Medically refractory epilepsy in autism concludes that treatment resistant epilepsy in autism affected individuals has less favorable result outcome when intervened upon with nerve stimulation or surgery.
Epilepsy rates within the autism population are reported to be at approximately 20% to 35%; about 25% begin to experience seizure during puberty. Hormonal changes during puberty are thought to contribute to the manifestation of seizure activity.
A subset within the autism population experience sub-clinical seizures which cannot be detected via simple observation.
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Since autism is a psychiatric label that that does not provide information on known cause, and since it is a label utilized to inform on such a wide and diverse population as far as intellectual ability, function and unique presentation of features per each individual - it is difficult to interpret the neurology behind why an affected individual is displaying symptoms related to seizure or movement disorder. EEG, as the sole diagnostic tool, is required to verify seizure activity. However, many with the autism label are difficult to test because of their behaviors.
Difficulty in assessment was experienced in my daughter's case upon worsening of autism during puberty. However, EEG and video EEG were attempted:
Throughout a long process of attempts in treatment the above cited manifestations were eventually thought to be the result of a rare variant of periodic catatonia. After that, through happenstance - MRI indicated that a stroke had occurred; and the area of the brain involved had been known to be associated with the type of catatonia exhibited.
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With regard to catatonia, it is prominent in patients with epilepsy; however, there are catatonic presentations that are absent of detected EEG activity; and further, EEGs are described to be difficult to interpret because of muscle rigidity producing artifacts that are present during a catatonic spell. Catatonic events seem to involve neural networks underlying termination of movement in contrast to those underlying initiation of movement (link). Problems with termination of movement were present for Sarah, she was hopeless to do battle with the spells that would take her over.
For those within the autism population, consideration into the implications of seizure will continue to prove a most complex proposition for the researchers and doctors - due to the numerous variables involved with all the subset groups who are represented by the autism label.