Review articleFeatures of the broader autism phenotype in people with epilepsy support shared mechanisms between epilepsy and autism spectrum disorder
Section snippets
The association between epilepsy and autism spectrum disorder
Epilepsy is a disorder characterised by unprovoked seizures, with diagnosis requiring at least one unprovoked seizure and high risk for another (Fisher et al., 2014). The reported prevalence of epilepsy ranges from 0.2–2% (M = 1%; Bell et al., 2014). Age at onset is typically in childhood or late adulthood, but first seizures can occur at any age (Cockerell et al., 1995).
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterised by persistent impairment in reciprocal social
Literature search
We conducted a systematic search of the published literature available through the PubMed, PsycINFO, and Current Contents Connect databases. The key words entered to retrieve relevant reports are listed in Table 2. We evaluated the titles and abstracts of the retrieved reports to find those that examined FER or ToM in our target groups of PWE and ASD-relatives. The literature search was completed in August 2014 and included peer-reviewed journal articles; article abstracts; conference and
Results
Table 5 provides an overview of the demographic and clinical characteristics of the participants from the meta-analysed studies. Individuals with epilepsy were older and had lower IQ than relatives of individuals with ASD across studies of FER and of ToM (t-test P-values <0.001). In FER studies, PWE had a greater ratio of males to females than was observed in ASD-relatives (Chi-square test P-value < 0.001). There was no difference in the sex ratio of patients with epilepsy and ASD-relatives from
Discussion
In this meta-analysis, we assessed the evidence for expression of BAP features, specifically deficits in FER and ToM in the absence of ID, in PWE and ASD-relatives compared to controls. We included 31 reports of PWE and 22 of ASD-relatives, providing data on 1449 PWE and 1295 ASD-relatives. As hypothesised, we found that FER and ToM were reduced in PWE compared to controls. These findings were robust to the exclusion of outlying studies of large effect and to publication bias. FER and ToM
Conclusion
Our results, based on data from over 1000 epilepsy patients and ASD-relatives, show that PWE, including those with non-TLE, have reduced FER and ToM compared to controls and that the social cognition deficit in PWE is more severe than that in ASD-relatives. Moreover, earlier age at epilepsy onset and longer epilepsy duration are associated with poorer FER and ToM. Based on these patterns of FER and ToM deficits in PWE, we have presented a dual-strike model. It suggests that social cognition
Acknowledgements
We kindly thank the authors who responded to our requests for additional data as well as Dr. Sue Finch from The University of Melbourne’s Statistical Consulting Centre for providing statistical advice.
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2017, Seminars in Pediatric NeurologyCitation Excerpt :These group of studies confirm what is observed in clinical practice, that ASD is more common in children with epilepsy and ID. A recent meta-analysis on data of 1,449 people with epilepsy and 1,295 ASD relatives, found that facial emotional recognition and theory of mind were poorer in epilepsy compared to controls and theory of mind was poorer in those with epilepsy than ASD relatives.29 In this study neither age or IQ were associated with social cognition deficits in people with epilepsy or in ASD relatives.
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