The prevalence and nature of behavior problems among 224 children (ages 4 to 14 years) with epilepsy, in the six month period before the first recognized seizure, were studied at the Indiana School of Nursing, Indianapolis. Compared to their 135 healthy siblings, children with seizures had a higher than expected rate of antecedent behavior problems, with 32% in the clinical or at-risk range. Those with previous events suggestive of seizures had a 39% risk of behavior disorders before the first recognized seizure occurred. Children with seizures, especially boys, had higher scores than their siblings in total behavior problems, and in internalizing, attention, thought, and somatic complaints. Children with partial seizures showed higher rates of behavior problems than those with primary generalized epilepsy syndromes, regardless of previous seizures. Behavior problems are an integral component of epilepsy syndromes, and may occur independently and preceding the onset of clinical seizures. 
COMMENT. Behavior problems sometimes precede the onset of epilepsy and occur independently of seizures and anticonvulsant drugs. Children who develop partial seizures are at greater risk of antecendent behavior disorders than those with primary generalized epilepsy syndromes. The increased rate of attentional problems evident in the children with epilepsy in the above study, and especially in those with previous symptoms suggestive of seizures, provides support for the theory of transient cognitive impairment (TCI) associated with subclinical seizures (Ped Neur Briefs October 2000;14:74-75) [2, 3]. As reviewed in our October issue of Ped Neur Briefs, children with resistant complex partial seizures have more severe thought disorder and cognitive impairments than those with primary generalized epilepsy. 
In a recent study of BECTS at the Medical College of Georgia, Augusta, GA, of 22 children with centrotemporal spikes without clinical seizures, 31% had behavior problems and 17% had learning disabilities. So-called benign rolandic epilepsy may not be benign in neurodevelopmental outcome. 
Antiepileptic treatment of children with behavioral and attention disorders and epileptiform EEGs without clinical seizures is controversial and of questionable value (Ped Neur Briefs Oct 2000;14:74). On the positive side, an improvement in psychosocial functioning with AED treatment was correlated with reduction in subclinical EEG epileptiform discharges in 8 of 10 children . The opposite, negative results were reported following treatment of a group of 8 children with behavior disorders and EEG epileptiform discharges without clinical seizures; valproate had adverse effects on learning, memory, and behavior (Ped Neur Briefs Dec 2000;14:92) . The need for controlled studies of the effects of various AEDs on TCI and behavior in children with epileptiform EEGs without seizures is indicated.