalities were found in two-thirds of patients with ASD, there were many cases in which seizures were not detected clinically. A significant association was found between clinical seizures and EEG abnormalities. Further analysis could deepen the understanding of this finding and its implications.