Clinical StudyPositron emission tomography findings in children with infantile spasms and autism
Introduction
Infantile spasms are one of the epileptic syndromes etiologically related to autism. Existing studies report a 9% to 17.6% rate of autism in patients with infantile spasms.[1], [2], [3] Studies in which such patients underwent positron emission tomography (PET) examination have reported focal or diffuse hypometabolism that regresses when seizures cease.[4], [5], [6] Studies on autistic children have reported bilateral temporal lobe hypometabolism, especially in the associative auditory cortex (superior temporal gyrus) and in the multimodal cortex (superior temporal sulcus).[7], [8]
A study by Chugani et al.9 that prospectively followed children with infantile spasms has linked bilateral temporal hypometabolism with the development of autism. Apart from this study, there have been no other studies where patients with autism and infantile spasms underwent PET examination. For this reason, we set out to evaluate PET findings in children with infantile spasms and autistic features in this cross-sectional study.
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Materials and methods
The present study enrolled 90 patients with infantile spasms who were above 3 years of age (52 male and 38 female) and had been followed at the Department of Pediatric Neurology of the Istanbul University Medical Faculty. The Autism Behaviour Checklist (ABC) and the Childhood Autism Rating Scale (CARS) were administered by a trained clinician to the parents/guardians and these children, respectively. For ascertainment of autism status, we used DSM IV diagnostic criteria for autism spectrum
Results
The age of the 24 patients enrolled in the study varied between 3 years and 16 years, the average age being 7.8 ± 4 years. Fifteen patients were male (62.5%) and nine were female (37.5%). Nine male patients and six female patients were diagnosed with autism (Table 1). No significant relation was found between the sex of the patients and autism (Fisher’s exact test, p = 1.000). Follow-up time varied between 2 years and 16 years, the average being 7.1 ± 4 years. (Table 1).
The seizures were symptomatic in 12
Discussion
We evaluated 90 patients with infantile spasms, older than 3 years of age, and included 17 (18.9%) with autism in the study group. Riikonen et al.3 diagnosed autism in 12.5% of 192 patients with infantile spasms; Sidenvall et al.1 diagnosed autism in 9% of 57 patients. In contrast to these two studies, the rate of autism in a small 17-patient group was 35% in a study by Saemundsen et al.,2 and 17.6% when only patients with a mental age above 24 months were taken into account. In our opinion, the
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