一歲時無故抽搐可能是泛自閉症障礙症候群的徵兆


  May 27, 2008(英國倫敦) — 一篇對冰島將近100名在一歲時有無故抽搐的孩童所進行的族群基礎研究中,13.7%會發生泛自閉症障礙症候群(autism spectrum disorders,ASD);相較於無症狀或者隱原性抽搐(無已知原因),出現有症狀的抽搐(有已知原因)後續發生自閉症的風險高達近9倍。
  
  冰島Kopavogur州立診斷與諮商中心、自閉症與溝通異常小組的Evald Saemundsen博士表示,這些發現在第7屆自閉症國際年會中口頭發表;他表示,一歲時有抽搐病史,須注意發生ASD的可能性,特別是有症狀者。
  
  【癲癇和ASD】
  Saemundsen博士指出,癲癇(復發、無故抽搐)是其中一種和自閉症有關的最初的生物因素;案例研究指出,嬰兒時期發生過痙攣的小孩,自閉症發生率較高;但還不清楚一歲時的其他無故抽搐是否與未來出現ASD有關。
  
  研究者目標在確認一歲時的無故抽搐和未來的ASD是否有關。
  
  他們檢視1982至1998年的醫院紀錄,確認冰島所有在一歲時有抽搐診斷的小兒病患;分辨出來的121名小孩中, 5 位死亡、1 位住國外;聯絡其他115名小孩的雙親,95對雙親同意讓他們的小孩(61 名女孩和34名男孩,平均年紀11歲)參與此研究。
  
  雙親回覆社會溝通問卷,作為小孩自閉症行為的初步檢測;接著使用自閉症診斷面議量表(ADI-R)與自閉症診斷觀察量表(ADOS)和/或兒童自閉程度評量表(CARS)評估這些小孩。
  
  95名小孩中,17人有嬰兒痙攣、78 人有其他類型的抽搐;總共有13名小孩(8名女孩和5名男孩)有ASD;除了其中1個之外,其他都有智力障礙,6個有重度智力障礙(IQ < 20)。
  
  這13名有ASD的小孩中, 6人有嬰兒痙攣、7人有其他類型的癲癇;嬰兒痙攣的小孩比有其他類型癲癇的小孩更可能發生ASD(勝算比,1.55; 95% CI, 0.33 – 7.37)。
  
  【有症狀的抽搐更強力預測ASD】
  如果小孩一開始就有有症狀的抽搐,不論何種類型,發生ASD的比率幾乎是無症狀抽搐者的將近9倍(OR, 8.73; 95% CI, 1.88 – 40.54)。
  
  Saemundsen 醫師表示,本研究所發表的:一歲時出現無故抽搐的小孩,有13.7% ASD高發生率的研究發現,仍需要後續研究;他向Medscape Psychiatry表示,即將發表有關此研究的文獻。
  
  第7屆自閉症國際年會:口頭發表 113.7。2008年5月15-17日。

Unprovoked Seizures in First Year of Life May Signal Autism Spectrum Disorder

By Marlene Busko
Medscape Medical News

May 27, 2008 (London, United Kingdom) — In a population-based study of close to 100 children from Iceland who had unprovoked seizures in the first year of life, 13.7% went on to have an autism spectrum disorder (ASD).

Having symptomatic seizures (with a known cause) as opposed to nonsymptomatic or cryptogenic seizures (with an unknown cause) was associated with an almost 9-fold higher risk of subsequent autism.

Evald Saemundsen, PhD, from the division of autism and communication disorders, State Diagnostic and Counseling Center, in Kopavogur, Iceland, reported these findings in an oral presentation at the 7th Annual International Meeting for Autism Research.

"A history of seizure in the first year of life should attract attention to the possibility of subsequent ASD, particularly in cases where seizures are of symptomatic origin," he said.

Epilepsy and ASD

Epilepsy (recurrent, unprovoked seizures) was 1 of the first biological factors associated with autism, Dr. Saemundsen noted. Cases studies have reported a high prevalence of autism in children with previous infantile spasms, a type of epilepsy. But it was unknown whether other unprovoked seizures in the first year of life present a risk of ASD.

The researchers aimed to determine whether there was a link between unprovoked seizures in the first year of life and ASD.

They examined hospital records from 1982 to 1998 to identify all pediatric patients in Iceland who had been diagnosed with seizures during their first year of life.

Of the 121 children they identified, 5 had died and 1 lived abroad. The parents of the remaining 115 children were contacted, and 95 parents consented to allow their children — 61 girls and 34 boys, with a mean age of 11 years — to participate in the study.

The parents replied to the social communication questionnaire, which was used as an initial test of the children's autistic behaviors. The children were then assessed using the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) and/or the Childhood Autism Rating Scale (CARS).

Of the 95 children, 17 had infantile spasms and 78 had other types of seizures.

A total of 13 children — 8 girls and 5 boys — had ASD. All but 1 had intellectual disability, and 6 had profound intellectual disability (IQ < 20).

Of the 13 children with ASD, 6 had infantile spasms, and 7 had other types of epilepsy. The children with infantile spasms were more likely to have subsequent ASD than were children with other types of epilepsy (odds ratio, 1.55; 95% CI, 0.33 – 7.37).

Symptomatic Seizures Strongly Predicted ASD

Children with seizures of symptomatic origin, irrespective of type, were nearly 9 times more likely to develop ASD than were those who had nonsymptomatic seizures (OR, 8.73; 95% CI, 1.88 – 40.54).

The high prevalence of ASD (13.7%) in children with unprovoked seizures in the first year of life that was found in this study warrants further investigation, said Dr. Saemundsen.

The article about the current study is about to be published, he told Medscape Psychiatry.

7th Annual International Meeting for Autism Research: Oral Presentation 113.7. May 15-17, 2008.

    
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