• Review;
  • Children;
  • Attention;
  • Epilepsy;
  • Antiepileptic drugs;
  • ADHD;
  • Hyperactivity;
  • Behavior

Summary:  Attention problems are frequently seen in children with epilepsy. This review gives an overview of the most used constructs of attention and analyzes the available evidence for attention deficits in children with epilepsy, the effects of epilepsy variables on attention, and the possible pathophysiological mechanisms involved. Children with benign childhood epilepsy with centrotemporal spikes (BCECTS) have sustained attention difficulties. Right (R)-sided interictal epileptiform activity in these children interferes with R hemisphere function including sustained attention. Children with BCECTS also show selective and divided attention deficits if they have epileptiform discharges during sleep. Children with complex partial seizures (CPSs) have sustained attention deficits but no difficulties in selective or divided attention. Cognitive difficulties in children with epilepsy arise more frequently the earlier the onset of the epilepsy, and this could influence attentional ability development. Antiepileptic drug treatment is unlikely to impair attention, but phenobarbital has behavioral side effects similar to those in attention deficit–hyperactivity disorder. Concerning pathophysiology, evidence indicates that interictal epileptiform activity in children with BCECTS impairs sustained attention and that ongoing epileptiform discharges during sleep may impair attention. Further systematic studies of different aspects of attention in children with epilepsy are needed. Attention in children with drug-resistant epilepsy has not been addressed, and prospective studies before and after epilepsy surgery could be a useful model to study the influence of seizures on attentional ability.