Neuropsychological functioning and academic achievement were determined at the time of the first seizure in a prospective study of 282 children (ages 6-14 years, with IQ >70) and compared with 147 healthy siblings examined at Indiana University, Case Medical Center, and Cincinnati Children's Hospital. Children with seizures scored lower than siblings on all neuropsychological tests, especially involving attention/executive/construction, but academic achievement was unaffected. Neuropsychological deficit was exhibited by 27.4% of children with seizures vs 18.2% of healthy siblings (p=0.04). Almost twice as many with seizures showed deficits in attention/executive/construction, verbal memory and learning, language and processing speed. Only symptomatic/cryptogenic seizure etiology was a risk factor for cognitive deficit. Children taking valproic acid scored lower for processing speed vs no-AED group (p=0.009). Among children with seizures, those on AEDs performed worse than no-AED group on all neuropsychological factors, but not on academic achievement. EEG epileptiform activity was associated with slower processing speed (p=0.004) but not with academic achievement. Risk factors for cognitive deficits were multiple seizures, AEDs, symptomatic/cryptogenic etiology, and epileptiform activity on initial EEG; a child with all 4 risk factors is 3 times more likely than healthy siblings to have neuropsychological deficits by the first clinic visit. Absence epilepsy was an added risk factor. 
COMMENT. Children identified with a first seizure exhibit neuropsychological deficits in 27% cases. In those with risk factors, up to 40% have cognitive deficits. Children with multiple seizures, symptomatic/cryptogenic seizure etiology, those on AEDs, or with epileptiform discharges on the initial EEG should be referred for neuropsychological and educational evaluation.