The Combination of Mind and Brain Alteration in A Resource-Limited Country: Autism Spectrum Disorders and Epilepsy in A Child Psychiatry Unit in Dakar

Abstract

Purpose of the study: Autism spectrum disorders (ASD) and epilepsy can coexist in the same person, constituting poor bilateral prognosis factors. This study describes the sociodemographic elements of patients with ASD and studies the clinico-paraclinical aspects of their epilepsy and its evolution in 2003. Patients and Methods: Cross-sectional and descriptive study in Child psychiatry at CHNU Fann, with analysis of the files of all patients followed between January 2004 and September 2018 for ASD with/without epilepsy. We used a standardized survey with several items. Results: Forty -five patients with ASD collected, with an epileptic frequency of 37.8%. The main history was fetal suffering (24.4%) and parental inbreeding (22.2%). Most of the symptoms of ASD were seen before 3 years old (66.6%) and epilepsy started before 5 years (94%). Seizures were generalized (58.8%), mainly tonic-clonic (80%) or focal (35.3%), with a frequency of 2 seizures / day at 1 seizure / week. The EEG showed abnormalities in frontal areas in 60%, and Centro-parietal in 26.6%. Brain imaging and evoked auditory potential were normal respectively in 93.9%, and 87.2%. Management was multimodal for ASD (neuropsychological, psychomotor, speech therapy) and medicated for epilepsy, mainly by monotherapy (82.4%) with Valproate (58.8%), Phenobarbital (17.6). Forty percent of patients were out of school and 55.6% in primary school. Twenty-five patients were self-reliant to moderately independent, mainly the epileptics (60%). The 2023 evaluation of this cohort concerns 60% of patients with epilepsy in complete remission and behavioral and language stability under continuous management. Conclusion: We find a statistic difference by age between epilepsy and ASD with a genetic predisposition related to parental inbreeding and a family history of ASD and epilepsy and to a lesser extent the existence of acute fetal suffering. The contribution of EEG was significant with a predilection of frontal abnormalities whose epileptic treatment appears to improve the impact in children's behavioral disorders.