New Recommendations on Treatments for Seizures in Autism

SAN DIEGO, Sept. 25, 2013 /PRNewswire-USNewswire/ -- Current estimates indicate that autism spectrum disorder affects 1 in 88 children, and that the incidence of this disorder is continuing to rise. Medical abnormalities associated with autism are being increasingly recognized. Seizures affect a substantial portion; some estimates suggest that up to 1/3 of children with autism may eventually develop seizures. The incidence of seizures appears to increase with age, becoming more prevalent in adolescents and adults with autism. Despite the seriousness of seizures with respect to health and well-being, effective treatments have not been well studied in individuals with autism.

To determine which treatments might be effective in controlling seizures and improving other autism-related symptoms, Richard E. Frye, M.D., Ph.D., Director of Autism Research and the Autism Multispecialty Clinic at Arkansas Children's Hospital, along with colleagues, performed a systematic review of the medical literature for treatments for seizures in individuals with autism, and asked an expert panel to suggest treatments used in clinical practice. Over 30 traditional and novel treatments were rated on their effectiveness for treatment of seizures in epilepsy, for treatment of seizures in autism, and their effect on the symptoms of autism.

In general, it was found that limited evidence is available on the effectiveness of treatments for seizures in children with autism, but certain traditional treatments were found to be potentially helpful for both seizures and autism-related symptoms. These included certain antiepileptic drugs (particularly valproate, lamotrigine, and levetiracetam), the ketogenic and modified Atkins diet, and immunomodulation and neurofeedback treatments. Treatment for specific syndromes related to autism were also considered to be of potential use, including L-carnitine, multivitamins, and N-acetyl-L-cysteine in mitochondrial disease and dysfunction, and folinic acid in cerebral folate abnormalities. Lastly, novel treatments such as magnesium, pyridoxine, omega-3 fatty acids, the gluten-free casein-free diet, and transcranial magnetic simulation were found to have some support from the medical literature for improving both seizures and autism-related symptoms.

"Overall, this study provides some guidelines for optimally treating seizures and epilepsy in individuals with autism, and points the way for promising research studies. Most importantly, this study demonstrates that certain treatments could be beneficial for treating both autism symptoms and seizures at the same time," says Dr. Richard Frye, the lead author of the study. Dr. Daniel Rossignol, another key author, says, "This study will help guide pediatricians and other physicians in choosing effective treatments for seizures in individuals with autism, especially since guidelines do not exist at this time.  These treatments might also target abnormalities that contribute to autism symptoms as well." Dr. James Adams, a co-author says, "This paper was inspired by the death of a child with autism due to a seizure, and we hope that it helps families to find effective treatments for their loved ones and keep them safe."

This study was performed in collaboration with researchers and clinicians at several universities as well as practitioners in private practice.  

A review of traditional and novel treatments for seizures in autism spectrum disorder: findings from a systematic review and expert panel:

Richard Eugene Frye, Daniel Rossignol, Manuel F Casanova, Vicki Martin, Gregory Brown, Stephen M. Edelson, Robert Coben, Jeffrey David Lewine, John C Slattery, Chrystal Lau, Paul Hardy, S Hossein Fatemi, Timothy D. Folsom, Derrick Fraser MacFabe, James Adams. 

A review of traditional and novel treatments for seizures in autism spectrum disorder: Findings from a systemic review and expert panel

Abstract

Despite the fact that seizures are commonly associated with autism spectrum disorder (ASD), the effectiveness of treatments for seizures has not been well studied in individuals with ASD. This manuscript reviews both traditional and novel treatments for seizures associated with ASD. Studies were selected by systematically searching major electronic databases and by a panel of experts that treat ASD individuals. Only a few anti-epileptic drugs (AEDs) have undergone carefully controlled trials in ASD, but these trials examined outcomes other than seizures. Several lines of evidence point to valproate, lamotrigine, and levetiracetam as the most effective and tolerable AEDs for individuals with ASD. Limited evidence supports the use of traditional non-AED treatments, such as the ketogenic and modified Atkins diet, multiple subpial transections, immunomodulation, and neurofeedback treatments. Although specific treatments may be more appropriate for specific genetic and metabolic syndromes associated with ASD and seizures, there are few studies which have documented the effectiveness of treatments for seizures for specific syndromes. Limited evidence supports L-carnitine, multivitamins, and N-acetyl-L-cysteine in mitochondrial dis-ease and dysfunction, folinic acid in cerebral folate abnormalities and early treatment with vigabatrin in tuberous sclerosis complex. Finally, there is limited evidence for a number of novel treatments, particularly magnesium with pyridoxine, omega-3 fatty acids, the gluten-free casein-free diet, and low-frequency repetitive transcranial magnetic simulation. Zinc and L-carnosine are potential novel treatments supported by basic research but not clinical studies.This review demonstrates the wide variety of treatments used to treat seizures in individuals with ASD as well as the striking lack of clinical trials performed to support the use of these treatments. Additional studies concerning these treatments for controlling seizures in individuals with ASD are warranted.

Published in Frontiers in Child Health and Human Development, 2013 (1) 3-26.

The full article is available for free at:  http://www.frontiersin.org/child_health_and_human_development/10.3389/fpubh.2013.00031/abstract

SOURCE Autism Research Institute