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Cognition in childhood-onset epilepsy.

In 1986, Ellenberg et al.2 reported that the IQ of a population based cohort of children with epilepsy at age 7 did not differ significantly from that of their siblings and that there was no decline between age 4 and 7. While there is still controversy whether there is any cognitive deterioration in most children, it has been increasingly recognized that, while the prognosis for seizure remission is often favorable, that of the cognitive and behavioral morbidities is less so. These comorbidities of epilepsy are significant even in children who are medically controlled. Sillanpaa et al. reported that in a cohort of adults followed prospectively since childhood with childhood-onset epilepsy there was a higher rate of only completing primary education, of being unmarried and not having children and being unemployed compared with population based controls.3 These results were true even in the subgroup of children with idiopathic/cryptogenic epilepsy who were doing well in terms of being seizure free off medications for many years. The negative impact persisted for many years as even those who were seizure free and off medications were less likely to be driving as adults despite no legal barriers to doing so.4 More recently Berg et al.5 described a much higher rate of needing special educational services in a community based cohort of children with epilepsy. Those with medically refractory epilepsy were more likely to require this. However, children with medically refractory epilepsy are also more likely to have a remote symptomatic etiology,3,6 which makes the comparison more difficult as these children have brain lesions that may result in impaired cognition independent of their seizures.