Does treatment have an impact on incidence and risk factors for autism spectrum disorders in children with infantile spasms?

Jonathan Y. Bitton, Michelle Demos, Katia Elkouby, Mary Connolly, Shelly K. Weiss, Elizabeth J. Donner, Sharon Whiting, Gabriel M. Ronen, Luis Bello-Espinosa, Elaine C Wirrell, Ismail S. Mohamed, Joseph M. Dooley, Lionel Carmant

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective Infantile spasms (IS) are a severe form of childhood epilepsy associated with autism spectrum disorders (ASD) in up to 35% of cases. The objective of this post hoc analysis of our randomized control trial was to determine whether rapid diagnosis and treatment of IS could limit the incidence of ASD while identifying risk factors related to ASD outcome. Methods Patients with IS were randomized in a standardized diagnostic and treatment protocol. Clinical and electroencephalogram (EEG) evaluations were completed at all eight visits over 5 years, while cognitive evaluations were administered at 0, 6, 24 and 60 months, respectively. Autism was initially screened by means of the Checklist for Autism in Toddlers (CHAT) at 24 months, and formally assessed at the 30-and 60-month follow-ups using the Autism Diagnostic Observation Schedule - Generic (ADOS-G). Results Of the 69 patients included in the study, 25 could not be assessed due to severe delay or death. Eleven of the 42 patients screened with CHAT, were found to be at risk of an ASD outcome. ADOS was performed in 44 and 10 were diagnosed with ASD. The CHAT proved to correlate highly with the ADOS (80% ppv). Only patients with symptomatic IS developed ASD (p = 0.003). Earlier diagnosis or successful treatment did not correlate with a reduced rate of ASD. Other risk factors were identified such as having chronic epileptic discharges in the frontotemporal areas after disappearance of hypsarrhythmia (p = 0.005 and p = 0.007) and being of nonwhite origin (p = 0.009). Significance ASD was only observed in children with sympyomatic IS. Other clinical risk factors include chronic frontotemporal epileptic activity and being of non-white origin. Early diagnosis and treatment did not prevent ASD as an outcome of IS. However, patients at risk for ASD could be identified early on and should in the future benefit from early intervention to potentially improve their long-term outcome.

Original languageEnglish (US)
Pages (from-to)856-863
Number of pages8
JournalEpilepsia
Volume56
Issue number6
DOIs
StatePublished - Jun 1 2015

Fingerprint

Infantile Spasms
Incidence
Autistic Disorder
Checklist
Therapeutics
Early Diagnosis
Autism Spectrum Disorder
Clinical Protocols
Electroencephalography
Epilepsy
Appointments and Schedules
Observation

Keywords

  • Autism spectrum disorder
  • Cognitive neurology
  • Developmental psychiatry
  • Pediatric epilepsy
  • West syndrome

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Bitton, J. Y., Demos, M., Elkouby, K., Connolly, M., Weiss, S. K., Donner, E. J., ... Carmant, L. (2015). Does treatment have an impact on incidence and risk factors for autism spectrum disorders in children with infantile spasms? Epilepsia, 56(6), 856-863. https://doi.org/10.1111/epi.12997

Does treatment have an impact on incidence and risk factors for autism spectrum disorders in children with infantile spasms? / Bitton, Jonathan Y.; Demos, Michelle; Elkouby, Katia; Connolly, Mary; Weiss, Shelly K.; Donner, Elizabeth J.; Whiting, Sharon; Ronen, Gabriel M.; Bello-Espinosa, Luis; Wirrell, Elaine C; Mohamed, Ismail S.; Dooley, Joseph M.; Carmant, Lionel.

In: Epilepsia, Vol. 56, No. 6, 01.06.2015, p. 856-863.

