EEG Features in Autism Spectrum Disorder: A Retrospective Analysis in a Cohort of Preschool Children

Abstract

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that can be associated with intellectual disability (ID) and epilepsy (E). The etiology and the pathogenesis of this disorder is in most cases still to be clarified. Several studies have underlined that the EEG recordings in children with these clinical pictures are abnormal, however the precise frequency of these abnormalities and their relationship with the pathogenic mechanisms and in particular with epileptic seizures are still unknown. We retrospectively reviewed 292 routine polysomnographic EEG tracings of preschool children (age < 6 years) who had received a first multidisciplinary diagnosis of ASD according to DSM-5 clinical criteria. Children (mean age: 34.6 months) were diagnosed at IRCCS E. Medea (Bosisio Parini, Italy). We evaluated: the background activity during wakefulness and sleep, the presence and the characteristics (focal or diffuse) of the slow-waves abnormalities and the interictal epileptiform discharges. In 78.0% of cases the EEG recordings were found to be abnormal, particularly during sleep. Paroxysmal slowing and epileptiform abnormalities were found in the 28.4% of the subjects, confirming the high percentage of abnormal polysomnographic EEG recordings in children with ASD. These alterations seem to be more correlated with the characteristics of the underlying pathology than with intellectual disability and epilepsy. In particular, we underline the possible significance of the prevalence of EEG abnormalities during sleep. Moreover, we analyzed the possibility that EEG data reduces the ASD clinical heterogeneity and suggests the exams to be carried out to clarify the etiology of the disorder.

Keywords: EEG; autism; epileptiform abnormalities; paroxysmal abnormalities; sleep.

Figure 1

Four examples of the neuroradiological findings we reported in the text: (A) Macrocephaly and hyperintensity of peritrigonal white matter; (B) Mild asymmetry of lateral ventricles; (C) Chiari type I malformation; (D) Slight enlargement of Cisterna Magna.

Figure 2

Male, 4 years-6 months PSG-EEG: (A) normal background activity in wakefulness; (B,C) PS-IEDs during NREM-2 phase of sleep; (D) reduction of PS-IEDs during NREM-3 phase of sleep.

Figure 3

Male, 4 years PSG-EEG: background activity in wakefulness characterized by abundant rapid rhythms on the anterior regions.

Figure 4

Male, 4 years PSG-EEG: background activity in sleep characterized by asynchronous and/or asymmetrical spindles and by K-complexes of irregular morphology with mixed paroxysmal slow waves.

Figure 5

Female, 2 years-11 months, PSG (2–3 non-REM sleep): asynchronous sharp waves on right central-temporal and left frontal regions are showed. The background activity is characterized by excessive fast activity mainly over anterior areas, asynchronous sleep spindles.