Published data on the use of antiepileptic drugs (AED) in the treatment of autism (ASD) and associated affective disorders and epilepsy have been reviewed at the Department of Neurology, Miami Children’s Hospital, FL. A total of 10 case reports or open-label studies included 2 adults and 29 children, ages 22 months to 14 years. Mental retardation was present in 21 of the 31 patients, epilepsy (generalized and complex partial) in 18, and EEG abnormalities in the absence of clinical seizures in 6. Affective symptoms (manic or depressive episodes) occurred in 7. In one report of 13 patients, MRI and SPECT were abnormal in 50% and 100%, respectively, without specific details noted. Antiepileptic drugs (valproic acid (VPA) in 4, lamotrigine (LMG) in 13, and carbamazepine (CBZ) in 1) were used to control seizures in all 18 patients with epilepsy and ASD, and in 5 of 6 patients with EEG abnormalities without seizures. They were used as mood stabilizers in 7 children with affective symptoms without seizures. VPA was effective in control of seizures and EEG abnormalities in all 8 children treated, CBZ was effective in 3 of 4 chjildren, and LMG was effective in 6 of 13 patients. Improved communication skills were reported in all 8 receiving VPA, 8 of 13 on LMG, and 2 of 3 treated with CBZ. Improvements in communication and socialization skills were correlated with control of seizures or EEG abnormalities. Improvement in affective symptoms in all 7 patients with mood disorders following therapy with VPA and CBZ was associated with control of seizures and EEG epileptiform abnormalities. Placebo-controlled, double-blind studies are required to investigate the role of AED in the management of affective disorders, ASD, with or without seizures and abnormal EEG. Autism, affective disorders, and epilepsy are frequently comorbid and may share common neuroanatomic and neurochemical neural circuits. 
COMMENT. Uncontrolled studies suggest that antiepileptic drugs may have a role in the management of affective disorders and autistic spectrum disorder, with or without an associated epilepsy or abnormal EEG. The frequent use of AED in the management of behavior disorders in children with epileptiform EEGs in the absence of clinical seizures indicates the urgent need for controlled studies. The authors have provided an excellent review of the available data on this important problem and the coexistence of autism, epilepsy, and affective disorders.