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Both cognitive and behavioral problems are common in people with epilepsy. State-dependent cognitive impairment is potentially reversible and treatable. People having frequent absence seizures may present as having withdrawn behavior, fragmented thought processes which may be mistaken for a psychosis, attention-deficit disorder with motor over activity, or, if the frequency of the seizures is variable, attention seeking behavior. It is important to be aware of the possibility of reversible, state-dependent cognitive impairment in an individual who is in a constant postictal state from frequent seizures. Reducing the seizure frequency can improve cognitive function markedly. It has become evident that a number of children who present with markedly autistic features have unsuspected epileptiform discharges either during the day or at night. If frequent epileptiform discharges are found in association with cognitive or behavioral problems then early, energetic treatment should be initiated.
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