Epilepsy and Social Functioning in Autism

Youth with epilepsy and autism spectrum disorder (ASD) are significantly more impaired on some measures of social functioning than those with ASD alone, according to a study published online in Behavioral and Brain Functions.

Epilepsy has been linked to decreased cognition. Past studies have suggested that the link between epilepsy and increased autism severity may be modulated by the effect of epilepsy on IQ. However, after controlling for IQ, the findings suggest a direct effect of epilepsy on certain autistic symptoms.

“Based on our statistical model, there seemed to be a significant relationship between epilepsy and autistic characteristics in ASD children that is not explained by the association between epilepsy and low IQ,” wrote first author Chanyoung Ko, MD, of Yonsei University (South Korea), and colleagues.

“Participants diagnosed with both ASD and epilepsy appeared to be more socially impaired, especially in their capacity to pick up on social cues and organize expressive acts of social communication. In addition, ASD participants with epilepsy generally scored higher [indicating more impairment] on other items that ascertain social cognition and social motivation,” they added.

In the study, researchers reviewed medical records of 182 individuals seen at a tertiary care referral center at Severance Children’s Hospital in South Korea between January 2013 and July 2015. Included individuals had complete child and adolescent psychiatric evaluations. 

Researchers used propensity score matching to match 22 participants with ASD and epilepsy to those with ASD alone, matched by age, gender, and IQ. They evaluated social functioning using parental report on a standardized Korean version of the Social Responsiveness Scale (SRS), which evaluates autism severity and social behavior, with a higher score indicating greater likelihood or more severity of autistic symptoms.

Key Results:

• Those with epilepsy and ASD showed significantly more impairment in social awareness (P=0.03) and social communication (P=0.027), than those with ASD alone.

• No significant difference between the two groups for social cognition (P=0.081), social motivation (P=0.0505), and autistic mannerisms (P=0.065)

♦ A trend toward greater severity in all three of these categories among those with ASD and epilepsy (P<0.1)

• Those with ASD and epilepsy scored significantly higher on total SRS t-score, indicating more severe autistic symptoms, than those with ASD alone (P=0.023).

The authors noted several limitations, including the study’s small size, its retrospective, nonrandomized design, and evaluation of social functioning using parental report. The study excluded individuals with very severe intellectual disabilities, and may not represent all children with ASD and epilepsy. Finally, the ASD only group showed a trend toward higher IQ than the ASD plus epilepsy group, which had more co-conditions like organic brain syndromes and fragile X syndrome.

Nevertheless, the authors suggest that the findings may have several clinical implications.

“Early detection of social deficits as well as intensive social skills training should be considered as an integral part of long-term care plans [for those with ASD and epilepsy],” they concluded, “Given that ASD and epilepsy affect one another’s behavioral phenotype as well as response to psychopharmacological treatment, proper management for epilepsy may in turn reduce autistic symptom severity in these individuals with ASD and epilepsy.”

Take-home Points

• Past studies have suggested that the link between epilepsy and increased autism severity may be modulated by the effect of epilepsy on decreased cognition. 

• A single center study from South Korea suggests epilepsy may have a direct effect on certain autistic symptoms, specifically social awareness and social communication.

• The authors suggest early detection of social deficits, intensive social skills training, and proper management of epilepsy may decrease autistic symptom severity in those with epilepsy and ASD.

Reference: Ko C, et al. The effect of epilepsy on autistic symptom severity assessed by the social responsiveness scale in children with autism spectrum disorder. Behav Brain Funct. 2016 Jun 27;12(1):20.