Psychogenic nonepileptic seizures as a manifestation of psychological distress associated with undiagnosed autism spectrum disorder

Miyawaki, Dai; Iwakura, Yoshihiro; Seto, Toshiyuki; Kusaka, Hiroto; Goto, Ayako; Okada, Yu; Asada, Nobuyoshi; Yanagihara, Erika; Inoue, Koki

doi:10.2147/ndt.s98698

Cited by 12 publications

(15 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The clinical formulation of these combined NES and ASD cases frequently suggested that NES were likely precipitated by the psychological stress of living with unacknowledged or inadequately managed ASD. Interventions related to impairments associated with ASD (for example educational adjustments or social support) led to a reduction in frequency of NES without using a treatment targeted directly at the functional symptoms [6]. It is not known whether ASD is common in other functional disorders or in adults.…”

Section: Discussionmentioning

confidence: 99%

“…Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterised by deficits in social communication and interaction, restricted or repetitive interests and consequent impairment of functioning and is a common comorbidity in children and young people with epilepsy [5]. ASD has been reported as being associated with NES only in a single case report [6].…”

Section: Purposementioning

confidence: 99%

See 1 more Smart Citation

Autism spectrum disorder in children and young people with non-epileptic seizures

McWilliams

Reilly

Gupta

et al. 2019

Seizure

View full text Add to dashboard Cite

Non-epileptic seizures are paroxysmal events which to an observer resemble epileptic seizures. Proposed risk factors incorporate biopsychosocial aspects including factors in the affected individual. Unexpectedly high rates of autism spectrum disorder (ASD) occurred in the clinical population reported here. Although elevated levels of psychiatric co-morbidity are known to be present in patients with NES, ASD has only been previously described in a single case report. Methods This case series captures rates of ASD in 59 children and young people who were referred to a specialist paediatric mental health service at Great Ormond Street Hospital, London, UK for assessment and treatment of non-epileptic seizures between 2012 and 2016. Results 10/59 (16.9%) of the children and young people with non-epileptic seizures also had ASD, with 5/10 (50%) of these undiagnosed with ASD before referral. Children and young people with ASD were significantly more likely to have tics or attention-deficit hyperactivity disorder than those without ASD. Conclusion ASD may be a common co-morbidity in non-epileptic seizures. Careful clinical assessment with consideration of ASD traits is therefore important in the non-epileptic seizures population. It is beneficial to diagnose ASD early as its presence is likely to require a modified approach to assessment and treatment of non-epileptic seizures. Study of the development of non-epileptic seizures in ASD may suggest hypotheses for the pathogenesis of non-epileptic seizures in the wider population. Keywords • non-epileptic seizures • functional neurological symptoms • autism • children Highlights • Assessment of non-epileptic seizures should include detailed screening for autism • Assessment of epilepsy in autism should involve considering non-epileptic seizures • Possible reasons for an association between NES and ASD are discussed

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%

Autism spectrum disorder in children and young people with non-epileptic seizures

McWilliams

Reilly

Gupta

et al. 2019

Seizure

View full text Add to dashboard Cite

show abstract

“…Children with undiagnosed ASD suffer from social di culties related to the traits [8] and we suggest that their overlooked distress can be a predisposing factor for the development of anxiety disorders. Children with ASD often show anxiety, which Boulter et al (2014) pointed out to be associated with intolerance to uncertainty [9].…”

Section: Discussionmentioning

confidence: 92%

“…It is highly possible that children with ASD are more vulnerable to verbal threat information from the media because they interpret it literally, possibly worsening their anxiety. In undiagnosed cases, children do not have any support for their ASD traits and anxiety can exacerbate [8]. The effect of the COVID-19 pandemic on mental health concerns, including anxiety symptoms, has been reported [1], which can continue to increase in such an unprecedented condition.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 phobia in a boy with undiagnosed autism spectrum disorder: a case report

