Neurodevelopmental disorders such as autism spectrum disorder (ASD) and fragile-X syndrome (FXS), are becoming increasingly prevalent in children and earlier diagnosis of these disorders are desired by many parents of these children. Analyzing event-related potentials (ERPs) using electroencephalograms (EEGs) is one of the common methods used by researchers and doctors to understand and diagnose ASD as well as epilepsy. Epilepsy is very common with children diagnosed with ASD and using EEGs could be a possible way to better understand ASD and predict epilepsy risk.
In a recent seminar presentation at Loyola University Chicago, Maggie Guy spoke about her research article “A single-session behavioral protocol for successful event-related potential recording in children with neurodevelopmental disorders”, which explored the development of a behavioral support protocol to obtain high-quality ERP data from children with neurodevelopmental disorders, such as ASD and FXS. ERPs are a neuroscience tool used to measure the timing and nature of neural responses and can be used to increase understanding of connections between behavioral symptoms and neural deficits in the primary sensory pathways as well as higher order processing. Although there is a lot of past research about cognitive processing of children with neurodevelopmental disorders, the generalizability of EEG and ERP research does not reflect the heterogeneity of the neurodevelopmental disorder spectrum. During Guy’s study, she worked to decrease the generalizability of ERP research by developing a behavioral support protocol where parents would begin the familiarization of the EEG appointment protocols with their children before coming into the actual appointment in the laboratory. This prior at-home familiarization and desensitization protocol, which included a video that explained the EEG net with a lab member explaining the process as well as a protocol to regulate emotional response, allowed children with neurodevelopmental disorders to feel more comfortable with the EEG laboratory protocol before they came into their lab appointment. The child also got to choose a reinforcement toy, which reinforced positive behavior when the EEG net was on. This behavioral support protocol deemed to be extremely effective, where 77% of participants completed the study, which shows that a “one-size-fits-all” approach cannot be applied to ERP studies involving children with neurodevelopmental disorders because they have different needs.
An article by UCLA Health titled “EEGs help predict epilepsy risk in children with autism spectrum disorder” explores the connection between ASD and epilepsy, and how EEGs can be used to diagnose epilepsy. Dr. Hiroki Nariai, who is the assistant professor of pediatrics, division of pediatric neurology, and medical director of the pediatric epilepsy surgery program, explains that there is a connection between ASD and epilepsy, but the precise nature of the relationship is unknown. Dr Nariai explains that they do not know the precise underlying mechanisms of the relationship between ASD and epilepsy, but 20-40% of children with ASD develop epilepsy, which is a large number compared to 1% of the general population. Children with epilepsy, especially the severe form, also have strong association with autism, which proves both conditions share a common brain pathophysiology. Children with ASD often get EEGs due to their abnormal behavior, which can include not responding to their name, losing language skills, and random body jerking, and their EEGs are often abnormal. This study included examining a database of EEGs conducted on children with autism over 15 years and they tracked when those children developed epilepsy over the 15-year period. When examining the data, Dr. Nariai looked at interictal epileptiform discharges (IEDs), commonly called spikes, which are excitations of the neurons and are a precursor of seizures. These spikes can be used as an indicator that the child could have a higher risk of developing epilepsy. They also found a lot of slow wave activity in children with ASD, which was also intriguing because the presence of EEG slowing also predicts future development of epilepsy. It was determined that of patients exhibiting EEG spikes or slowing, the positive predictive value shows that about 60% will develop epilepsy. But the negative predictive value was more than 80% that the patient would not develop epilepsy for a while and of the children showing spikes or slowing, about 90% did not have seizure activity five years after EEG testing. The value of using EEG as a diagnostic tool allows doctors to prepare parents. If the EEG comes back abnormal, then the parents can be prepared that their child has a higher risk of developing epilepsy down the road, and they can be educated about epilepsy and seizures in advance. If the EEG comes back clear, then the parents can have some ease regarding the future. Although EEG technology can be helpful in ASD and epilepsy diagnosis, Dr. Nariai says the EEGs should not be done regularly because children with ASD have many sensory issues and may need sedation to undergo an EEG. This study opens the door for future research regarding the correlation between ASD and epilepsy, especially with using EEG testing.
Both Guy’s research article and the study done by UCLA Health explore the effects of neurodevelopmental disorders on cognition, primarily focusing on ASD, and how EEG can be used as a diagnostic tool. Guy focuses on developing a behavior support protocol for children with neurodevelopmental disorders, including ASD, and Dr. Nariai focuses on the correlation between ASD and epilepsy, where both use EEG technology. Dr. Nariai explains that children with ASD have sensory issues and it is difficult for them to complete an EEG without sedation, so I am curious how the implementation of Guy’s behavioral support protocol for desensitization and familiarization would allow more EEGs to be completed in Dr. Nariai’s studies. Using the behavioral support protocol would most likely allow more children diagnosed with ASD to undergo EEGs and allow more information for their likelihood to develop epilepsy to be captured.
References:
Guy, M. W., Black, C. J., Hogan, A. L., Coyle, R. E., Richards, J. E., & Roberts, J. E. (2021). A single‐session behavioral protocol for successful event‐related potential recording in children with Neurodevelopmental Disorders. Developmental Psychobiology, 63(7). https://doi.org/10.1002/dev.22194
Uclahealth. (2024, September 19). EEGs help predict epilepsy risk in children with autism spectrum disorder. UCLA Health. https://www.uclahealth.org/news/article/eegs-help-predict-epilepsy-risk-children-with-autism
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