Alexandra LaRue
Rutgers University-Camden
Kristina Mira, MEd, QBA
Association for Science in Autism Treatment

Introduction

Epilepsy and autism

Photographed by Pavel Danilyuk (pexels.com)

Comorbidity – the co-occurrence of two or more medical or psychological conditions in the same individual – is highly prevalent among people with autism spectrum disorder (ASD) and other developmental disorders (O’Connell, 2021). Individuals with ASD often receive additional diagnoses including anxiety, attention-deficit/ hyperactivity disorder (ADHD), sleep disorders, gastrointestinal issues, intellectual disabilities, and epilepsy (Al-Beltagi, 2021). Gaining a deeper understanding of how each condition manifests both independently and in conjunction with ASD can help family members, clinicians, and educators better understand the individual’s support needs and identify the most effective and individualized intervention approaches. With that in mind, this article seeks to provide readers with information and resources pertinent to the overlap of epilepsy and ASD.

Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that presents specific deficits across varying degrees of intensities (hence the use of the term spectrum). The core characteristics of an ASD diagnosis include challenges with social communicative behaviors and engagement in restrictive, repetitive behaviors (Watkins et al., 2022). According to a recent study conducted by The Autism and Developmental Disabilities Monitoring Network, the rate of ASD in children is the highest recorded in history with approximately 1 in 31 children aged 4 and 8 meeting diagnostic criteria (Shaw et al., 2025). There are numerous evidence based diagnostic tools available to diagnose autism, including : M-CHAT-R/F, DSM-5, ADOS-2, ADI-R, and CARS-2 (Lucato dos Santos et al., 2024; Watkins et al., 2022). It is recommended that children with ASD receive consistent and ongoing support as early as possible based on their individual presentations and unique needs. These supports may include, but are not limited to, behavioral, speech, and occupational therapies. However, there are also many cases of co-morbidities, or co-occurrences, of other diagnoses with ASD including epileptic disorders. In these cases, there may be specific additional interventions, like medications or surgeries, recommended to achieve best outcomes (Capal & Jeste, 2024; Kwon et al., 2022; Watkins et al., 2022).

Epilepsy and Autism

Autism spectrum disorder and epilepsy have been shown to be related. Epilepsy is common, affecting approximately one in twenty-six Americans (about 3% of the population; 0.6% of children), and around 20% of people with autism (Center for Disease Control, 2024; Besag, 2018). An official diagnosis of epilepsy is made when an individual has at least two unprovoked seizures occurring more than 24 hours apart or one unprovoked seizure and a high risk for seizure recurrence (as determined by significant clinical risk factors such as presence of prior brain injury, significant structural abnormalities on neuro imaging, or epileptiform abnormalities on EEG. Very simply put, “seizures” are caused by a misfiring of neurons, or cells in the brain, and may manifest in many different ways such as convulsions, staring spells, and sensory or emotional disturbances (The Epilepsy Foundation, n.d.).

Seizures are often split into two categories: focal onset and generalized onset. Focal seizures (previously referred to as partial seizures) originate in a specific region of the brain and have a wide variety of presentations, including motor, sensory, and cognitive symptoms. During focal seizures, some individuals have preserved awareness, while other individuals have impaired awareness. Focal seizures can progress to a generalized seizure, a seizure that involves both sides of the brain. Generalized onset seizures typically result in impaired consciousness and bilateral motor manifestations, but may also present as non-motor seizures, such as absence seizures, which appear as staring spells.

Epilepsy often presents in early childhood or adolescence in autistic individuals, with a higher prevalence in individuals with intellectual disabilities than without (Bishop et. al., 2022; Zarakoviti et al., 2022). Genetic studies have identified numerous variations in genes that are thought to contribute to both autism and epilepsy. The majority of these genes are involved in neuronal synaptic structure and function. Individuals with autism who have been diagnosed with epilepsy often undergo genetic testing if it has not been done already based on their ASD diagnosis or if additional tests are warranted.

Epilepsy Diagnostic Processes

Diagnosing epilepsy often requires thorough diagnostic testing. First, after the initial seizure, a full medical history and neurological examination is taken by the physician. Depending on the initial history and examination, common next steps in diagnostic testing include placement of an electroencephalogram (EEG) and further neuroimaging. EEG is a non-invasive test in which electrodes are placed on the scalp to record the electrical activity of the brain. EEG testing is useful in confirming the presence of abnormal electrical activity in the brain. This may assist in determining the type of seizure, location of seizure, and treatment decisions. However, since an EEG records brain activity during a short timeframe (between twenty minutes and an hour), the likelihood of recording abnormal activity can be low. Because of this, a normal EEG test cannot entirely rule out epilepsy, since brain activity can rapidly recover after a seizure. In the event of a normal EEG, an ambulatory EEG, and EEG that lasts anywhere between twenty-four and seventy-two hours in-hospital or at home, may be conducted to increase the chance of recording a seizure (Hasan & Tatum, 2021).