Sakamoto

Miyawaki

Goto

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

BackgroundThe coronavirus disease (COVID-19) is affecting mental health profoundly. Previous studies have reported pandemic-related anxiety. Anxiety disorder and autism spectrum disorder (ASD) are relatively common comorbidities. However, thus far, there is no report of any patient with undiagnosed ASD who developed anxiety disorders caused by the COVID-19 pandemic.Case presentationIn this case report, we describe an 8-year-old Japanese boy with undiagnosed ASD who developed COVID-19 phobia, resulting in avoidant restrictive food intake disorder (ARFID). As COVID-19 was highly publicized in the mass media and the risk of droplet infection was emphasized upon, the patient began to fear viral contamination from food, culminating in a refusal to eat or even swallow his saliva. He was admitted to a pediatric medical center in Osaka with life-threatening dehydration and was then referred to our child psychiatry department for treatment. We clinically diagnosed the patient with COVID-19 phobia resulting in ARFID. We identified the characteristics of ASD from his present social communication skills and developmental history. We provided psychoeducation of ASD for the parents as well as administered supportive psychotherapy for the patient. Shortly after our intervention, which was designed to relieve his ASD-related anxiety, his dysphagia improved. Our findings suggest that children with undiagnosed ASD may develop COVID-19 phobia. In these cases, intervention for ASD, such as sharing information with parents and teachers to explain what autism is and how it is likely to affect the child’s development and function, and to make an individual education plan may be more appropriate than starting treatment for anxiety disorders as the first-line option.ConclusionCOVID-19 is the biggest pandemic in the recent past and more undiagnosed ASD patients who develop COVID-19 phobia may seek treatment. Clinicians should consider the underlying ASD in these patients and assess their developmental history, such as joint attention, as well as their present social communication skills.

show abstract

“…Although the difficulty these patients have when interacting with their environment may stem from disturbances in higher-order brain networks, they may also be a result of changes in lower-level sensory function (or some combination of these). Indeed, there has been a recent focus on examining changes in sensory processing in epilepsy patients [3–6], and although a recent account of PNEE reports no systematic study of sensory function in this population [7], several case studies do suggest sensory abnormalities in this understudied population [8, 9]. However, this work, in both epilepsy and PNEE patients, has largely been restricted to examining single sensory systems.…”

Section: Introductionmentioning

confidence: 99%

Multisensory temporal function and EEG complexity in patients with epilepsy and psychogenic nonepileptic events

Noel¹,

Kurela²,

Baum

et al. 2017

Epilepsy & Behavior

View full text Add to dashboard Cite

Cognitive and perceptual comorbidities frequently accompany epilepsy and psychogenic nonepileptic events (PNEE). However, and despite the fact that perceptual function is built upon a multisensory foundation, little knowledge exists concerning multisensory function in these populations. Here, we characterized facets of multisensory processing abilities in epilepsy and PNEE patients, and probed the relationship between individual resting-state EEG complexity and these psychophysical measures in each patient. We prospectively studied a cohort of epilepsy (N = 18) and PNEE (N = 20) patients who were admitted to Vanderbilt‘s Epilepsy Monitoring Unit (EMU) and weaned off of anticonvulsant drugs. Unaffected age-matched controls staying with the patients in the EMU (N = 15) were also recruited as controls. All participants performed two tests of multisensory function: an audio-visual simultaneity judgment and an audio-visual redundant target task. Further, in the cohort of epilepsy and PNEE patients we quantified resting state EEG gamma power and complexity. Compared with both epilepsy patients and control subjects, patients with PNEE exhibited significantly poorer acuity in audiovisual temporal function as evidenced in significantly larger temporal binding windows (i.e., they perceived larger stimulus asynchronies as being presented simultaneously). These differences appeared to be specific for temporal function, as there was no difference among the three groups in a non-temporally based measure of multisensory function - the redundant target task. Further, patients with PNEE exhibited more complex resting state EEG patterns as compared to their non-psychogenic counterparts, and EEG complexity correlated with multisensory temporal performance on a subject-by-subject manner. Taken together, findings seem to indicate that PNEE patients bind information from audition and vision over larger temporal intervals when compared with control subjects as well as patients with epilepsy. This difference in multisensory function appears to be specific to the temporal domain, and may be a contributing factor to the behavioral and perceptual alterations seen in this population.

show abstract

Psychogenic nonepileptic seizures as a manifestation of psychological distress associated with undiagnosed autism spectrum disorder

Cited by 12 publications

References 21 publications

Autism spectrum disorder in children and young people with non-epileptic seizures

Autism spectrum disorder in children and young people with non-epileptic seizures

COVID-19 phobia in a boy with undiagnosed autism spectrum disorder: a case report

Multisensory temporal function and EEG complexity in patients with epilepsy and psychogenic nonepileptic events

Contact Info

Product

Resources

About