FOCAL EPILEPSY AND EXECUTIVE DYSFUNCTION IN AUTISM SPECTRUM DISORDER (ASD)

Abstract

Recent advances in neuroscience have allowed researchers to introduce functional neuromarkers of autism spectrum disorders (ASD) into clinical practice. Most promising are studies of brain work in milliseconds, such as quantitative EEGs, event-related potentials (ERPs), low resolution electromagnetic tomography(sLORETA), especially when it is possible to use Human Brain Index (HBI) methodology to compare test results obtained by a child with ASD with the normative database. The use of HBI methodology make possible to determine functional neuromarkers of ASD and comorbidities, such as epilepsy, impaired cognitive and emotional control or executive function (FF) disorders. Such procedure can contribute to more effective diagnosis, as well as provide personalized care for patients with ASD. In this case study we use the HBI methodology for more effective diagnosis of the child with ASD (level 2) with focal epilepsy and EF dysfunction in hope that we can provide more effective therapies which might improve her quality of life. We present the case of a 11-years-old girl with an initial diagnosis of ASD with focal epilepsy and EF dysfunction. The patient was sent to the Teaching-Reintegration Centre in Kraków with remarks that she simply could not function in everyday life. A neuropsychological examination using standardized batteries to assess the girl's cognitive, emotional and social functioning confirmed the presence of ASD (level 2), and co-occurring executive function disorders (EF). She was also analyzed from the clinical EEG perspective as well as from the QEEG/ERPs perspective and current coexistence of 3 Hz Spike-Wave Discharges on EEG and focal epilepsy was found. In the examination several episodes of 3 Hz paroxysms were found in the ventro-lateral prefrontal cortex (BA 11) in 40 min EEG recoding in Eyes open, Eyes closed as well as in task conditions. The patient’s ERPs showed that to the first stimulus (continue cue) temporal P2 wave with larger duration and longer latency was elicited in comparison to the average of the norm for her age from the Human Brain Index (HBI) normative database at Chur, Switzerland. The P30 cue was smaller in the patient than in the healthy controls from HBI and statistically significant deviations from the average were found. Also in response to NOGO stimulus no positive parietal-central P3 was observed, which appears in the ERPs of ealthy controls from HBI. The ERPs differences in the VCPT show statistically significant deviations in the patient’s brain function when compared to the ealthy controls from HBI. It should be stressed that the number of trials for the first stimulus presentation and NOGO condition were large enough for computing reliable ERPs, as it was indicated by Kropotov (2009; 2016). HBI methodology was helpful in finding functional neuromarkers of co-existence of 3 Hz Spike-Wave Discharges on EEG with focal epilepsy and EF disorder in girl with ASD (level 2). Therefore, it was possible to offer more effective rehabilitation of the disorders, which will contribute to the integration of the self system and better quality of her life.