Research output: Contribution to journalArticle

Bitton, JY, Demos, M, Elkouby, K, Connolly, M, Weiss, SK, Donner, EJ, Whiting, S, Ronen, GM, Bello-Espinosa, L, Wirrell, EC, Mohamed, IS, Dooley, JM & Carmant, L 2015, 'Does treatment have an impact on incidence and risk factors for autism spectrum disorders in children with infantile spasms?', Epilepsia, vol. 56, no. 6, pp. 856-863. https://doi.org/10.1111/epi.12997
Bitton, Jonathan Y. ; Demos, Michelle ; Elkouby, Katia ; Connolly, Mary ; Weiss, Shelly K. ; Donner, Elizabeth J. ; Whiting, Sharon ; Ronen, Gabriel M. ; Bello-Espinosa, Luis ; Wirrell, Elaine C ; Mohamed, Ismail S. ; Dooley, Joseph M. ; Carmant, Lionel. / Does treatment have an impact on incidence and risk factors for autism spectrum disorders in children with infantile spasms?. In: Epilepsia. 2015 ; Vol. 56, No. 6. pp. 856-863.
@article{a08aedf95609419aac414fec60e3a83f,
title = "Does treatment have an impact on incidence and risk factors for autism spectrum disorders in children with infantile spasms?",
abstract = "Objective Infantile spasms (IS) are a severe form of childhood epilepsy associated with autism spectrum disorders (ASD) in up to 35{\%} of cases. The objective of this post hoc analysis of our randomized control trial was to determine whether rapid diagnosis and treatment of IS could limit the incidence of ASD while identifying risk factors related to ASD outcome. Methods Patients with IS were randomized in a standardized diagnostic and treatment protocol. Clinical and electroencephalogram (EEG) evaluations were completed at all eight visits over 5 years, while cognitive evaluations were administered at 0, 6, 24 and 60 months, respectively. Autism was initially screened by means of the Checklist for Autism in Toddlers (CHAT) at 24 months, and formally assessed at the 30-and 60-month follow-ups using the Autism Diagnostic Observation Schedule - Generic (ADOS-G). Results Of the 69 patients included in the study, 25 could not be assessed due to severe delay or death. Eleven of the 42 patients screened with CHAT, were found to be at risk of an ASD outcome. ADOS was performed in 44 and 10 were diagnosed with ASD. The CHAT proved to correlate highly with the ADOS (80{\%} ppv). Only patients with symptomatic IS developed ASD (p = 0.003). Earlier diagnosis or successful treatment did not correlate with a reduced rate of ASD. Other risk factors were identified such as having chronic epileptic discharges in the frontotemporal areas after disappearance of hypsarrhythmia (p = 0.005 and p = 0.007) and being of nonwhite origin (p = 0.009). Significance ASD was only observed in children with sympyomatic IS. Other clinical risk factors include chronic frontotemporal epileptic activity and being of non-white origin. Early diagnosis and treatment did not prevent ASD as an outcome of IS. However, patients at risk for ASD could be identified early on and should in the future benefit from early intervention to potentially improve their long-term outcome.",
keywords = "Autism spectrum disorder, Cognitive neurology, Developmental psychiatry, Pediatric epilepsy, West syndrome",
author = "Bitton, {Jonathan Y.} and Michelle Demos and Katia Elkouby and Mary Connolly and Weiss, {Shelly K.} and Donner, {Elizabeth J.} and Sharon Whiting and Ronen, {Gabriel M.} and Luis Bello-Espinosa and Wirrell, {Elaine C} and Mohamed, {Ismail S.} and Dooley, {Joseph M.} and Lionel Carmant",
year = "2015",
month = "6",
day = "1",
doi = "10.1111/epi.12997",
language = "English (US)",
volume = "56",
pages = "856--863",
journal = "Epilepsia",
issn = "0013-9580",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Does treatment have an impact on incidence and risk factors for autism spectrum disorders in children with infantile spasms?

AU - Bitton, Jonathan Y.

AU - Demos, Michelle

AU - Elkouby, Katia

AU - Connolly, Mary

AU - Weiss, Shelly K.

AU - Donner, Elizabeth J.

AU - Whiting, Sharon

AU - Ronen, Gabriel M.

AU - Bello-Espinosa, Luis

AU - Wirrell, Elaine C

AU - Mohamed, Ismail S.

AU - Dooley, Joseph M.

