John diagnosed with autism at 18 months old presents to your developmental clinic at 30 months old. His mother reports developmental regression of previously acquired developmental milestones. He has now lost his previously acquired language skills and only makes incomprehensible babbles. He is otherwise clinically well and does not have any clinical seizures. You wonder whether an electroencephalogram (EEG) should be performed on John to rule out possible underlying subclinical epilepsy that may contribute to his developmental regression.

And I guess the next thing that follows is ‘and what do you do about it’? I’m not sure that there’s a great value in treating purely laboratory abnormalities in most settings. It’s probably true in some diseases – like the use of Imatinib in PCR-proven relapse of CML – but does a low serum magnesium need magnesium supplementation? Is the chase for an underlying abnormality in ASDs part of a doctor desire to have something to do, rather than accept that it’s other folk – the OTs, teachers, psychologists and speech & language therapists – that are going to make a difference?

Authors

Choong Yi Fong (Paediatric Neurology Specialist Registrar, Evelina Children’s Hospital, London, UK) [choongyi@hotmail.com]

Gillian Baird (Neurodevelopmental Paediatric Consultant, Guy’s Hospital, London, UK)

Elizabeth Wraige (Consultant Paediatric Neurology, Evelina Children’s Hospital, London, UK)