Reading performance in Egyptian children with idiopathic epilepsy

Background Idiopathic epilepsy is often considered mild, yet affected children may experience cognitive and language difficulties, including reading deficits. This study aimed to assess reading abilities and associated cognitive-linguistic skills in Egyptian children with idiopathic epilepsy, and to explore associations between epilepsy-related characteristics and Arabic literacy outcomes. Methods This cross-sectional study included 60 Egyptian children aged 6 years 6 months to 9 years 6 months with idiopathic epilepsy and normal intellectual functioning (IQ > 85). Exclusion criteria included intellectual disability, hearing loss, ADHD, autism spectrum disorder, or other neurological conditions affecting learning. Reading and cognitive-linguistic skills were assessed using eight subtests of the Modified Arabic Dyslexia Screening Test (MADST), measuring phonological processing, rapid naming, working memory, reading fluency, and decoding. Results Three-quarters (75.0%, n = 45) scored below the 25th percentile (at-risk range) on one-minute reading fluency, 66.7% ( n = 40) on phonemic manipulation, and 76.7% ( n = 46) on verbal fluency. After adjusting for age, sex, and total IQ, polytherapy was independently associated with poorer one-minute reading (β = − 9.12, P = 0.002), phonemic manipulation (β = − 2.47, P = 0.005), backwards digit span (β = − 0.95, P = 0.007), pseudoword reading (β = − 1.89, P = 0.013), real-word reading (β = − 6.78, P = 0.015), and semantic fluency (β = − 2.34, P = 0.011). Earlier age at onset correlated with reduced reading fluency ( r = − 0.28, P = 0.031), while longer epilepsy duration was associated with better fluency ( r = 0.31, P = 0.017). No significant differences were observed across epilepsy syndrome types ( P > 0.05). Conclusions Egyptian children with idiopathic epilepsy showed high rates of below-threshold performance on reading-related and cognitive-linguistic measures. Polytherapy was the most robust correlate of poorer outcomes, though causality cannot be inferred from this cross-sectional design. These preliminary findings suggest that systematic literacy screening may be warranted in routine pediatric epilepsy care, with particular attention to children on multiple antiseizure medications.