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Is autism driven by epilepsy in infants with Tuberous Sclerosis Complex

R. Moavero, K. Kotulska, L. Lagae, A. Benvenuto, L. Emberti Gialloreti, B. Weschke, K. Riney, M. Feucht, P. Krsek, R. Nabbout, AC. Jansen, K. Wojdan, J. Borkowska, K. Sadowski, C. Hertzberg, MM. Van Schooneveld, S. Samueli, A. Maulisovà, E....

. 2020 ; 7 (8) : 1371-1381. [pub] 20200723

Language English Country United States

Document type Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't

OBJECTIVE: To evaluate the relationship between age at seizure onset and neurodevelopmental outcome at age 24 months in infants with TSC, as well as the effect on neurodevelopmental outcome of early versus conventional treatment of epileptic seizures with vigabatrin (80-150 mg/kg/day). METHODS: Infants with TSC, aged ≤4 months and without previous seizures were enrolled in a prospective study and closely followed with monthly video EEG and serial standardized neurodevelopmental testing (Bayley Scales of Infant Development and Autism Diagnostic Observation Schedule). RESULTS: Eighty infants were enrolled. At the age of 24 months testing identified risk of Autism Spectrum Disorder (ASD) in 24/80 children (30.0%), and developmental delay (DD) in 26/80 (32.5%). Children with epilepsy (51/80; 63.8%) had a higher risk of ASD (P = 0.02) and DD (P = 0.001). Overall, no child presented with moderate or severe DD at 24 months (developmental quotient < 55). In 20% of children abnormal developmental trajectories were detected before the onset of seizures. Furthermore, 21% of all children with risk of ASD at 24 months had not developed seizures at that timepoint. There was no significant difference between early and conventional treatment with respect to rate of risk of ASD (P = 0.8) or DD (P = 0.9) at 24 months. INTERPRETATION: This study confirms a relationship between epilepsy and risk of ASD/DD. However, in this combined randomized/open label study, early treatment with vigabatrin did not alter the risk of ASD or DD at age 2 years.

Brigham and Women's Hospital Harvard Medical School Boston MA 02115

Child Neurology and Psychiatry Unit Systems Medicine Department Tor Vergata University Via Montpellier 1 Rome 00133 Italy

Child Neurology Unit Neuroscience and Neurorehabilitation Department Bambino Gesù Children's Hospital IRCCS P zza S Onofrio 4 Rome 00165 Italy

Department of Biomedicine and Prevention Tor Vergata University of Rome Via Montpellier 1 Rome 00133 Italy

Department of Child Neurology Brain Center University Medical Center Utrecht Utrecht The Netherlands

Department of Child Neurology Charité University Medicine Berlin Augustenburger Platz 1 Berlin 13353 Germany

Department of Child Neurology Medical University of Warsaw Warsaw Poland

Department of Development and Regeneration Section Pediatric Neurology University Hospitals KU Leuven Leuven Belgium

Department of Neurology and Epileptology The Children's Memorial Health Institute Al Dzieci Polskich 20 Warsaw 04 730 Poland

Department of Paediatric Neurology Charles University 2nd Faculty of Medicine and Motol University Hospital Prague Czech Republic

Department of Pathology Amsterdam UMC University of Amsterdam Amsterdam Neuroscience Meibergdreef 9 Amsterdam The Netherlands

Department of Pediatric Neurology Reference Centre for Rare Epilepsies Necker Enfants Malades Hospital University Paris Descartes Imagine Institute Paris France

Department of Pediatrics Medical University Vienna Vienna Austria

Diagnose und Behandlungszentrum für Kinder und Jugendliche Vivantes Klinikum Neuköln Berlin Germany

Neuroscience Unit Queensland Children's Hospital 501 Stanley Street South Brisbane QLD 4101 Australia

Pediatric Neurology Unit UZ Brussel Brussels Belgium

School of Clinical Medicine University of Queensland St Lucia QLD 4072 Australia

Stichting Epilepsie Instellingen Nederland Heemstede The Netherlands

Transition Technologies ul Pawia 5 Warsaw 01 030 Poland

Warsaw University of Technology Institute of Heat Engineering Warsaw Poland

References provided by Crossref.org

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