FIRES and autistic troubles

By  Professor Lieven Lagae MD PhD, Paediatric Neurology – Epilepsy , President of the European Paediatric Neurology Society, Editor-in-chief European Journal of Paediatric Neurology – 2013

The association between FIRES and autistic behavior remains interesting and a challenge to understand.The key question is whether this autistic behavior seen in children with FIRES is very specific for this epilepsy syndrome. Indeed many early onset epilepsies are associated with autism. For instance, in tuberous sclerosis, children often present with infantile spasms in the first year of life and develop severe autism in the next years. It is believed that this might be associated with interference of the developing communicative networks in the brain at this vulnerable age. Autistic behavior is seen in many other refractory epilepsies, such as Lennox Gastaut and Dravet syndrome. So it seems that refractory epilepsy is indeed a risk factor for developing autistic traits. Now, FIRES is  a special case, since most children with FIRES only start with their epilepsy after the age of 4-5 years. At that age, it can be expected that normal communication and social interactions are already well developed. In this way the occurrence of autism in FIRES is somewhat surprising: is it due to the unexplained and not yet well understood inflammatory changes in FIRES, is it due to the specificities of the epilepsy (for instance more frontal lobe seizures), or is it again due to the fact that many FIRES children have refractory epilepsy? We do not know yet.