Seizure outcomes in persons with autism spectrum disorder undergoing epilepsy surgery: A systematic review and meta‐analysis

Abstract Objectives Autism spectrum disorder (ASD) and epilepsy commonly co‐occur. Surgical interventions are viable treatment options for individuals with drug‐resistant epilepsy. However, past research in patients with ASD and epilepsy has yielded mixed results regarding seizure outcomes following epilepsy surgery. Methods We adhered to the Preferred Reporting Item for Systematic reviews and Meta‐Analyses (PRISMA) standards. Medline, Embase, and PsycInfo were queried from inception to November 2024. Included studies reported seizure frequency following epilepsy surgery in persons with ASD. Forty‐six studies reporting on 325 patients with ASD and epilepsy were included for analysis. A total of 137 patients underwent resective surgery, 167 underwent neuromodulation (138 vagus nerve stimulation [VNS], 27 responsive neurostimulation [RNS], 2 deep brain stimulation [DBS]), and 21 underwent other palliative procedures (17 corpus callosotomy and 4 laser interstitial thermal therapy). Outcomes were stratified into four categories based on a combination of Engel classification and percentage seizure reduction at latest follow‐up. Results Resections yielded seizure freedom in 54% of patients, whereas neuromodulation led to >80% seizure reduction in 33.5% of patients. The incidence proportion of seizure freedom after surgery was higher in patients with MRI abnormalities was .55 (95% confidence interval [CI]: .34–.75) vs patients without MRI abnormalities (.19, 95% CI: .01–.81). Incidence proportion of seizure freedom after temporal resection was .80 (95% CI: .50–.94) vs .66 (95% CI: .48–.80) for extratemporal resection. Improvement in neuropsychiatric or quality of life outcomes was reported in the majority of patients after surgery. Significance Our study provides the most comprehensive review to date of epilepsy surgery in ASD. Based on past work, there is potential for properly selected patients with ASD and epilepsy to experience a significant reduction in seizure frequency or seizure freedom, as well as improved quality of life, following epilepsy surgery.