Epilepsy is the most common pediatric neurological disorder, with a prevalence of approximately 0.5%-1%. Despite the introduction of more than 10 new generation antiepileptic drugs in the last decade, epilepsy treatment remains challenging. Approximately 30% of patients who are treated still have recurrent seizures. Among these, the co-occurrence or co-morbidity of epilepsy can then directly affect epilepsy and its treatment. Likewise, epilepsy and antiepileptic drugs can affect epilepsy co-morbidities. It is common for epilepsy to be accompanied by other disorders, developmental disorders, or psychological disorders, and at least 1/3 of children with epilepsy have a combination of other disorders/disorders. The following causes occur: (1) epilepsy with co-morbidities of the same origin (e.g., frontal lobe injury); (2) convulsions or seizures resulting in sequelae of convulsive brain injury; (3) side effects of antiepileptic drugs (AEDs); (4) poor parenting and environmental influences; and (5) genetic and congenital factors. There are differences in epilepsy co-morbidities between children and adults due to the developing nature of various body systems, including the central nervous system. Child-specific epilepsy co-morbidities include attention deficit hyperactivity disorder (ADHD), pervasive developmental disorder, cerebral palsy, and mental retardation. The co-morbidities of epilepsy in both children and adults are accidental injury, migraine, sleep disorders, movement disorders (manifested mainly by involuntary movements), psychiatric abnormalities (including mood disorders, affective disorders, dysthymia, conduct disorder, oppositional defiant disorder, and conduct disorder), and physical developmental abnormalities (including osteoporosis, obesity, and hypothyroidism). This article focuses on pediatric epilepsy and its co-morbidities: 1. Attention deficit hyperactivity disorder (ADHD): the core symptoms are attention deficit, hyperactivity, and impulsivity. ADHD is divided into three subtypes: attention deficit-oriented, hyperactive/impulsive-oriented, and mixed. The prevalence of ADHD in children with epilepsy is about 8-77%, which is significantly higher than that in school-age children. 2. Pervasive developmental disorder: a group of comprehensive mental developmental disorders that start in infancy and early childhood. The main manifestations are: (1) abnormal interpersonal and communication patterns, such as: verbal and non-verbal communication disorders; (2) limited, stereotyped and repetitive interests, activities and behavioral content; (3) communication and emotional disorders. It includes autism, pervasive developmental disorder without other features, Asperger’s syndrome and Rett’s syndrome. 8-28% of patients with autism have epilepsy. This prevalence is significantly higher than co-morbidities such as cerebral palsy or severe mental retardation. Some specific types of epilepsy syndromes also have a higher prevalence of co-occurring autism: about 6-23% of Asperger syndrome and >83% of Rett syndrome are associated with recurrent seizures, severe developmental delays and autism-like disorders. A retrospective study by Hollander et al. showed that in 14 children with epilepsy co-morbid with autism treated with divalproex sodium, symptoms of autism improved in 10 of them. 3. Cerebral palsy (CP): This is a non-progressive brain injury caused during the developmental period from before birth to 1 month after birth, and its main manifestations are central motor deficits, reflexes and postural abnormalities. CP occurs in approximately 15-38% of children with epilepsy. CP coexists with epilepsy and varies with the type of CP suffered. The spastic type has a higher rate of epilepsy co-morbidity than the involuntary movement type. The prevalence of epilepsy was higher in children with severe and multiple developmental disorders. The incidence of epilepsy is twice as high in children with both CP and mental retardation than in children with only CP or mental retardation. Mental retardation (MR) is a group of syndromes in which mental development is incomplete or impaired, characterized by mental retardation and social adjustment difficulties. The onset of the disease is before maturity (before 18 years of age), the child has a lower than normal intelligence level, IQ <70-75 points, with more than moderate social adaptation difficulties. The prevalence of epilepsy varies with the severity of MR. Symptomatic epilepsy and MR often have the same etiology and occur as a result of underlying brain injury. Symptomatic epilepsy is 10 times more likely to be associated with MR than primary epilepsy [6]. 5. Sleep disorders: the importance of good sleep should not be underestimated, as it is very important for improving learning and memory capacity. Sleep disorders and fatigue can cause cognitive dysfunction, decreased academic performance and difficulty in seizure control. The prevalence of sleep disorders in patients with epilepsy is about 28-56%, which is two times higher than that of the general population. Sleep disorders include prolonged sleep latency, increased awakenings, and prolonged phase 1 and phase 2 sleep. These conditions are more likely to occur in patients with generalized, frequent seizure-refractory epilepsy. Sleep deprivation has been shown to cause seizures and interictal epileptiform discharges in 30-50% of patients. In addition, patients with epilepsy often present with certain specific sleep disorders. About 10% of patients with epilepsy and 1/3 of patients with refractory epilepsy have sleep apnea, and other sleep disorders include periodic limb movements, ictal sleep disorder, nocturnal epilepsy, and sleep deprivation syndrome. It has been well documented that control of sleep disorders, especially sleep apnea, is beneficial to the treatment of epilepsy and improves patient alertness during the day. 6. Migraine: Migraine is more common in children, and the frequency of attacks increases with age. The literature reports that the prevalence of migraine in children: 3-7 years old is 3%, 7-11 years old is 4-11%, and 11-15 years old is 8-23%. The average age of onset is 7,2 years for boys and 10,9 years for girls. The relationship between migraine and epilepsy is complex. Because many of the symptoms overlap, it is easy to confuse the two at the time of diagnosis. In about 1/3 of patients with epilepsy, the headache can occur an hour before or after the seizure. Epilepsy-related headaches are more persistent and severe than other postictal symptoms, and 40-70% of patients have photophobia, nausea, and palpitations. The prevalence of migraine is two times higher in patients with epilepsy than in the general population. Two of the benign childhood epilepsies (benign childhood epilepsy with central-temporal spikes, and occipital lobe epilepsy) are closely associated with migraine. In addition, some children with migraine have an EEG similar to that of benign childhood epilepsy described above, despite the absence of seizures. There are also a few reports in the literature that migraine can induce seizures. 