While all forms of epilepsy share one common trait – they involve repeated seizures due to abnormal electrical activity in the brain – think of epilepsy as an umbrella term for a condition that can present itself in hundreds, if not thousands, of different ways. A major focus in epilepsy research in recent years is the idea of “comorbidities,” or other conditions that occur alongside epilepsy. This can include a variety of conditions, including Autism Spectrum Disorder, ADHD, learning difficulties, and mood symptoms such as anxiety and depression.

Autism and Epilepsy

A growing body of research demonstrates increased rates of autism in people with epilepsy, with estimates ranging between about 20-30 percent. The likelihood of someone with epilepsy also being autistic increases in people with lower IQ scores. For example, about 20 percent of people with epilepsy and an IQ below 70 will also meet criteria for an autism diagnosis; that number goes up to about 50 percent with an IQ of 40 or lower. Research also suggests that there appear to be several shared genetic abnormalities associated with both epilepsy and autism. Many patients with epilepsy also show more subtle difficulties with social skills, but do not meet criteria for a formal diagnosis such as ASD.

ADHD and Epilepsy

Research suggests up to half of people with epilepsy have attention problems, and many of them will meet criteria for a diagnosis of ADHD. Symptoms of inattention, particularly difficulties with sustained attention (maintaining the same level of attention and effort over several minutes or longer), are more common than hyperactivity and impulsivity, though both can be seen. While medication side effects can be a contributing factor, particularly if children are on multiple anti-seizure medications (ASMs), research shows they do not fully account for symptoms.

Learning Difficulties and Epilepsy

People with epilepsy often show difficulties with learning and other cognitive functions, likely due to abnormal electrical activity and, in some instances, structural differences in the brain. This can appear in many ways, including learning disorders such as dyslexia or more widespread difficulties. When individuals with epilepsy show difficulty in formal cognitive testing and struggle with independent living skills, they may meet criteria for a diagnosis of intellectual disability. In other instances, specific learning skills may be affected, such as memory or processing speed (how quickly a person processes information), though they may not meet criteria for a formal diagnosis. Fine motor skills are also often impaired, which can interfere with independent living skills like getting dressed or eating as well as academic skills such as writing or typing.

Some forms of epilepsy have a known “cognitive phenotype,” or known pattern of difficulties with learning skills. For example, patients with conditions like Lennox-Gastaut Syndrome and Dravet Syndrome are much more likely to be diagnosed with an intellectual disability. A neuropsychological evaluation is often helpful for identifying what specific areas a patient is showing difficulties in, as well as identifying their strengths. Together, this data is used to provide recommendations to the family and treatment team to help ensure the patient is receiving appropriate supports at home and school, as well as identifying relevant diagnoses such as learning or mood disorders.

Mood Disorders and Epilepsy

Mood symptoms, particularly depression, are often seen individuals with epilepsy. This is likely due to a number of factors, including stress and anxiety associated with having a chronic illness. Additionally, the hippocampus, a part of the brain that is particularly sensitive to abnormal electrical activity such as seizures, appears to play a key role in depression. People with epilepsy also often face activity restrictions, such as not being able to drive. If someone undergoes surgery for their epilepsy, they are typically unable to engage in activities such as swimming or playing contact sports for weeks or months afterwards, and this can also be a source of frustration for many patients. Keppra, a commonly prescribed anti-seizure medication, is also known to cause increased irritability in some patients. In some instances, this can be treated with vitamin supplementation, and if family notices these changes in their child, they should contact their neurologist immediately and let them know.

A referral to a pediatric psychologist, a type of psychologist who specializes in helping children and adolescents with chronic medical conditions, may also be helpful for people with epilepsy struggling with anxiety or depression. Depression symptoms have been associated with worsening of seizures, so it is important to work with the patient’s treatment team to address these symptoms when they occur.

References

Berg, A. T., Tarquinio, D., & Koh, S. (2017). Early life epilepsies are a comorbidity of developmental brain disorders. Seminars in Pediatric Neurology 24(4), 251-263.

Camfield, C., & Camfield, P. (2017). Cognitive disabilities and long-term outcomes in children with epilepsy: A tangled tail. Seminars in Pediatric Neurology (24)4, 243-250.

Kanner, A. M., Schachter, S. C., Barry, J. J., Hersdorffer, D. C., Mula, M., Trimble, M., … & Gilliam, F. (2012). Depression and epilepsy: epidemiologic and neurobiologic perspectives that may explain their high comorbid occurrence. Epilepsy & Behavior, 24(2), 156-168.

Richard, A. E., Scheffer, I. E., & Wilson, S. J. (2017). Features of the broader autism phenotype in people with epilepsy support shared mechanisms between epilepsy and autism spectrum disorder. Neuroscience & Biobehavioral Reviews, 75, 203-233.

Salpekar, J. A., & Mula, M. (2019). Common psychiatric comorbidities in epilepsy: how big of a problem is it? Epilepsy & Behavior, 98, 293-297.

Tran, L. H., & Zupanc, M. L. (2017). Neurocognitive comorbidities in pediatric epilepsy: lessons in the laboratory and clinical profile. Seminars in Pediatric Neurology (24)4, 276-281.

Tuchman, R. (2017). What is the relationship between autism spectrum disorders and epilepsy? Seminars in Pediatric Neurology, 24(4), 292-300.