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Título

AUTISM SPECTRUM DISORDER (ASD) ASSOCIATED WITH HIPPOCAMPAL SCLEROSIS AND MESIAL TEMPORAL LOBE EPILEPSY

RESUMO

Case Report: Female, 4 years old, had her first consultation 1 year ago due to epileptic seizures and difficulties in cognitive development. The characteristic episodes of focal seizures started at 9 months of age, the last one occurring when the patient was 2 years old. Anamnesis: antisocial behavior, echolalia, and stereotypes. She had previously used depakene (suspended due to jaundice observed in the physical exam) and valproate. Valproate was replaced by carbamazepine, and clonazepam was introduced to avoid possible withdrawal crises. In the return visit, in regular use of the medications, the absence crisis did not reoccur, but the cognitive and behavioral symptoms, compatible with the autistic spectrum, still persistent. Magnetic resonance imaging showed right hippocampal hypotrophy with hypersignal on T2, suggestive of medial hippocampal sclerosis. Electroencephalogram (EEG) showed slow-wave spike complexes of 5 to 6 Hz in central and parietal regions intermittently with slowing of regional rhythms and negative spikes in right temporal (T4) and left central (C3). There is also excessive slow and fast activity without Alpha-Theta predominance, typical of the patient's age range. The patient is on a combined follow-up with speech therapy, psychopedagogy and occupational therapy.

Discussion: Medial temporal lobe epilepsy is commonly manifested by focal seizures, with EEG manifestations as spike-like epileptiform activity and sharp wave, which may be followed by slow wave, with maximum electronegativity in leads T3-F7/T4-F8, especially in sphenoidal leads, having already been reported by Andrade-Valença (2006) in concomitance with hippocampal sclerosis. However, the association of these pathologies with the ASD is an expensive record in the literature. In the meantime, besides the patient in question having clinical imaging and exams proving the three conditions, the diagnosis of these conditions was made early. Thus, therapy with carbamazepine and clonazepam was efficient in controlling the epileptic seizures. As for the behavioral changes, it is expected that with advancing age and multiprofessional intervention they will evolve with improvement.

Final Comments: The case is unique because of the diversity of symptoms stemming from the combination of two distinct diagnoses that complement each other in the patient's clinical picture. The therapy used in the case, along with the multiprofessional follow-up has had good results.

Palavras Chave

ASD; Hippocampal sclerosis; Epilepsy