Hunter et al., Epilepsy and Behavior 93(2019): 87-93.

Children diagnosed with epilepsy early in life (age 4 or younger), often have neurobehavioral problems that impact their health and well being. Neurobehavioral problems can affect both cognition and behavior.

  • Cognitive difficulties include problems with language, learning, memory, comprehension, and problem solving.
  • Behavioral problems often include difficulty with mood, anxiety, social skills, emotional control, attention, and hyperactivity.

These cognitive and behavioral problems can bring major challenges for children and families. Identifying problems early can help to lessen challenges and enable families and medical teams to strive for the best health and quality of life outcomes possible.


The purpose of this study was to better understand how common it is for children with an early diagnosis of epilepsy (age 4 or younger) to have cognitive or behavioral problems and to consider the risk factors that may make it more likely for a young child with epilepsy to be affected.

Description of Study

  • 46 children with an early diagnosis of epilepsy (age 4 or younger) living in Scotland participated in the study.
  • All children included were newly diagnosed with epilepsy.
  • Age appropriate cognitive and behavioral assessments were done within 5 months of a child’s epilepsy diagnosis.
  • The results of the children with epilepsy were compared to a “control” group of children without epilepsy who were similar in age, birth history, and family history.
  • Epilepsy related risk factors (such as age at first seizure, age at diagnosis of epilepsy, family history of epilepsy, seizure frequency, anti-seizure medications, cause of epilepsy) and non-epilepsy related risk factors (such as age, gender, history of premature birth, socioeconomic status, family history of psychiatric problems) were considered in the analysis.

Summary of Study Findings

  • Approximately 2 out of 3 children (63%) with early diagnosis of epilepsy had cognitive or behavioral problems.
  • In the control group of children (without epilepsy), about 1 out of 4 (27%) children had cognitive or behavioral problems.
  • Almost half (43%) of the children with early epilepsy had two or more cognitive or behavioral problems.
  • Risk factors were different for each cognitive and behavioral problem. However, three risk factors were generally identified as making it more likely for neurobehavioral problems to occur:
    1. Being female
    2. A child being on more than one antiseizure medication
    3. A family history of psychiatric problems
  • Decreased cognitive ability, poor social functioning, mood and anxiety problems, and a risk for autism spectrum disorder were frequently seen in the group of children with early diagnosis of epilepsy.
  • No specific cause of epilepsy was linked to a child having increased odds of one or more neurobehavioral problems.

What does this mean?

  • This study supports a need for early assessment of cognitive and behavioral problems in children who are diagnosed with epilepsy early in life.
  • Neurobehavioral problems, often two or more, were identified frequently and very soon after the diagnosis of epilepsy. These findings support the need for early neurobehavioral assessment.
  • Identifying problems early allows for timely referral and treatment.
  • It also helps to ensure the proper supports and accomodations can be put in place, so that children have the best chance for functioning well at home and at school.

Article published in Epilepsy & Behavior, April 2019.

Authored By: 
Elaine Kiriakopoulos MD, MSc
Authored Date: 
Reviewed By: 
Elaine Wirrell MD
Tuesday, April 30, 2019