Epilepsy And Autism

Introduction 

Epilepsy and autism are two distinct neurological conditions that present unique challenges for those living with them. However, these conditions can co-occur, creating a complex clinical picture. As such, understanding the link between epilepsy and autism is vital to ensure effective management of the conditions. 

By detailing each condition and the relationship between them, this article aims to provide key information on treatment options and care plans to improve the quality of life for individuals with epilepsy and autism. 

What is epilepsy? 

Different regions of the brain communicate constantly via chemical and electrical signals. This communication allows us to function and go about our daily lives. 

Individuals with epilepsy experience sudden, and often unprovoked, bursts of electrical activity in one or more parts of their brain.¹ These large bursts briefly alter the way that the brain communicates, resulting in what is known as a seizure. 

For an epilepsy diagnosis to be considered, an individual must have at least 2 seizures that are more than 24 hours apart.² Electroencephalograms (EEGs), which assess the electrical activity of the brain, and brain scans, are vital in the diagnostic process.¹ Across the UK, around one in 100 people are affected by epilepsy.³

What causes epileptic seizures?

Sudden bursts of activity in the brain can trigger epileptic seizures. However, in over half of those diagnosed with epilepsy, the root cause behind increased electrical signalling remains unclear.⁴

In some individuals, epilepsy can develop as a result of damage or sudden changes to the brain, for example:⁵

• A brain tumour 
• An infection in the brain 
• A stroke 
• A severe head injury 

Types of seizure  

Seizures are the main symptom of epilepsy. There are a wide variety of seizures that occur as a result of the neurological condition, depending on the regions of the brain that are affected. 

There are 2 main classifications of seizure: focal and generalised.⁶ Focal seizures are bursts of activity in one region of the brain, whilst generalised seizures involve multiple regions, across both sides of the brain.⁶ 

During focal seizures, individuals are aware of what is going on but aren’t in control of the seizure itself. Generalised seizures cause a brief loss of consciousness, and the individual will not remember what has happened.

Within both groups, there are a range of seizure types that all present with different symptoms:⁷

• Clonic - repeated limb jerking on one or both sides of the body 
• Tonic - stiffness or tension on one or both sides of the body 
• Tonic-clonic - both stiffness and muscle jerking
• Atonic - sudden loss of all muscle strength
• Absence - staring into space 

Predicting an epileptic seizure 

Some people who experience seizures are able to detect when they are about to have one by sensing an ‘aura’.⁸ This is an unusual feeling, sensation or movement that occurs prior to a focal seizure. Some examples of auras are: 

• Deja vu
• Blurry vision
• Uncontrollable movements, like lip-smacking or grunting
• A rising feeling in the stomach

What is autism?

Autism is a lifelong neurological and developmental disorder that is thought to affect more than one in 100 people in the UK.⁹ Each individual with autism experiences the condition differently, but it ultimately changes the way people interact with and navigate the world. The spectral nature of autism means that some people will need little to no support, whilst others may depend on a parent or carer. 

Signs of autism 

Autism presents differently from individual to individual. However, there are several telltale signs that are often seen across all patients. These are:¹⁰

• Challenges with social interaction 
• Repetitive behaviour 
• Restrictive behaviour 
• Difficulty maintaining eye contact
• Special interests or hobbies
• Sensory overload 
• Meltdowns 
• Sleep issues 

Social interaction challenges 

One of the most common challenges that autistic people face is social communication. Social situations often create difficulties, as people with autism can struggle to maintain eye contact, interpret tone of voice and understand body language.¹¹ For example, interpreting sarcasm as truth. 

Therefore, understanding other people's feelings can be challenging, making social situations quite daunting and anxiety-inducing for autistic individuals. Because of this, many people with autism can feel overwhelmed in social settings and seek out alone time more frequently than neurotypical individuals.

Repetitive and restrictive behaviours 

One way to manage the unpredictable nature of the world is through routine. People with autism thrive when there are set goals or instructions for the day, making it easier for them to go about their daily lives.¹²

Change to this routine can become distressing for autistic people. To help adjust to changes or manage anxiety, repetitive movements or ‘stimming’ can be soothing. These are behaviours like hair twirling, hand flapping or spinning around, that can regulate emotions to prevent autistic meltdown.¹²

Gender differences in autism 

With the majority of research into autism up to this point is focused on boys and men, it is easy to understand why so many women and girls are often misdiagnosed or go without support until much later in life. 

