Several articles in this issue reinforce Aicardi's dictum that in epilepsy, seizures are only the tip of the iceberg. They remind us that epilepsy is a symptom of a brain disorder and that children with epilepsy can have extra needs that may or may not be due to the epilepsy itself. Rightly, there has been increasing emphasis that proper medical management encompasses more than ‘just’ seizure control. Quality of life measures in childhood epilepsy are still not perfect, but they suggest only a moderate association with seizure control. Social inclusion, lifestyle restrictions, effects on family life, associated physical impairments, learning and/or behaviour difficulties, and unwanted effects from treatment are all recognized as major factors, as well as seizure frequency and severity. More recently we are finding how prevalent attentional difficulties, including attention-deficit–hyperactivity disorder, are in children with epilepsy and the importance of sleep problems.
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