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Identifying early markers for future school achievement in children with early‐onset epilepsy

tic drug(s) administered, and the psychosocial effects of experiencing seizures. A new avenue of research points to altered brain development in individuals with epilepsy, suggesting that abnormal neurodevelopment is an inherent component of the epileptic syndrome rather than consequent to it. Children with epilepsy already at, or near time of seizure onset, exhibit structural abnormalities including enlarged ventricles and reduced thalamic volumes. Specifically, the volume of the right thalamus was found to be smaller in children with idiopathic generalized epilepsy (IGE) at the onset of the seizure disorder and, during a 2year follow-up, the rate of its volume loss was greater in the study children compared with healthy comparison children. Furthermore, children with idiopathic generalized epilepsy did not exhibit the expected increase of frontal lobe volume, neither for white nor grey matter. Also, reduced integrity of white matter tracks between the thalamus and other brain regions, such as the prefrontal areas, was documented in children with ADHD suggesting that similar brain regions are impaired in both epileptic conditions and ADHD. Thus, neurodevelopmental abnormalities may comprise not only the structural underpinnings of the epileptic syndrome but also those of its cognitive, attentional, and behavioral manifestations. Contributing factors of the epileptic syndrome, i.e. seizure type, frequency, electroencephalographic features, antiepileptic drugs, and socio-economic aspects, can all play a role in the ultimate clinical picture of each particular child. Individuals with epilepsy and comorbid conditions require a holistic approach, with emphasis on treatable factors potentially improving their quality of life. Santos et al. have presented sufficient evidence to convince, even the most dogmatic amongst us, that methylphenidate is effective and safe for children with the dual diagnosis of ADHD and epilepsy, even when the seizure disorder is active.