Eighty percent of children with active epilepsy in Sussex Schools, UK, who underwent psychological evaluation had a DSM-IV-TR behavioral disorder and/or cognitive impairment (IQ <85). Intellectual disability (ID) (IQ <70) (40%), ADHD (33%), and ASD (21%) were the most common neurobehavioral diagnoses, and only one-third had previously been diagnosed. Seizures in the first 24 months, generalized seizures, status epilepticus, and polytherapy were independently associated with ID, and ID was associated with a diagnosis of ASD. Epilepsy-related factors (e.g. age of onset, seizure frequency) did not independently predict behavioral disorders, suggesting that seizures per se are not the cause of behavioral problems. [1]

COMMENTARY. The identification of neurobehavioral comorbidities might lead to improved methods of control of both seizures and their associated behavioral disorders. As an example, the use of methylphenidate (MPH) for the management of co-morbid ADHD may be associated with improved control of both seizures and ADHD. The addition of MPH is reported safe in children with ADHD and epilepsy whose seizures are controlled with AEDs [2]. Caution is advisable in the use of stimulants in cognitively impaired hyperactive children whose seizures are AED refractory [3].