Abstracts

Rationale: Autism is frequently associated with epilepsy, and seizures are medically refractory in approximately 1/3 of cases. Limited data and experience have been reported to support surgical intervention in patients with autism and treatment resistant epilepsy (TRE), despite evidence that epilepsy surgery is safe, effective, and improves quality of life in children and adults with both normal and impaired development. We report a series of children with autism and TRE who underwent surgery. Methods: Between 2004 and 2012, among a group of approximately 4400 patients evaluated for epilepsy, 1297 presented with the co-morbidity of autism. Amongst these patients, 250 were found to have TRE and 33 underwent evaluation and surgery for epilepsy. Results: 47 surgeries were performed, including 13 staged resections with invasive monitoring (grid, strip, +/- depth electrodes), 2 single-stage lesionectomies, 2 hemispherotomies, 14 corpus callosotomies, and 3 vagus nerve stimulator placements. Two patients underwent invasive monitoring without a secondary resection. With a mean follow-up of 34 months, Engel outcomes were as follows: Engel I, 16 patients; Engel II, 7 patients, Engel III, 7 patients, Engel IV, 3 patients. Disruptive behavior decreased in 29 children and there were improvements in social interactive abilities and psychosocial functioning in 22. Invasive monitoring was well tolerated in all patients who underwent staged resections in the EMU/ICU. Conclusions: Epilepsy surgery is feasible, safe, and effective in carefully selected children with autism and TRE. Marked improvements in behavior and quality of life accompanied a cessation or significant reduction in seizures.