Highlights Cognitive impairment is a major comorbidity of temporal lobe epilepsy (TLE). Three discrete cognitive phenotypes of TLE are identified here. The phenotypes are linked to network, clinical, and socioeconomic characteristics. This taxonomy advances clinical and theoretical understanding of the cognitive complications of TLE.

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Objective-To identify cognitive phenotypes in children with new onset focal and generalized idiopathic epilepsies and determine their relationship with epilepsy syndrome, brain structure, neurodevelopmental history and family characteristics.Methods-138 children with new onset epilepsy and 95 controls (age 8-18) underwent neuropsychological, clinical and quantitative MR evaluations. Control participants' neuropsychological data were subjected to confirmatory factor analysis with resultant factor scores then applied to epilepsy participants and subjected to latent class analysis. Identified cognitive phenotypes were examined in relation to epilepsy syndrome, quantitative neuroimaging, familial and neurodevelopmental variables.Results-Confirmatory factor analysis identified five cognitive factors (verbal, perceptual, speed, attention, executive) and latent class analysis identified three clusters of epilepsy participants: 1) average and comparable to controls, 2) mild impairment across multiple cognitive domains, and 3) impairment across all domains with severe attentional impairment, representing 44%, 44% and 12% of the epilepsy sample respectively. Cognitive phenotype membership was not associated with epilepsy syndrome but was associated with increasing abnormalities in brain structure, parental IQ and features of early developmental history.Significance-Cognitive phenotypes are present in idiopathic childhood epilepsies that are unassociated with traditional epilepsy syndromes, but are associated with measures of brain structure, family history and neurodevelopmental features.

The PedsQL Epilepsy Module is a reliable measure of HRQOL with strong evidence of its validity across the epilepsy spectrum in both clinical and research settings.