B-78: A Neuropsychological Profile Integrating Brain Imaging and Neuropsychological Data: Differentiating Epilepsy and Autism Spectrum Disorder

Abstract

Objective: This case study describes the neurocognitive profile of a 9-year-old male with intractable epilepsy, highlighting the contribution of serial electroencephalogram (EEG) findings and neuropsychological data to diagnostic clarification. Method/Data Selection: Febrile seizures began at 18 months of age, and seizure activity persisted despite multiple antiepileptic medications, leading to regression in speech and motor development. An EEG at age 3 demonstrated left temporal and right frontal abnormalities with multifocal discharges. A second EEG the same year revealed generalized seizure activity and moderate encephalopathy, resulting in diagnoses of generalized tonic-clonic and myoclonic seizures. Medication tapering consistently triggered seizure recurrence, including myoclonic jerks and head drops with associated head injuries. Subsequent EEGs at ages 4 and 5 were suggestive of generalized epilepsy with multifocal onset, with increased involvement of the right frontal region. A diagnosis of autism spectrum disorder (ASD) was made by the neurologist at age 6. Results/Data Synthesis: Neuropsychological evaluation at age 9 revealed global cognitive impairment, including deficits in executive functioning, processing speed, working memory, and articulation errors, consistent with frontal and temporal lobe involvement. Testing confirmed significant impairment in visual-motor integration, specifically poor precision when completing fine-motor tasks. Deficits in motor aspects of speech were evident and no social communication deficits were observed. Conclusions: Results did not support ASD. His communication challenges are better explained by seizure-related neurocognitive impairment resulting in poor speed production, rather than the social-communication impairments characteristic of ASD. These finding underscore the importance of integrating EEG and neuropsychological data for accurate diagnosis and intervention planning.