Thirty-four adolescents with epilepsy, controls matched for age, sex, and general ability, were studied at the University Hospital, Cardiff, Wales. Adolescents with epilepsy had more difficult behavior in class, competitive sports were less popular and comprehension of reading material was significantly lower than that of control groups. The lowest reading scores were found in adolescents with myoclonic seizures, partial seizures with secondary generalization, or generalized tonic-clonic seizures. The low reading scores were also correlated with the EEG findings including 2 per second spike and wave, photosensitivity, generalized slow waves, or nonspecific generalized spike and wave. Problems in reading comprehension correlated with right focal slow wave, sharp waves, and spikes.

The effects of anticonvulsants on reading and behavior were also investigated. Higher reading scores were seen with ethosuximide and lower scores with benzodiazepines. The Rutter Behavior Scale was significantly higher in patients taking phenytoin indicating less good behavior in this subgroup. The lowest Rutter score occurred in the ethosuximide patients. [1]

COMMENT. This study shows that adolescents with epilepsy can attend school and lead full lives but they may have problems with comprehension of reading material and with behavior. The value of the EEG in predicting poor reading ability has been demonstrated and the recognition of localized cerebral lesions by MRI would be of additional interest. Correlations of the behavior and reading ability with degree of seizure control and efficacy of anticonvulsants might be pertinent.

A follow-up study of intractable seizures in childhood is reported by Huttenlocher PR and Hapke RJ [2] from the University of Chicago. There were no clear outcome differences related to seizure type except for a slightly worse prognosis in children with predominantly myoclonic seizures. A major finding of this study was the association between intractable seizures in childhood and mental retardation. The assumption that either seizures themselves or the anticonvulsant drugs may depress intelligence has prompted an increased interest in the effects of surgical treatment early in life. However, the reports of improvement in cognition after surgery are not well documented.