AU - Carmant, Lionel

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Objective Infantile spasms (IS) are a severe form of childhood epilepsy associated with autism spectrum disorders (ASD) in up to 35% of cases. The objective of this post hoc analysis of our randomized control trial was to determine whether rapid diagnosis and treatment of IS could limit the incidence of ASD while identifying risk factors related to ASD outcome. Methods Patients with IS were randomized in a standardized diagnostic and treatment protocol. Clinical and electroencephalogram (EEG) evaluations were completed at all eight visits over 5 years, while cognitive evaluations were administered at 0, 6, 24 and 60 months, respectively. Autism was initially screened by means of the Checklist for Autism in Toddlers (CHAT) at 24 months, and formally assessed at the 30-and 60-month follow-ups using the Autism Diagnostic Observation Schedule - Generic (ADOS-G). Results Of the 69 patients included in the study, 25 could not be assessed due to severe delay or death. Eleven of the 42 patients screened with CHAT, were found to be at risk of an ASD outcome. ADOS was performed in 44 and 10 were diagnosed with ASD. The CHAT proved to correlate highly with the ADOS (80% ppv). Only patients with symptomatic IS developed ASD (p = 0.003). Earlier diagnosis or successful treatment did not correlate with a reduced rate of ASD. Other risk factors were identified such as having chronic epileptic discharges in the frontotemporal areas after disappearance of hypsarrhythmia (p = 0.005 and p = 0.007) and being of nonwhite origin (p = 0.009). Significance ASD was only observed in children with sympyomatic IS. Other clinical risk factors include chronic frontotemporal epileptic activity and being of non-white origin. Early diagnosis and treatment did not prevent ASD as an outcome of IS. However, patients at risk for ASD could be identified early on and should in the future benefit from early intervention to potentially improve their long-term outcome.

AB - Objective Infantile spasms (IS) are a severe form of childhood epilepsy associated with autism spectrum disorders (ASD) in up to 35% of cases. The objective of this post hoc analysis of our randomized control trial was to determine whether rapid diagnosis and treatment of IS could limit the incidence of ASD while identifying risk factors related to ASD outcome. Methods Patients with IS were randomized in a standardized diagnostic and treatment protocol. Clinical and electroencephalogram (EEG) evaluations were completed at all eight visits over 5 years, while cognitive evaluations were administered at 0, 6, 24 and 60 months, respectively. Autism was initially screened by means of the Checklist for Autism in Toddlers (CHAT) at 24 months, and formally assessed at the 30-and 60-month follow-ups using the Autism Diagnostic Observation Schedule - Generic (ADOS-G). Results Of the 69 patients included in the study, 25 could not be assessed due to severe delay or death. Eleven of the 42 patients screened with CHAT, were found to be at risk of an ASD outcome. ADOS was performed in 44 and 10 were diagnosed with ASD. The CHAT proved to correlate highly with the ADOS (80% ppv). Only patients with symptomatic IS developed ASD (p = 0.003). Earlier diagnosis or successful treatment did not correlate with a reduced rate of ASD. Other risk factors were identified such as having chronic epileptic discharges in the frontotemporal areas after disappearance of hypsarrhythmia (p = 0.005 and p = 0.007) and being of nonwhite origin (p = 0.009). Significance ASD was only observed in children with sympyomatic IS. Other clinical risk factors include chronic frontotemporal epileptic activity and being of non-white origin. Early diagnosis and treatment did not prevent ASD as an outcome of IS. However, patients at risk for ASD could be identified early on and should in the future benefit from early intervention to potentially improve their long-term outcome.

KW - Autism spectrum disorder

KW - Cognitive neurology

KW - Developmental psychiatry

KW - Pediatric epilepsy

KW - West syndrome

UR - http://www.scopus.com/inward/record.url?scp=84930472154&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930472154&partnerID=8YFLogxK

U2 - 10.1111/epi.12997

DO - 10.1111/epi.12997

M3 - Article

C2 - 25944453

AN - SCOPUS:84930472154

VL - 56

SP - 856

EP - 863

JO - Epilepsia

JF - Epilepsia

SN - 0013-9580

IS - 6

ER -