Seizures in fetal alcohol spectrum disorder (FASD): evaluation of clinical, electroencephalographic, and neuroradiologic features in a large sample of Norwegian children.

AIM: Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term encompassing developmental, cognitive, and behavioural impairments resulting from prenatal alcohol exposure. An increased prevalence of epilepsy has been reported in individuals with FASD, yet clinical characteristics, neuroimaging findings, and electroencephalography (EEG) profiles remain insufficiently described. This study aimed to determine the frequency of EEG pathology and epilepsy in a large Norwegian FASD cohort and to explore whether the identified epilepsies may have an etiology unrelated to FASD.

METHOD: We conducted a cross-sectional study of 103 children diagnosed with FASD through multidisciplinary assessment, including a standardized 120-minute EEG recording. FASD was diagnosed in all cases according to the four-digit diagnostic code. Epileptic disorders and EEG abnormalities were classified, and detailed clinical, neurodevelopmental, and treatment-related data were collected.

RESULTS

Epilepsy was diagnosed in 8 children (7.8%), compared with a national prevalence of 0.6% in Norway. EEG abnormalities were observed in 17 (16.5%) of participants, including those with epilepsy. Among the eight children with epilepsy, three exhibited features suggestive of genetic or idiopathic epilepsy, and one child had a structural lesion identified on MRI.

INTERPRETATION: Both the Institute of Medicine (IOM) guidelines and the four-digit diagnostic code consider epilepsy as a potential contributing feature in FAS/FASD classification. Although our cohort demonstrated an increased frequency of epilepsy, three cases may be better explained by genetic or idiopathic mechanisms rather than FASD. This raises the question of whether epilepsy with a likely genetic basis should be included in the diagnostic evaluation of FASD.