Surgery Improves Outcomes in Autism Spectrum Disorder With Drug-Resistant Epilepsy

Surgical intervention may offer substantial seizure reduction and functional benefits for individuals with autism spectrum disorder (ASD) and drug-resistant epilepsy, according to findings published in Epilepsia.

Although epilepsy commonly co-occurs with ASD, patients often fail to achieve seizure control despite multiple antiseizure medications. To clarify surgical outcomes in this population, researchers conducted a systematic review and meta-analysis examining seizure and neuropsychiatric outcomes following epilepsy surgery.

Using Medline, Embase, and PsycInfo databases, the researchers identified 46 studies comprising 325 total patients with ASD who underwent surgery for drug-resistant epilepsy. Surgical interventions included resection (n=137), neuromodulation (n=167), and palliative procedures such as corpus callosotomy and laser interstitial thermal therapy (n=21). The mean age at surgery was 9.53 years, and the mean follow-up period was 29.9 months.

[M]any persons with ASD and intractable epilepsy can experience a meaningful reduction in seizure frequency following various forms of epilepsy surgery.

Among patients who underwent resective surgery, 54% (95% CI, 39%-68%) achieved seizure freedom, and an additional 25% (95% CI, 15%-39%) experienced at least an 80% reduction in seizure frequency. In contrast, neuromodulation procedures, including vagus nerve stimulation, responsive neurostimulation, and deep brain stimulation, achieved at least an 80% seizure reduction in 33.5% of patients overall, with seizure freedom achieved in only a small subset.

Resection was associated with significantly higher odds of seizure freedom compared with neuromodulation (odds ratio, 13.12; P <.001). Seizure control was also more likely among patients with magnetic resonance imaging abnormalities (55% vs 19% without) and after temporal versus extratemporal resections (80% vs 66%).

Behavioral and quality-of-life outcomes improved for most patients. Of 30 studies that systematically evaluated these domains, 24 reported better performance across measures such as alertness, sociability, and communication. In subsets assessed using standardized tools, including the Vineland Adaptive Behavior Scales and Autism Diagnostic Observation Schedule, postoperative improvements were documented.

Study quality, assessed with the Methodological Index for Non-Randomized Studies, was moderate, with an average score of 10.06 out of 16.

Limitations include small sample sizes, heterogeneity in study design, and inconsistent reporting of cognitive and behavioral outcomes.

“[M]any persons with ASD and intractable epilepsy can experience a meaningful reduction in seizure frequency following various forms of epilepsy surgery,” the study authors concluded.