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Abstract Over the past years, syndrome-oriented clinical and EEG diagnosis, and better etiological diagnosis, especially supported by neuroimaging, has helped to clarify the diversity of epilepsy in children, and has improved management. Knowledge of the cause and pathophysiology of childhood epilepsy has considerably improved with modern neuroimaging and molecular genetic studies. However, our understanding of the causes and the reasons why specific syndromes appear with precise agerelatedness is still very limited. Children with long-standing epilepsy have behavior problems at rates almost five times higher than that of the general population, and studies investigating children with new-onset epilepsy showed that behavior problems occur early in the course of the disorder and, in some children, even precede seizure onset. A number of risk factors for behavior problems in children with epilepsy have been identified, but many inconsistencies are observed, including patient status and family variables. Cognitive dysfunction is frequently encountered in children with epilepsy. This can be present soon after seizure onset and seen even in preschool children. While these cognitive impairments are common in the severe symptomatic epilepsies of childhood, they are also seen in benign conditions such as & Summary 109 BECTS, benign occipital lobe epilepsy and childhood absence epilepsy. In these “idiopathic” or “benign” childhood epileptic syndromes, normal cognition was previously considered a prerequisite for diagnosis. There is growing evidence of disturbance in language processing, visual perception, visuospatial skills, short-term memory, psychiatric status and general cognitive functioning in children with epilepsy. The establishment of routine cognitive monitoring of pharmacological antiepileptic therapies seems to be a feasible and promising approach to improve the medical care of patients with epilepsy. Having been established as an essential tool for the monitoring of invasive treatments of epilepsy, it is about time that neuropsychological methods find their way into routine care of pharmacologically treated patients with epilepsy. In this regard, future studies will have to demonstrate that this form of neuropsychological outcome and quality control is a useful tool to direct treatment decisions thereby leading to beneficial outcomes for the patient. Sleep and epilepsy are intimately related, with mutual and reciprocal interactions. Epilepsy can affect the quantitative and qualitative profiles of sleep in patients with complex partial seizures. It also modifies the sleep architecture in patients with temporal lobe seizures. Polysomnographic studies showed that there was a significant reduction in the duration of rapid eye & Summary 110 movement (REM) sleep in the absence of seizures during the nocturnal period. While sleep or sleep deprivation may result in deteriorating seizure control, seizures, as well as the interictal state and AED therapy, may have profound effects on sleep. Moreover, the relationship between epilepsy, sleep disorders, and quality of life is intriguing. from the overlapping features of NFLE and parasomnias to the role of OSA in refractory epilepsy and SUDEP and the settled role of sleep in memory dysfunction in epilepsy, there remain many unanswered questions. Diagnosis based on careful history and neurologic examination, laboratory studies, screening for other etiological processes should be done. Using neurophysiological and neuroimaging studies help to determine whether an epileptic syndrome is present, to guide the nature and extent of the evaluation, treatment, and prognosis. Cognitive and sleep problems also should be evaluated properly along with other neuropsychiatric co-morbidities of epilepsy in order to prevent the negative sequelae of those comorbidities and their negative impact on the epilepsy itself. The management of epilepsy in childhood is challenging both in terms of its recognition and diagnosis, and also in terms of selecting the most appropriate treatment approach, since - uniquely in the pediatric patient - this has implications not only for the individual’s current health status, & Summary 111 but also, potentially, for their longer-term development. Children with epilepsy have many unmet needs. Clinicians must not target them as young adult with same disease. Accurate diagnosis is crucial in order to ensure that the correct type of treatment is used, and also to guide prognosis and help inform treatment expectations. |