It is important to note that autism presents very differently in men and women. A main contributing factor to these gender differences in diagnosis is the concept of ‘masking’.¹³ This is more commonly seen in women and girls, and it is the ability to blend into society by forcing themselves to meet social norms. Masking may involve rehearsing social situations beforehand to appear confident or forcing eye contact during conversation.¹¹

Masking can be distressing for individuals with autism and is likely to result in other mental health issues, including depression and anxiety. 

The link between epilepsy and autism 

For decades, the potential link between epilepsy and autism has been debated, with questions like ‘Does autism cause epilepsy? Is epilepsy the cause of autism? Are there predispositions that lead to the development of both conditions?’.¹⁴

Whilst it is true that there are similar genetic and environmental factors that underpin both conditions, the exact relationship between them is yet to be discovered.

The facts 

There is evidence to suggest that people with autism are more likely to have epilepsy than the general population. Likewise, people with epilepsy are more likely to be autistic than people without epilepsy. 

There are several factors that may increase the chances of developing epilepsy alongside autism, with the main contributing factor being learning disabilities. Autistic people with learning difficulties, or intellectual disability, are 20% more likely to have epilepsy than neurotypical individuals.¹⁵ In autistic people without learning difficulties, the increased risk of epilepsy drops to around 8%.¹⁵  

Whilst all seizure types can occur in individuals with autism, generalised tonic-clonic seizures are the most common.¹⁶

Environmental factors 

Epileptic seizures tend to have a series of triggers that are largely down to environmental factors. There is a large overlap between triggers that cause the onset of epileptic seizures and sensory overload in autistic individuals. 

Possible environmental factors that can trigger a seizure are:¹⁷

• Flashing lights 
• Loud noises 
• Sleep deprivation 
• Stress and/or anxiety

It is common for people with autism to experience problems when processing sensory information, like sounds, smells and tastes. Sensory overload occurs when your brain can’t process the surrounding environment and becomes overwhelmed. This can present itself through intense anxiety and physical discomfort. 

Some people with epilepsy have reported feelings of sensory overload, particularly post-seizure where all sensory inputs can feel heightened and overwhelming.¹⁸ Whilst there is limited research into the link between sensory overload and epilepsy, it is known that sensory triggers like flashing lights can rapidly induce seizures. ^8,17 

Co-management of epilepsy and autism 

Managing epilepsy alongside autism can be challenging, particularly for those who are non-verbal and cannot communicate seizure auras. Therefore, knowing seizures could happen and having a detailed plan in place is vital in case of an emergency. 

Anti-epileptic drugs 

Currently, the treatment of epilepsy remains standardised across both autistic and non-autistic individuals. This comes in the form of anti-epileptic medication, with each drug type working in slightly different ways. Some examples of anti-epileptic drugs are: ⁷

• Carbamazepine 
• Topiramate 
• Ethosuximide 
• Levetiracetam 

The main goals of anti-epileptic medication are preventing the onset of seizures and reducing their frequency.⁷ They also aim to improve the quality of life of the individual with minimal adverse effects. 

Despite this, altering electrical and chemical activity in the brain to reduce seizures is likely to result in some negative side effects such as drowsiness and mood swings. In individuals with autism, these adverse effects are more common.¹⁹

Seizure action plans 

Seizures can be a daunting experience for both the individual having the episode, and surrounding people witnessing it. Seizure action plans contain essential information about the individual's medical needs, history and seizure type to educate everyone on what to do if a seizure occurs.²⁰

By having a seizure action plan in place, individuals and their support network are able to live their lives without fear of the next seizure. They are particularly important for autistic individuals with intellectual disability who have limited speech. 

Summary

Epilepsy and autism are neurological conditions that occur as a result of a combination of genetic and environmental factors. Currently, there is no evidence to suggest that autism causes epilepsy, or vice versa. However, the increased risk of epilepsy in individuals with autism suggests the role of underlying factors that have not yet been identified. Through the use of anti-epileptic medication and a detailed seizure action plan, epilepsy in autistic individuals can be managed to allow for a good quality of life.