Neuropsychological function and quantitataive volumetric measurement of grey and white matter of cerebrum were determined in 53 children (ages 8-18 years) with recent-onset idiopathic epilepsy and compared to controls in a study at University of Wisconsin, Madison. Children with recent-onset epilepsy have mild diffuse cognitive impairment, regardless of epilepsy syndrome. In a subset of children, academic difficulties antedated the first seizure and were present at time of diagnosis. Children with a history of academic problems at onset of epilepsy have the most impaired cognition and also, significant volumetric reductions in the left occipital and parietal lobe grey matter. In contrast, in the epilepsy group as a whole, no overall differences in magnetic resonance morphometric analyses of total cerebral or lobar volumes were recognized. 
COMMENT. Evaluation of neuropsychological function is an important aspect of epilepsy management in children. It is disturbing to find that academic difficulties may antedate the onset of epilepsy and can be associated with significant reductions in grey matter, specifically in the left occipital and parietal lobes. The mechanisms of these epilepsy related neuropsychological and cerebral volume disorders remain to be determined. The seizures per se and/or adverse effects of antiepileptic medications are not the only factors responsible for academic difficulties among children with epilepsy, and preexisting developmental cerebral abnormalities may be more important causes.