There are several other tests used to detect epilepsy as well. Imaging scans, including CT and MRI may identify possible lesions or damaged tissue that may be the underlying cause of the seizures (i.e., grey matter abnormalities) (Aklamanu, 2025). If there are no structural abnormalities or injuries found, genetic testing may be performed to evaluate for any genetic abnormalities causing seizures. Chromosomal microarrays, epilepsy gene panels, and whole exome sequencing are the most common tests used to diagnose genetic epilepsies (Habela et. al., 2024). Genetic testing, while often tedious and time consuming, can open doors for patients and families to better understand their health and specific treatment options for their or their family members’ genetic epilepsy.

Epilepsy Treatment and Disease Management

Beyond diagnosis, treatment and disease management efforts are dependent on the type and cause of seizures, and can consist of a variety of options (Tomson et. al., 2023). Pharmacological methods are often the first option explored, since there are over twenty different anti-seizure medications on the market. Some of the most common anti-seizure medications (ASMs) are Levetiracetam, Oxcarbazepine, Lacosamide, Lamotrigine, Phenobarbital, Ethosuximide, Topiramate, Valproate, Zonisamide, and Clobazam. ASMs often work by slowing down the abnormal excitatory electrical impulses in the brain that are responsible for the seizure activity. Due to the nature of many ASMs, fatigue, brain fog, behavioral issues, weight fluctuations, and many other side effects may occur, depending on the medication. Side effects and disease management can be particularly troublesome in individuals on the autism spectrum. It is important for one to carefully discuss medication options and side effect profiles with ones’ care team and to monitor closely once a medication regimen is prescribed.

At least 30% of individuals with epilepsy do not respond to medication therapy (The Epilepsy Foundation, n.d.). In select conditions where ASMs are ineffective in treating seizures, surgical interventions may be considered. Focal resection, the removal of the diseased or damaged tissue, is the most common type of epilepsy surgery. For individuals with refractory temporal lobe epilepsy, resection is particularly advantageous, with a significant percent of recipients achieving long term seizure freedom; however, extratemporal epilepsies (i.e., frontal lobe epilepsy) have mixed results (De Tisi et al., 2011; Hagemann et al., 2022). Neurostimulation therapy, such as vagus nerve stimulation (VNS) or responsive neurostimulation (RNS), may also be considered if more invasive neurosurgical techniques are not possible, such as for generalized epilepsies or focal epilepsies where there are multiple damaged regions, the region is unable to be completely resected, or the region is unable to be resected at all due to location or safety reasons (Jehi, 2018). Neurostimulation devices are implanted on either the skull (RNS) or the upper left chest (VNS), utilizing electrodes to send electrical signals to brain cells and the nervous system to change or control cell activity, thereby limiting or eliminating seizure activity (Wong et. al., 2019; González et., al., 2019; Kusyk et al., 2022).

Diagnosis Differentiation: Epilepsy, Autism or Both?

To identify the most effective interventions for an individual, it is crucial to first collect a very detailed history about the events concerning seizure occurrence. In children with autism, differentiating between behavioral symptoms (such as staring spells, repetitive movements, developmental regression, and not responding to one’s name) and seizure can be challenging (Capal & Jeste, 2024; Kwon et al., 2022; Besag, 2018). The term stereotypy refers to semi-voluntary, repetitive, purposeless movements or behaviors (such as hand flapping and body rocking). Given that stereotypies are common among children with autism, it is important to note that, unlike seizures, stereotypies may be voluntarily suppressed, are often self-soothing and helpful to sensory regulation, and are not associated with drowsiness or confusion after the event (McCarty & Brumback, 2021). Misdiagnosis can be a risk when seizures and behavioral symptoms share common presentations, resulting in a delay to accessing effective treatment options (Besag, 2018; Capal & Jeste, 2024) . Based on the diagnostic challenges that these commonalities may present, practitioners must use appropriate assessment tools to identify each disorder accurately and independently. Luckily, there are several established evidence-based tools to guide the diagnostic process.

Resources for Caregivers and Families

For both the individual and their families, managing comorbid epilepsy and autism can be stressful, scary, and draining. Thankfully, there are many helpful resources across the world that provide individuals and families assistance in understanding, navigating, and coping with diagnoses such as epilepsy and autism.

Authors’ Note: We would like to thank Scott Myers, MD, and Isabelle Mawby, MD for their guidance on the draft of this article.

References

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Reference for this article

LaRue, A., & Mira, K. (2025). Epilepsy and autism: Understanding the overlap. Science in Autism Treatment, 22(8).

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