7. Accidental injuries: Accidental injuries are more common in children with epilepsy. In particular, children with typical aphasic seizures have a significantly higher incidence of unintentional injuries (24,6 per 100 person-years) than other chronic conditions (18,7 per 100 person-years). These unintentional injuries include drowning, falls, etc. The incidence of drowning in children with epilepsy is 7,5-13,9 times higher than in the general population. The incidence of bone fractures is 2 times higher than in the general population, and it is caused by seizures or long-term use of AEDs, resulting in reduced bone density. Frequent seizures, persistent epilepsy and co-occurring attention deficit or cognitive dysfunction increase the risk of accidents. 8, obesity: Chinese school-age children's health survey: from 1985 to 2000, overweight children aged 7-18 years old increased 28 times, and obese children increased 4 times. 44,880 children aged 7-18 years old surveyed, overweight children accounted for 4,5%, and obese children accounted for 2,1%. In the case of children with epilepsy, AED-related obesity should also be taken seriously. Studies have shown that after taking valproate (VPA) or carbamazepine (CBZ), 50% and 25% of epilepsy patients can have different degrees of weight gain, respectively. 9. Bone disease: Childhood and adolescence are critical stages of bone mineralization. Poor bone mineralization increases the incidence of pathological fractures and osteoporosis in adulthood. Epilepsy in children can affect bone health in many ways. These include: recurrent seizures or secondary epilepsy combined with cerebral palsy, which limits physical activity, and AEDs themselves, which affect bone health. Long-term clinical observations have shown that the use of PHT and PB is associated with rickets, and experiments have also demonstrated that CBZ and VPA cause abnormal bone metabolism, decreased bone density, and decreased bone turnover (mainly reduced bone formation), while inadequate calcium intake and high body mass index are predisposing factors that exacerbate bone abnormalities. BMD was measured in 35 age-matched healthy children. The number of children with low BMD was 32 (35%) among children with epilepsy, which was significantly higher than that of the control group (14%), and the duration of medication was negatively correlated with BMD. 10, mood disorders: refers to anxiety, fear, compulsion, shyness, sadness and other emotional abnormalities that start in childhood. It is more common in school-age and adolescent female children with epilepsy. 1) Depression: The prevalence of depression in patients with epilepsy is 3-10 times higher than in the general population. This is associated with neurobiological, medical and psychosocial factors. In a study by Harris and Barrowclough et al. the suicide rate was found to be 5 times higher in patients with epilepsy than in the general population and 25 times higher in patients with complex partial epilepsy of temporal lobe origin. In patients with refractory epilepsy, the prevalence of depression was as high as 55%, whereas in patients with controlled epilepsy, the prevalence of depression was reduced to 9%. 2) Anxiety: Anxiety disorders are the most common childhood mood disorder, and the prevalence of anxiety in children with epilepsy is about 3-50%. Anxiety can be experienced as a precursor to seizures, as a symptom during or after seizures, or as a negative effect of AEDs or the presence of a disorder independent of epilepsy. The prevalence of anxiety is higher in adolescents with epilepsy than in young children. The prevalence of anxiety is higher in children with refractory epilepsy and in children with epilepsy treated with a combination of AEDs. Understanding the relationship between anxiety and epilepsy requires a combination of seizure and AEDs treatment. Anxiety can serve as a precursor to seizures or as a postictal symptom. Seizure fear is associated with complex partial seizures of temporal lobe origin. Panic attacks are easily confused with complex partial seizures. The presence or absence of automatism and loss of consciousness are key to distinguish between the two. In addition, anxiety and nervousness are associated with the use of AEDs such as felbamate, topiramate and withdrawal of AEDs [17]. 11, Behavioral and psychological disorders: refers to the inability to act in a socially appropriate manner such that the consequences of their behavior are inappropriate for themselves or society. The prevalence of behavioral abnormalities in children with primary and secondary epilepsy was 28,6% and 58,3%, respectively, according to an epidemiological survey by Rutter et al. The prevalence of behavioral abnormalities in the general population of children was only 6.6%. Similar epidemiological findings were obtained by Davies et al. in children with primary and secondary epilepsy, with prevalence rates of 26, 2% and 56%, respectively. Their data also showed that 37% of children with epilepsy had psychological disorders compared to 9% of controls. 12. Other co-morbidities of epilepsy: central nervous system infections, craniocerebral trauma, febrile convulsions, etc. Co-morbidities are often overlooked in the diagnosis and treatment of epilepsy. Timely and adequate treatment of epileptic co-morbidities can improve epilepsy treatment. For example, depression is strongly associated with health-related quality of life (HRQOL). Treating co-morbid depression in epilepsy can significantly improve HRQOL in patients with epilepsy.Therefore, understanding epilepsy and epilepsy co-morbidities, exploring the relationship between epilepsy and co-morbidities, studying proper parenting practices, and implementing early intervention and rehabilitation for co-morbidities as early as possible are essential for optimal management of children with epilepsy. This requires the intervention and continuous efforts of neurology, clinical psychology, developmental pediatrics/behavioral pediatrics, neurorehabilitation, and other related specialties.