Une nouvelle étude montre que le comportement d’enfants atteints de Troubles du Spectre Autistique permet de prédire s’ils feront ou non des crises d’épilepsie

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En comparaison avec la population générale, les enfants souffrant d’un trouble du spectre de l’autisme (TSA) ont plus de risque de faire des crises d’épilepsie. La prévalence [1] de l’épilepsie chez les enfants souffrant de TSA est entre 2.4 et 46% alors qu’elle est de 0,4 à 0,8% dans la population générale du même âge. Inversement, la prévalence de TSA chez les jeunes patients souffrant d’épilepsie est plus forte que dans la population générale du même âge, suggérant un lien neuro-développemental [2] entre ces deux pathologies.

Afin de comprendre les conséquences d’une comorbidité [3] TSA-épilepsie sur le développement des capacités cognitives [4] de jeunes patients atteints d’autisme, une large étude prospective [5] appelée « The Autism Treatment Network (ATN) » a suivi pendant environ trois ans 472 jeunes patients, âgés de 2 à 17 ans, qui n’avaient jamais fait de crises d’épilepsie au moment de leur recrutement dans l’étude. Au cours de l’étude, seuls 22 d’entre eux (4.7%) ont fait des crises d’épilepsie. En comparant les deux populations de jeunes patients atteints d’autisme avant l’apparition des crises, il est apparu sur les différentes échelles de mesure (Vineland II, ABC, CBCL, PiedsQL) [6] que les jeunes patients qui vont faire des crises d’épilepsie sont déjà différents de ceux qui ne feront pas de crises, par la faiblesse de leur communication, la présence de comportements répétitifs, et leurs moins bonnes capacités motrices.

Ces observations souffrent cependant de plusieurs facteurs limitants. En premier, ni les types de crises, ni l’impact des traitements antiépileptiques n’ont été étudiés et suivis. En effet, des crises de type Tubéreuse de Bourneville sont souvent associés à l’autisme alors que d’autres, comme les crises temporales, beaucoup moins. Les traitements antiépileptiques peuvent avoir des effets complexes aussi bien sur la sévérité de l’autisme que sur les crises et donc fausser le diagnostic.

Un aspect particulièrement intéressant de l’article est que dans cette cohorte, les aspects autistiques sont observés bien avant la survenue de crises, suggérant que celles-ci ne sont pas la cause du trouble autistique. Leur origine commune est donc bien la maturation cérébrale pendant la grossesse avec une expression échelonnée des symptômes autistiques et épileptiques. Reste à savoir ce que sont ces altérations précoces et les mécanismes qu’elles partagent ou non.

Référence : Capal, J. K., Macklin, E. A., Lu, F., & Barnes, G. (2020). Factors associated with seizure onset in children with autism spectrum disorder. Pediatrics, 145(Supplement 1), S117-S125.


[1]

Prévalence : représente ici le nombre de cas d’une maladie (épilepsie) dans une population donnée (enfants TSA) comparé au nombre de cas de cette même maladie dans la population générale (exprimée en %).

[2]

Neurodéveloppement : développement du système nerveux pendant la grossesse et les premières années de vie

[3]

Comorbidité : présence d’une maladie s’ajoutant à la maladie initiale

[4]

Capacités cognitives : ensemble des processus mentaux qui se rapportent à la connaissance

[5]

Etude prospective : une cohorte de patients est suivie au cours du temps. S’oppose à étude rétrospective dans laquelle les patients sont interrogés sur les évènements de leur passé.

[6]

Mesures de qualité de la vie et comportements adaptatifs (Vineland Adaptive Behavior Scales) et mesure de l’hyperactivité (Aberrant Behavior Checklist).

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