There is evidence that seizures, mental and behavioral health problems, and neurodevelopmental disorders often have similar underlying pathologies, suggesting that epilepsy is a spectrum disorder. An estimated 45% to 50% of people with epilepsy also have a cognitive or psychiatric diagnosis.12, 24 In some studies, both psychiatric diagnoses and subtle cognitive impairment preceded the development of seizures.25 Approximately 30% of adults with epilepsy have depression, anxiety, or both.26 In a large population-based cohort study, cognitive dysfunction was diagnosed in 55%, 26%, and 9% of nearly 65,000 people with epilepsy who were ages five or younger, six to 18, and 19 to 34, respectively.26 Although the prevalence of autism spectrum disorder was 1.3% in people with epilepsy in this study, 75% of those who had the condition were children and adolescents, representing a prevalence of 4.3% for people with epilepsy under age 18.26 Similarly, the association between epilepsy and attention deficit–hyperactivity disorder (ADHD) was strong. The overall prevalence of ADHD among people with epilepsy was 3.4%, but in those ages 18 and younger it was 12.8%. Even children with epilepsy who have no severe cognitive deficits often have subtle but diffuse deficits in memory, attention, processing speed, and other domains.

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