It is hard to tell how common such problems are, since there are biases in all studies. Children with psycho-social problems are far more likely to be identified and included in studies than those without problems. Also, children with continuing seizures are more likely to be identified than the 80 percent whose seizures are completely controlled or outgrown.Whatever the true incidence, such problems are sufficiently common that they should be monitored. Problems with learning and even with retardation are usually caused by brain injury rather than the seizures themselves. Learning problems, as well as hyperactivity and behavioral problems, may be caused by medication. Close monitoring of your child’s school performance should be your responsibility and if you have concerns, you should discuss them with your physician.Depression is not uncommon in children. It may be hard to identify. Symptoms of depression include sleep disturbances, school problems, fatigue or listlessness, lack of enthusiasm, easy crying, and irritability, among others. Depression can be due to medication, particularly phe-nobarbital. But depression also may be a consequence of a child’s or family’s reaction to the seizures and their treatment. If you are concerned about these problems, you should discuss them with your doctor. Early identification of depression can lead to earlier help.In general, psycho-social problems are sufficiently common in children with epilepsy that families and physicians should be alert to them. Preventive discussions with members of the family and the school may avoid problems and permit early identification. Psycho-social problems should not be allowed to become a handicap.*216\208\8*

Epilepsy is a clinical diagnosis based on a detailed description of events. There is no single test which can always make, or exclude, a diagnosis of epilepsy. Moreover, as also explained in earlier chapters, epilepsy is not a single condition. There are many different types of epilepsy, and there are many different causes of epilepsy. Investigations may be useful to:

• add weight to, or support the clinical diagnosis of epilepsy;

• help ‘classify’ the type of epileptic seizure and epilepsy syndrome. This is important in predicting the likely outcome of the epilepsy in a given individual, and the treatment that should be used; and

• help detect or find a cause for the epilepsy.

The main investigations which may be used in epilepsy are the electroencephalogram (EEG) and brain imaging techniques, most commonly computerized tomographic scanning (CT scanning) or magnetic resonance imaging (MRI). Other investigations such as X-rays, blood tests, lumbar puncture (spinal tap), or tissue biopsy are much less commonly undertaken.

*47\188\2*