2. Fetal alcohol spectrum disorder: Epilepsy and neuropsychiatric disorders

Abstract

The Fetal Alcohol Syndrome (FAS) is a congenital disorder due to prenatal exposure to alcohol, leading to a dysmorphic infant: microcephaly, developmental delay and often seizures. Many offspring at risk are non-dysmorphic, referred to as Fetal Alcohol Spectrum Disorder (FASD), including possible and probable FAS and FRND, requiring high diagnostic acumen. Aim A retrospective analysis of 400 cases of FAS, FASD and FRND revealed an unexpectedly high incidence of seizure disorder in 20%, including frequent epileptic seizures in 12% (Bell et al. ACER 2010). The current study examines a cohort for neuropsychiatric difficulties encountered in the management of these adolescents and adults ( N =10). Methods Only those subjects that came to medical attention and/or psychosocial intervention had detailed neuropsychiatric assessment. Hence there is a bias towards over-estimating the prevalence of neuropsychiatric difficulties. They were all examined by the same neuropsychiatrist (MGS), had EEG recorded with electrodes in the 10–20 system plus zygomatics, almost always with sleep: spontaneous, after sleep-deprivation or overnight polysomnographic recording with video-EEG in a sleep lab. All EEGs were read blind by the same board-certified clinical neurophysiologist (PAH). Representative subjects are reviewed. Results In addition to a high prevalence of seizure disorder (approximately 10 times normal), recurrent afebrile unprovoked seizures (epileptic) were found in 12% of the study cohort (>10×normal), requiring long-term follow-up and treatment with AEDs appropriate for the seizure types: CBZ, OxCBZ, VPA, LMT or TPM. Breakthrough seizures require (BZDs) benzodiazepines for acute management, loading doses of PHT and/or PB for status epilepticus. Neuropsychiatric issues included attention deficit +/− hyperactivity, mood instability, dysprosody and depression, often responding to the same AEDs as above, plus SSRI or antipsychotics. The adolescents experienced learning difficulties in school and/or at work, requiring cognitive behavior therapy, speech therapy and possibly EEG biofeedback. Conclusion The FASD is associated with increased seizure risk, learning disorder, neuropsychiatric difficulties that require further intervention. Whether these are due to developmental cerebral dysgenesis, neurotoxicity of ethanol or metabolites in utero, or sequelae of postnatal traumatic brain injuries, vitamin deficiency or a disorder in brain metabolism as a result of epigenetic response to a hostile neural environment, remains to be determined in future studies.