Neurophysiological mechanisms by which epilepsy may interfere with learning ability are reviewed from the Department of Clinical Neurophysiology, Mauds ley Hospital, and Department of Psychology, Middlesex Hospital, London, England. Five mechanisms are listed: 1) Disruption of ongoing processing by epileptiform activity that interferes with attention to incoming information, its storage or retrieval; 2) disruption of storage and retrieval of information by discharges temporally distant from the learning experience; 3) permanent damage to neural tissue; 4) antiepileptic drug toxicity; 5) disruption of brain function by chronic frequent discharges during sleep. Subclinical generalized spike wave discharges may be accompanied by transitory cognitive impairment demonstrable by psychological testing during EEG recording. Left-sided focal spiking produces errors on verbal tasks whereas right-sided discharges impair handling of non-verbal material. Subclinical discharges may disrupt educational skills in children and impair driving performance in motorists. Suppression of discharges by antiepileptic drugs may improve psychological functioning. Spike wave monitors may find a place in special schools to alert teachers to a child’s absence attacks. [1]

COMMENT. The above article is the first in a report of the Symposium on Epilepsy and Education at the XVIIIth International Epilepsy Congress, New Delhi, India, October 1989. Other reports in this Epilepsia supplement include references to epileptic syndromes and cognitive functioning (Dam M) ; effects of antiepileptic drugs (Trimble MR); the EEG in assessing cognitive function (Stores G) ; and the effects of discontinuation of antiepileptic drugs on cognition (Blennow G et al). Community based studies in the United Kingdom have shown that up to 30% of children with epilepsy underachieved in school and many are referred for special education.