| Objective:Autism is one of the commom co-morbidities in children with epilepsy. We used SRS(Social Responsiveness Scale, SRS) as a screening tool for autism spectrum disorder(ASD) in outpatients with epilepsy campared with children in the primary school. To analyze the related factors for ASD in pediatric epilepsy patients.Methods:A case control study was conducted from 2013.9 to 2014.3. Epileptic patients between 4-18y from epileptic center in Children’s Hospital of Fudan University and primary students between 6-12y as control group were enrolled. SRS was completed by caretakers and clinical history would be collected, including maternal characteristics, antenatal characteristics, seizure history, EEG, IQ, imaging and AEDs. Evaluation between epileptic patients and primary students was conducted in order to identify the underlying factors of co-occurring ASD.Results:1. From September 2013 to March 2014,74 epileptic patients between 4-18y in epileptic center of Children’s Hospital of Fudan University were enrolled,2 patients had missing data hence excluded. Among 72 eligible patients in epilepsic group,70.8% were boys(N=51), while 29.2% were girls(N=21), the male-to-female ratio was 2.4.’1, the mean age was 8.1±2.9 years old,22 children with epilepsy got positive results in SRS screening, positive rate was 30.56%.134 children were enrolled as control group,52.2% were boys(N=70),47.8% were girls(N=64), the male-to-female ratio was 1.1:1, the mean age was 8.2±1.9 years old,15 children got positive results in SRS screening, positive rate was 11.19%.2. The SRS positive rate was 30.56%, the total score and 5 subscales’score of SRS were 52.64±24.64,8.56±3.80,11.08±5.03,15.54±9.26,10.54±4.86, 6.92±5.48(X±S) in epileptic patients, significantly higher than control group(11.19%, X2=11.92, P=0.0006, OR=2.943,95%CI=[1.388,6.241], t=5.21, P<0.0001, t=439, P<0.0001,t=4.35,P<0.0001, t=4.56, P< 0.0001, t=4.32, P<0.0001, t=2.65, P=0.009). The result showed that patients with epilepsy were more likely to have ASD than general population because of impaired social skills. Focus on mental health of children with epilepsy was recommended.3. Among epileptic patients, who had a positive result in SRS, the mean score in 5 subscales were 11.86±3.72,16.36±3.47,25.91±8.04,15.14±4.62, 12.73±5.33(X±S), significantly higher than negative ones(t=5.96, P< 0.0001,t=8.21, P<0.0001,t=8.00,P<0.0001, P=6.82, P<0.0001,t=6.87, P < 0.0001). Positive SRS result showed weakly social awareness, social cognition, social communication, social motivation, and obviously autistic mannerisms.4. Among epileptic patients, early onset epilepsy(age of seizure onset<2y, X2=5.26, P=0.02) and intellectual disability(ID, X2=30.04, P<0.0001) were associated with SRS positive result, indicated that epilepsy with early onset epilepsy or ID may associate with autism-like behaviour. ID(OR=33.222, 95%CI=[6.518-169.330]) was significantly associated with SRS positive result in logistic regression analysis, but early onset epilepsy did not show the association, it might be one of the confounding factors.Conclusion:The SRS positive rate in screening for ASD was 30.56% in epileptic center of Children’s Hospital of Fudan University. Patients with epilepsy were more likely to have ASD compared with general population, characterized by impaired social skills. ID was associated with ASD in epilepsy, early onset epilepsy (≤2y) might be one of the confounding factors. This study provided clinical evidences for developing ASD screening programme in pediatric epilepsy outpatient department, in order to improve early diagnosis and intervention on co-morbidity of epilepsy and ASD. |
PDF Full Text Request