Key Treatment Issues for Epilepsy in the Context of Autism Spectrum Disorder

Abstract

The relationship between epilepsy and autism spectrum disorder (ASD) is complex and multifaceted. The prevalence of ASD in children with epilepsy is notably high, particularly in those with developmental epileptic encephalopathies (DEEs). DEEs, characterized by co-occurring epileptic activity and developmental impairments, often overlap with ASD, further complicating clinical presentations of difficulties in motor skills, language, social interaction, and adaptive behavior. The co-occurrence may be attributable to shared pathophysiological mechanisms, common genes, pre- and peri-natal risk factors, and disruptions in neurotransmitter pathways, particularly the glutamatergic and GABAergic systems. The presence of ASD in epilepsy profoundly impacts treatment choices and necessitates a careful balance between seizure control and behavioral management. Effective management of epilepsy in individuals with ASD requires a comprehensive approach, including anti-seizure medications (ASMs) like valproate and levetiracetam, which may address both seizures and behavioral issues. EEG monitoring is crucial for accurate diagnosis, distinguishing between epileptic and ASD-related behaviors. This review carefully details the overlap and physiological underpinnings of both disorders and underscores the necessity of tailored therapeutic approaches to medical care, emphasizing a multidisciplinary strategy to optimize outcomes.