title: Does treatment have an impact on incidence and risk factors for autism spectrum disorders in children with infantile spasms?
abstract: OBJECTIVE
  Infantile spasms (IS) are a severe form of childhood epilepsy associated with autism spectrum disorders (ASD) in up to 35% of cases. The objective of this post hoc analysis of our randomized control trial was to determine whether rapid diagnosis and treatment of IS could limit the incidence of ASD while identifying risk factors related to ASD outcome.
  
  
  METHODS
  Patients with IS were randomized in a standardized diagnostic and treatment protocol. Clinical and electroencephalogram (EEG) evaluations were completed at all eight visits over 5 years, while cognitive evaluations were administered at 0, 6, 24 and 60 months, respectively. Autism was initially screened by means of the Checklist for Autism in Toddlers (CHAT) at 24 months, and formally assessed at the 30-and 60-month follow-ups using the Autism Diagnostic Observation Schedule-Generic (ADOS-G).
  
  
  RESULTS
  Of the 69 patients included in the study, 25 could not be assessed due to severe delay or death. Eleven of the 42 patients screened with CHAT, were found to be at risk of an ASD outcome. ADOS was performed in 44 and 10 were diagnosed with ASD. The CHAT proved to correlate highly with the ADOS (80% ppv). Only patients with symptomatic IS developed ASD (p = 0.003). Earlier diagnosis or successful treatment did not correlate with a reduced rate of ASD. Other risk factors were identified such as having chronic epileptic discharges in the frontotemporal areas after disappearance of hypsarrhythmia (p = 0.005 and p = 0.007) and being of nonwhite origin (p = 0.009).
  
  
  CONCLUSIONS
  ASD was only observed in children with sympyomatic IS. Other clinical risk factors include chronic frontotemporal epileptic activity and being of non-white origin. Early diagnosis and treatment did not prevent ASD as an outcome of IS. However, patients at risk for ASD could be identified early on and should in the future benefit from early intervention to potentially improve their long-term outcome.
authors.affiliation: Research Centre and Division of Neurology, Department of Pediatrics, Sainte-Justine Hospital (CHU Sainte-Justine), Montreal, Quebec, Canada.
authors.forename: Jonathan Y
authors.initials: JY
authors.lastname: Bitton
authors.affiliation: Division of Neurology, Department of Pediatrics, Faculty of Medicine, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Demos
authors.affiliation: Research Centre and Division of Neurology, Department of Pediatrics, Sainte-Justine Hospital (CHU Sainte-Justine), Montreal, Quebec, Canada.
authors.forename: Katia
authors.initials: K
authors.lastname: Elkouby
authors.affiliation: Division of Neurology, Department of Pediatrics, Faculty of Medicine, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Connolly
authors.affiliation: Division of Neurology, Department of Pediatrics, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shelly K
authors.initials: SK
authors.lastname: Weiss
authors.affiliation: Division of Neurology, Department of Pediatrics, Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Donner
authors.affiliation: Division of Neurology, Department of Pediatrics, Faculty of Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Whiting
authors.affiliation: Division of Neurology, Department of Pediatrics, Faculty of Medicine, McMaster Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Ronen
authors.affiliation: Division of Neurology, Department of Pediatrics, Faculty of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Luis
authors.initials: L
authors.lastname: Bello-Espinosa
authors.affiliation: Division of Neurology, Department of Pediatrics, Faculty of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.|Division of Child and Adolescent Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Elaine C
authors.initials: EC
authors.lastname: Wirrell
authors.affiliation: Division of Neurology, Department of Pediatrics, Faculty of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.|Division of Neurology, Department of Pediatrics, Faculty of Medicine, Izaak Walton Killam (IWK) Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Ismail S
authors.initials: IS
authors.lastname: Mohamed
authors.affiliation: Division of Neurology, Department of Pediatrics, Faculty of Medicine, Izaak Walton Killam (IWK) Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Dooley
authors.affiliation: Research Centre and Division of Neurology, Department of Pediatrics, Sainte-Justine Hospital (CHU Sainte-Justine), Montreal, Quebec, Canada.
authors.forename: Lionel
authors.initials: L
authors.lastname: Carmant
mesh_terms: D002659:Child Development Disorders, Pervasive / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D015331:Cohort Studies; D004311:Double-Blind Method; D004569:Electroencephalography; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012307:Risk Factors; D013036:Spasms, Infantile / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D013997:Time Factors
keywords: Autism spectrum disorder; Cognitive neurology; Developmental psychiatry; Pediatric epilepsy; West syndrome