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Learning disabilities and epilepsy often occur together. Each in its own right and in association with the other can present significant management challenges. Many of these challenges are psychological, social or educational in nature. They require a detailed assessment and regular review and monitoring. Some of the difficulties that will be encountered are communication problems, which can make accurate assessment and formulation difficult. Behavioural problems which are easily mis-attributed to one or other of the conditions are also common. Effective management will require a close collaboration between carers, the primary care team and specialist services, amongst whom knowledge and information must be exchanged. When balancing the need for seizure control with a patient's need for quality of life, it must not be assumed that the health professionals' views will necessarily be the same as those of the patient or the patient's family. Two case histories which illustrate these problems are presented.