Epilepsy, learning, and behavior in childhood.

Several major issues exist with regard to epilepsy and learning in childhood. A small subgroup of children have a decreasing I.Q. In addition, a high proportion of children with epilepsy, possibly one half, have some schooling difficulties. Learning problems may be a consequence of the epilepsy or a result of associated factors. It is important to distinguish between the slowing of acquisition of skills and actual loss of skills; the practical implications for the child and family are very different in these two situations. In the very small proportion of children in whom actual loss of skills occurs, it is essential to seek a cause, because a cause can usually be identified and may require specific management. The importance of distinguishing between state-dependent, potentially reversible intellectual impairment and permanent impairment cannot be overemphasized. State-dependent intellectual impairment, e.g., arising from ongoing nonconvulsive status epilepticus (NCSE) or antiepileptic drug (AED) toxicity, must be identified and every effort made to eliminate it. Studies at St Piers Lingfield have shed light on these issues although the answers to many of the questions remain incomplete. Educational difficulty is among the factors that may affect behavior. However, there are many other causes for behavioral disturbance in the child with epilepsy. A specific framework for assessing the child with epilepsy and behavioral disturbance allows the cause or causes of the behavioral disturbance to be identified and managed in a rational way.