Cognitive and behavioural comorbidities are prevalent in childhood and adult epilepsies and impose a substantial human and economic burden. Over the past century, the classic approach to understanding the aetiology and course of these comorbidities has been through the prism of the medical taxonomy of epilepsy, including its causes, course, characteristics and syndromes. Although this ‘lesion model’ has long served as the organizing paradigm for the field, substantial challenges to this model have accumulated from diverse sources, including neuroimaging, neuropathology, neuropsychology and network science. Advances in patient stratification and phenotyping point towards a new taxonomy for the cognitive and behavioural comorbidities of epilepsy, which reflects the heterogeneity of their clinical presentation and raises the possibility of a precision medicine approach. As we discuss in this Review, these advances are informing the development of a revised aetiological paradigm that incorporates sophisticated neurobiological measures, genomics, comorbid disease, diversity and adversity, and resilience factors. We describe modifiable risk factors that could guide early identification, treatment and, ultimately, prevention of cognitive and broader neurobehavioural comorbidities in epilepsy and propose a road map to guide future research.

认知和行为合并症在儿童和成人癫痫中普遍存在，并造成巨大的人力和经济负担。在过去的一个世纪里，了解这些合并症的病因和病程的经典方法是通过癫痫医学分类的棱镜，包括其病因、病程、特征和综合征。尽管这种“病变模型”长期以来一直是该领域的组织范式，但从神经影像学、神经病理学、神经心理学和网络科学等不同来源积累了对该模型的实质性挑战。患者分层和表型分析的进展指向癫痫认知和行为合并症的新分类法，这反映了他们临床表现的异质性，并提高了精准医学方法的可能性。正如我们在这篇综述中讨论的那样，这些进展正在为修订的病因学范式的发展提供信息，该范式结合了复杂的神经生物学措施、基因组学、合并症、多样性和逆境以及恢复力因素。我们描述了可改变的风险因素，这些因素可以指导早期识别、治疗并最终预防癫痫的认知和更广泛的神经行为合并症，并提出了指导未来研究的路线图。和弹性因素。我们描述了可改变的风险因素，这些因素可以指导早期识别、治疗并最终预防癫痫的认知和更广泛的神经行为合并症，并提出了指导未来研究的路线图。和弹性因素。我们描述了可改变的风险因素，这些因素可以指导早期识别、治疗并最终预防癫痫的认知和更广泛的神经行为合并症，并提出了指导未来研究的路线图。