Abstracts

Rationale: Epilepsy in autism spectrum disorders (ASD) has a prevalence of 8-40%. Medically refractory epilepsy (MRE) is seen more often in persons with ASD who have a more severe intellectual disability. Epilepsy in children with ASD is associated with increased mortality. In addition, the often-multifocal nature of their epilepsy renders these patients poor surgical candidates for resection. The responsive neurostimulation (RNS) System provides stimulation directly to the seizure focus in response to epileptiform electrographic events as a method of treatment for MRE. The RNS System in combination with traditional pharmacological management has proven efficacious in the adult MRE population. We hypothesized children with ASD and MRE may benefit from RNS System therapy. Methods: We evaluated patients with ASD and MRE who underwent RNS System placement. Demographic information, etiology, seizure types, pre-implantation seizure frequency, previous surgical history, RNS implant characteristics, and post-implantation seizure frequency outcomes were collected. Results: Five patients with ASD and MRE had the RNS System placed at Mount Sinai. Patients 1 and 2 reported no change in seizure frequency at 6.8 and 9.8 months post-implantation, respectively. Patients 3 and 4 reported a 25-50% reduction in seizure frequency at 15 and 30 months post-implantation, respectively. At the time of this case series, patient 5 is 3 months post-implantation and is too recent to report initial seizure frequency outcomes (Table 1). Conclusions: There did not appear to be adverse effects of RNS System treatment, however, there is not sufficient experience to determine whether this will be an effective treatment for this population. Further evaluation in a large multicenter study is on-going to assess the outcomes in additional patients. Funding: No funding