儿童孤独症谱系障碍共患癫痫的诊治及管理

虽然儿童孤独症谱系障碍(ASD)共患癫痫现象已被识别多年,但二者之间的相互联系的确切机制尚不清楚。癫痫对ASD儿童精神行为影响研究尚少,但有较多的发育、社交沟通及自我照顾能力困难的倾向。需行治疗前综合性评估,包括病因学调查,及认知、语言、情感、社交及行为功能等评估。主要基于心理社会干预结合药物治疗。根据癫痫类型和药物耐受性,兼顾药物行为学副作用选择抗癫痫药。ASD患儿类似癫痫样发作行为常见,需仔细鉴别。疑似癫痫发作,应及时诊疗或转介。有证据显示ASD共患癫痫的难治性和死亡率增加。加强多学科交流是提高ASD共患癫痫早期识别及长程管理的重要环节。

Diagnosis,treatment and management of epilepsy in children with autism spectrum disorder

Although comorbidity between autism spectrum disorder (ASD) and epilepsy has been recognized for several years, the exact mechanism of the interaction is still not clear.There are few studies on the impact of epilepsy on mental and behavioral disorders in ASD children, but it is reported that ASD children comorbid with epilepsy are prone to having difficulty in growth and development, social communication as well as self-care.So it is required to give comprehensive assessment before treatment, including etiological investigation, cognitive, linguistic, emotional, social and behavioral functions.And the treatment is mainly based on psychosocial intervention combined with drugs.Antiepileptic drugs are selected according to the type of epilepsy and drug tolerance, taking into account the behavioral side effects of drugs.Seizures-like behaviors are common in children with ASD and need to be carefully identified.Suspected epileptic seizures should be promptly diagnosed and treated or referred.There is some evidence that ASD is associated with increasing refractory epilepsy and mortality.Therefore, strengthening multidisciplinary communication is an important link to improve the early identification and long-term management of ASD comorbidity epilepsy.