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Objective To characterize neuropsychological and academic status in children, age 8-18 years, with new/recent-onset idiopathic generalized epilepsy (IGE) and idiopathic localization-related epilepsy (ILRE) compared with healthy controls. Study design Participants underwent neuropsychological assessment and parents were interviewed regarding their child’s academic history. Cognitive scores for children with epilepsy were age- and sex-adjusted and compared with controls across both broad-band (IGE n = 41 and ILRE n = 53) and narrow-band (childhood/juvenile absence, juvenile myoclonic, benign epilepsy with centro-temproral spikes, and focal [temporal/frontal/NOS]) syndromes. Academic histories were examined including problems antecedent to epilepsy onset and diagnosis. Results Children with new-onset epilepsies exhibit considerable cognitive abnormality at baseline including patterns of shared abnormalities across syndromes (e.g., psychomotor slowing) as well as unique syndrome-specific cognitive effects (eg, executive function in IGE and language/verbal memory in ILRE) that are observed and sometimes exacerbated in specific IGE and ILRE syndromes. Academic difficulties are evident in approximately 50% of the children with epilepsy, affecting all syndrome groups to an equal degree. Discussion Patterns of shared and syndrome-specific cognitive abnormalities and academic problems are present early in the course of virtually all epilepsy syndromes examined here, including syndromes classically viewed as benign. This is the base upon which the effects of recurrent seizures, treatment and psychosocial effects will be added over time.

Objective Benign epilepsy with centrotemporal spikes (BECTS), the most common focal childhood epilepsy, is associated with subtle abnormalities in cognition and possible developmental alterations in brain structure when compared to healthy participants as indicated by previous cross-sectional studies. To examine the natural history of BECTS, we investigated cognition, cortical thickness, and subcortical volumes in children with new/recent onset BECTS and healthy controls (HC). Methods Participants were 8–15 years of age, including 24 children with new onset BECTS and 41 age- and gender-matched HC. At baseline and two years later, all participants completed a cognitive assessment and a subset (13 BECTS, 24 HC) underwent T1 volumetric MRI scans focusing on cortical thickness and subcortical volumes. Results Baseline cognitive abnormalities associated with BECTS (object naming, verbal learning, arithmetic computation, psychomotor speed/dexterity) persisted over two years, with the rate of cognitive development paralleling that of HC. Baseline neuroimaging revealed thinner cortex in BECTS compared to controls in frontal, temporal, and occipital regions. Longitudinally, HC showed widespread cortical thinning in both hemispheres, while BECTS participants showed sparse regions of both cortical thinning and thickening. Analyses of subcortical volumes showed larger left and right putamens persisting over two years in BECTS compared to HC. Significance Cognitive and structural brain abnormalities associated with BECTS are present at onset and persist (cognition) and/or evolve (brain structure) over time. Atypical maturation of cortical thickness antecedent to BECTS onset results in early-identified abnormalities that further continue to abnormally develop over time. However, cognition appears more resistant to further change over time compared to anatomical development.