Table 3.
Seizures treatments for autism spectrum disorder.
| Treatment | Grade of recommendation |
Prevalence of use |
Important adverse effects | |||
|---|---|---|---|---|---|---|
| Seizures | Behavioral and cognitive ASD symptoms | ASD with seizures | Behavioral and cognitive ASD symptoms | ASD with seizures | ||
| TRADITIONAL TREATMENTS | ||||||
| Valproate | B | A | C | 6% | 39% | Weight gain (occasional), alopecia, carnitine depletion (infrequent); hepatotoxicity, abnormal liver function tests, hyperammonemia, and pancreatitis (rare) |
| Lamotrigine | C | D – NE | C | 3% | 27% | Stevens–Johnson reaction, abnormal liver function tests, aseptic meningitis (rare) |
| Levetiracetam | C | D – NE | C | 1% | 23% | Agitation and mood instability (infrequent) |
| Ethosuximide | B | D – NE | C | <1% | 4% | Weight loss (occasional), gingival hyperplasia (infrequent) |
| Carbamazepine | B | D – SC | C | 1% | 26% | Dizziness, ataxia, nausea (occasional), hyponatremia, photosensitivity (rare) |
| Topiramate | B | D – PD | N | 1% | 25% | Weight loss, cognitive dysfunction, somnolence, agitation (occasional), metabolic acidosis, nephrolithiasis, glaucoma (rare) |
| Clonazepam | C | D – PD | N | 3% | 16% | Drowsiness, ataxia, cognitive dysfunction (occasional), abnormal liver function tests, respiratory depression (rare) |
| Oxcarbazepine | B | N | N | 2% | 22% | Dizziness, ataxia, nausea (occasional), hyponatremia, photosensitivity (rare) |
| Phenobarbital | B | D – PD | N | 2% | 13% | Drowsiness, lethargy, hyperactivity (common) |
| Phenytoin | B | D – PD | N | 1% | 14% | Dizziness, ataxia, nausea (occasional), abnormal liver function tests, gingival hyperplasia (infrequent) |
| Gabapentin | C | N | N | 1% | 8% | Weight gain, drowsiness, ataxia, cognitive dysfunction (occasional), edema (infrequent) |
| KD | B | B | C | 0% | 7% | Constipation, weight loss (occasional), nausea (infrequent), acidosis, nephrolithiasis (rare) |
| MAD | C | C | C | 1% | 3% | Constipation, slow weight gain (occasional), nausea (infrequent) |
| VNS | B | D – NE | D – NE | 0% | 4% | Hoarseness, throat discomfort (infrequent), shortness of breath, aspiration (rare) |
| Surgery – resection | C | D – PD | C | 0% | <1% | Cognitive and motor dysfunction (occasional), intracranial hemorrhage (infrequent), intracranial infection (rare) |
| Multiple subpial transections | C | C | C | Cognitive and motor dysfunction, intracranial hemorrhage (infrequent), intracranial infection (rare) | ||
| Steroids | C | D – SC | D – SC | 21% | 5% | Hyperglycemia, hypertension, edema, poor wound healing, weakness, emotional dysregulation, weight gain, nausea, insomnia, gastrointestinal ulcer (occasional) |
| IVIG | C | C | N | 1% | 3% | Fever, nausea, rash (occasional), aseptic meningitis (rare) |
| Neurofeedback | B | B | C | <1% | <1% | None reported |
| SPECIFIC SYNDROME AND TREATMENTS | ||||||
| Tuberous sclerosis complex | ||||||
| Vigabatrin | B | C | C | 0% | <1% | Retinal degeneration and central visual loss (infrequent) |
| Fragile X | ||||||
| AEDs | C | N | N | Various (see above) | ||
| Mitochondrial disease | ||||||
| l-carnitine/acetyl-l-carnitine | N | B | N | 22% | 18% | Abdominal discomfort, diarrhea, irritability (infrequent) |
| Multivitamins | N | B | N | 16% | 12% | Aggression, inattention, nausea (infrequent) |
| N-acetyl-l-cysteine | N | B | N | Abdominal discomfort, diarrhea, nausea (occasional) | ||
| Cerebral folate deficiency | ||||||
| Folinic acid | C | C | C | Hyperactivity, aggression (rare) | ||
| Milk-free diet | N | C | N | Hypocalcemia (rare) | ||
| Urea cycle disorders | ||||||
| Low-protein diet/ammonia binders/amino acid supplementation | B | C | N | None reported | ||
| Succinic semialdehyde dehydrogenase deficiency | ||||||
| Vigabatrin | D – NE | D – NE | D – NE | Retinal degeneration and central visual loss (infrequent) | ||
| Creatine deficiency syndromes | ||||||
| Creatine monohydrate | C | C | C | None reported | ||
| Biotinidase deficiency | ||||||
| Biotin | D – NE | D – NE | D – NE | None reported | ||
| Smith–Lemli–Opitz syndrome | ||||||
| Cholesterol | N | B | N | None reported | ||
| Branched-chain ketoacid dehydrogenase kinase deficiency | ||||||
| BCAA supplement | D – PD | D – NE | D – NE | None reported | ||
| Pyridoxine-dependent and responsive seizures | ||||||
| Pyridoxine | C | B | D – SC | 27% | 15% | Irritability, hyperactivity (uncommon) |
| Cobalamin metabolism | ||||||
| Cobalamin | C | C | N | 32% | 20% | Irritability, hyperactivity (uncommon) |
| Organic aciduria – d-glyceric aciduria | ||||||
| Fructose restriction | N | D – SC | D – SC | None reported | ||
| NOVEL TREATMENTS | ||||||
| Magnesium (Mg) | A | D – NE | N | 26% | 17% | Abdominal discomfort, diarrhea, nausea (infrequent) |
| Pyridoxine and Mg | N | B | N | Abdominal discomfort, diarrhea, nausea, irritability, hyperactivity (infrequent) | ||
| Zinc | D – BR | N | N | Abdominal discomfort, diarrhea, nausea (infrequent) | ||
| Dimethylglycine | D – NE | D – NE | N | 14% | 9% | None reported |
| Taurine | D – PD | N | N | 10% | 10% | None reported |
| l-Carnosine | D – BR | C | N | 5% | 5% | Hyperactivity (infrequent) |
| Omega-3 fatty acids | C | B | N | Abdominal discomfort, diarrhea, nausea (infrequent), abnormal liver function tests (rare) | ||
| Homeopathy | N | D – PD | N | None reported | ||
| Gluten-free casein-free diet | N | B | C | 41% | 25% | None reported |
| Feingold/elimination diet | D – SC | N | N | None reported | ||
| Slow repetitive transcranial magnetic stimulation | B | B | N | <1% | <1% | Headache (occasional) |
EO, Expert Opinion; NE, Neutral Effect / Inconsistent; PD, Possibly Detrimental; SC, Single Case Report or Series; BR, Based on bench research.