The association of seizures and behavior problems in children with new onset seizures was investigated in a prospective study of 224 children (aged 4-14 years) and 159 siblings (4-18 years) at Indiana University and Children’s Hospital Medical Center, Cincinnati, OH. Caregiver’s ratings of the behavior, based on the Child Behavior Checklist (CBCL) administered by telephone, were collected at baseline, and at 6 months, 12, and 24 months. During the 2-year period of follow-up, 163 (73%) children had at least one seizure recurrence, and 61 (27%) had none. In children with recurrent seizures, CBCL Total and Internalizing Behavior Problem scores on average were higher during seizure recurrence periods than when not experiencing recurrent seizures (p=0.041). Siblings had significantly lower Total and Internalizing Problem scores compared to patients either experiencing or not experiencing recurrent seizures. Externalizing Problems scores were not significantly different among children with or without recurring seizures, and siblings. Demographics and antiepileptic medication effects were controlled in these analyses. Both seizures and behavior problems may be caused by the underlying neurological disorder, the seizures per se may impair behavior, or children may have abnormal psychological responses to seizures. 
COMMENT. Children with recurrent seizures are at increased risk for behavior problems, even after correcting for possible effects of antiepileptic drug therapy.
Behavioral and emotional disorders are sometimes regarded as a form of epilepsy (see Progress in Pediatric Neurology III, PNB Publishers, 1997;pp70-71), but the concept of a behavioral epilepsy is controversial. In a multicenter Japanese study, a comparison of emotional and behavioral problems of 53 children having epileptiform EEGs and those of children without EEG abnormalities showed no significant differences. The authors concluded that the behavioral problems were coincidental.