Abstracts

Rationale: The postero-temporo-parieto occipital (TPO) junction has a key role to play in behavioural modification in Autistic spectrum disorder (ASD) as has been shown in various functional studies in this group of patients. The regional brain dysfunction in these patients is mainly in the temporal association and multimodal cortices. The temporo-parietal junction is the key node in the theory of mind network theory and that reduced perfusion in these patients in this region has been proposed as the causative factor in impaired social cognition. Methods: This is an observational study of two patients who underwent epilepsy surgery for two independent lesions in the same region; one was a TPO disconnection and the other a lesionectomy, who developed features of Autism after surgery. The lesion in the first case was an extensive right temporal cortical dysplasia extending posteriorly. In the second case it was a left temporo parietal occipital porencephalic cyst. In both the cases there was surgical modification in the temporal region and also the association areas.The Vineland Social Maturity Scale (VSMS), Binet Kamat Test (BKT), Child behavior checklist (CBCL), Pediatric quality of life scale (PedsQL)/QOLCE tests were performed. VSMS and BKT were used for assessing the cognition of patients whereas CBCL and PedsQL/QOLCE were used for assessing the behavior abnormality and quality of life respectively pre and post operatively. Results: The children were of moderate functioning pre operatively, however there was severe worsening post operatively. There were no features of autism pre operatively.(Table1) Conclusions: There are no cases in literature which have reported the development of Autism post resective or disconnection surgeries in this area.This is first such series of patients who developed features of autism after surgery, which correlated with the anatomical region implicated in the disease. The plausible explanation for these features in children who were not autistic pre-operatively highlights the network theory of epilepsy. Autistic features may precede or follow epilepsy if it involves the same networks. Funding: No sources of funding to declare.