Epilepsy in Children with Autism Spectrum Disorder: Clinical and Neuroimaging Correlates

Objective: This study aimed to investigate the associations between delays in gross motor developmental milestones (head control, unsupported sitting, and independent walking), speech delay, and brain magnetic resonance imaging (MRI) findings with co-occurring epilepsy in children with autism spectrum disorder (ASD).Material and Methods: This single-center, retrospective cross-sectional study reviewed the medical records of 94 children diagnosed with ASD who presented to a tertiary pediatric neurology outpatient clinic between January 2021 and January 2024. Gross motor delays were defined as failure to achieve head control by 4 months, unsupported sitting by 9 months, and independent walking by 18 months. Epilepsy was diagnosed following the International League Against Epilepsy criteria. Statistical analyses included Fisher's exact test and binary logistic regression.Results: The majority of participants were male (80%, n = 75), with a mean age of 76.4 months (SD=51.5). Epilepsy was diagnosed in 29% (n=27), of whom 7% (n=2) had drug-resistant epilepsy. Among 51 patients who underwent MRI, 76% (n=39) had no pathological findings; the most common abnormalities were periventricular leukomalacia (n=3), cerebral atrophy (n=2), and arachnoid cyst (n=2). In logistic regression analyses, none of the evaluated variables (sex, motor delays, speech delay, or abnormal MRI findings) were significantly associated with epilepsy, although delayed walking showed a trend (OR=2.62, p=0.068).Conclusion: Epilepsy is highly prevalent (29%) in children with ASD in a tertiary care setting. Clinicians should maintain a low threshold for seizure screening in children with ASD, particularly those with delayed independent walking, as this subgroup demonstrated a trend toward higher epilepsy risk.