Treatment Resistant Epilepsy in Autism Spectrum Disorder: Increased Risk for Females.
Girls with autism face double the risk of drug-resistant epilepsy—start neurology follow-up early.
01Research in Context
What this study did
Doctors looked at girls and boys who have both autism and epilepsy. They wanted to know if the girls’ seizures were harder to stop with medicine.
They wrote down each child’s seizure drugs, brain scans, and autism traits. This was a small case series, not a big trial.
What they found
Girls with autism plus epilepsy were twice as likely to have drug-resistant seizures. Even though their autism traits looked milder, their epilepsy was tougher.
Brain scans also showed more odd findings in the girls.
How this fits with other research
Souza et al. (2023) later pooled many papers and saw the same pattern: girls with autism carry more epilepsy and intellectual disability. The 2016 girls are now part of that bigger picture.
Gotham et al. (2015) seems to disagree at first glance. In their pre-term sample, boys had more seizures. But those boys were born very early, a different risk path. Once you add autism and full-term birth, girls pull ahead in hard-to-treat epilepsy.
Emerson et al. (2023) meta-analysis also stresses one key point: always check for intellectual disability when you compare boys and girls. The 2016 cases did not split by IQ, so future work should.
Why it matters
If you serve girls with autism, screen early for seizures and refer sooner to neurology. Track each new drug trial closely, because the first two may fail. Tell families that tougher epilepsy is common in this group, so they can plan ahead for school safety and emergency meds.
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02At a glance
03Original abstract
The male:female ratio in autism spectrum disorder (ASD) averages greater than 4:1 while the male:female ratio of ASD with epilepsy averages less than 3:1. This indicates an elevated risk of epilepsy in females with ASD; yet, it is unknown whether phenotypic features of epilepsy and ASD differ between males and females with this comorbidity. The goal of this study is to investigate sex differences in phenotypic features of epilepsy and ASD in a prospective sample of 130 children and young adults with an initial ASD diagnosis and subsequent epilepsy diagnosis. All participants were characterized by standardized diagnostic inventories, parent/caregiver completed questionnaires, and medical/academic record review. Diagnostic classifications of epilepsy, ASD, and intellectual disability were performed by board certified neurologists and a pediatric neuropsychologist. Results demonstrated a lower male:female ratio (1.8:1) in individuals with ASD and treatment-resistant epilepsy relative to those with ASD and treatment-responsive epilepsy (4.9:1), indicating a higher risk of treatment-resistant epilepsy in females. Mild neuroimaging abnormalities were more common in females than males and this was associated with increased risk of treatment-resistance. In contrast, ASD symptom severity was lower in females compared with males. Findings distinguish females with ASD and epilepsy as a distinct subgroup at higher risk for a more severe epilepsy phenotype in the context of a less severe ASD phenotype. Increased risk of anti-epileptic treatment resistance in females with ASD and epilepsy suggests that comprehensive genetic, imaging, and neurologic screening and enhanced treatment monitoring may be indicated for this subgroup. Autism Res 2016, 9: 311-320. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.
Autism research : official journal of the International Society for Autism Research, 2016 · doi:10.1002/aur.1514