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PEDIATRICS Vol. 107 No. 5 May 2001, pp. 1232-1235

A Long Letter and an Even Longer Reply About Autism Magnetoencephalography and Electroencephalography

The first 300 words of the full text of this article appear below.

To the Editor.

As discussed below, the paper by Lewine et al raises serious concerns, including ethical ones, which were not adequately addressed by Dr Neville (who also seems to be a proponent of neurosurgery for autism) in his commentary, and prompts the following comments (I wish it had been possible to reply more succinctly):

Lewine et al (Pediatrics 1999;104:405-418), citing "clinical parallels" between Landau-Kleffner syndrome (LKS) and "regressive autism," suggest that subclinical epilepsy in the form of "epileptiform activity" on electroencephalography (EEG) or magnetoencephalography (MEG) may cause the apparent regression of language and behavior seen in some children with autism. Although it is well-known that epilepsy occurs in some individuals with autism, the authors fail to emphasize that the significance of an epileptiform EEG in children without seizures is controversial. Moreover, they conflate "regressive autism" and LKS, although the latter is a distinct entity for which the etiology and significance of EEG changes remain uncertain.1,2 The matter is further confused by using the term "LKS variant" in relation to 20 children for whom "language dysfunction was considerably more severe than deficits in social or other cognitive domains." There is no consensus as to a precise definition of "LKS variant."

They attempt to buttress their argument that epileptiform activity plays a primary, causative role in autistic regression by citing the frequent association of seizures and autism in a number of conditions (tuberous sclerosis, infantile spasms, etc.). However, the vast majority of persons with autism, 85% to 90%, do not have associated medical conditions predisposing to epilepsy.3

It is stated that "all" the children with autism spectrum disorders (ASDs) had "occasionally" shown "unusual behavioral episodes including unprovoked blinking, crying, and/or holding of the hands to the ears" which "would often be considered to be suggestive of a possible seizure disorder." It . . . [Full Text of this Article]