Children are more susceptible to epilepsy than adults and are more likely to have cognitive dysfunction. The main manifestations of cognitive dysfunction in childhood are cognitive delay (reduced IQ and impairment in all aspects of cognitive function) and learning disability (essentially normal IQ and impairment in some aspect of cognitive function). Memory loss is the most common symptom of cognitive impairment in patients with epilepsy, followed by distractibility, slowed thinking, speech impairment, and reduced vocational skills. Temporal lobe epilepsy is more prone to cognitive impairment, especially if the lesions are located on both sides. Left temporal lobe lesions are associated with verbal memory loss and language impairment, while right temporal lobe lesions may lead to nonverbal memory impairment. The effect of seizures on cognition. The presence of cognitive impairment during seizures is considered an inherent feature of complex partial seizures, which can lead to memory and executive function decline but have little effect on intelligence. Generalized tonic clonic seizures affect all aspects of cognitive level. Symptomatic epilepsy is more likely to affect cognitive function than idiopathic epilepsy. In addition, age at onset, seizure frequency and duration are important factors affecting cognitive function. Different epilepsy syndromes affect cognition differently, e.g., infantile spasms or Lennox-Gastaut syndrome generally have mental decline, whereas adolescent myoclonic epilepsy rarely affects intelligence. The effect of abnormal discharges on cognition. In the absence of clinically significant seizures, the abnormal discharges presented by EEG monitoring also have an effect on cognitive function. The cognitive impairment caused by abnormal discharges is selective and may be related to the function associated with the focal site of the abnormal discharge and nearby areas of the brain, such as acquired aphasia syndrome (LK syndrome), and epileptic syndromes with persistent spike-and-slow wave discharges in slow-wave sleep (CSWS), both of which can have severe cognitive impairment without clinical seizures. Effect of antiepileptic drugs on cognition. Some AEDs have effects on cognitive function, including phenobarbital, phenytoin sodium, clonidine, and topiramate.AEDs primarily affect attention, alertness, psychomotor, and thus other cognitive functions such as memory. Moreover, AEDs are more likely to affect cognitive function in some specific populations, such as children, the elderly, and fetuses. This drug-induced cognitive impairment is reversible when the appropriate medication is discontinued. Epilepsy and psychobehavioral abnormalities. Between 10% and 30% of patients with epilepsy have significant psychobehavioral abnormalities, mostly manifested as depression, anxiety and other mood changes such as epileptic personality, schizophrenia-like psychosis, neurosis, and intellectual decline. Psychosomatic aspects of epilepsy are more prominent in patients with normal cognitive level of epilepsy. Depression is the most common complication in patients with epilepsy, causing a significant increase in the suicide rate in epileptic patients. Epileptic personality is mainly characterized by stubbornness, irritability, emotional outbursts, delayed behavior and self-centeredness, and about 50% of personality changes are seen in patients with temporal lobe epilepsy.