To determine school performance and psychiatric comorbidity in juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and generalized tonic–clonic seizures (GTCS) alone.

Despite the general agreement that idiopathic generalized epilepsy syndromes are not severe progressive epileptic syndromes, cognitive dysfunction, social problems and psychiatric comorbidities are frequent. However, most studies focus on these outcomes in JME, and school performance has not been extensively studied in idiopathic generalized epilepsy.

All children (< 18 years) fulfilled International League Against Epilepsy criteria after review of their medical records. Control groups were the pediatric background population or children with non-neurological chronic disease. Outcomes were on school performance and psychiatric comorbidity. We compared mean grade point averages using linear regression and estimated hazard ratios using Cox regression. We adjusted for the child’s sex, age, and year of birth; and parental highest education, receipt of cash benefits or early retirement.

We included 92 JAE, 190 JME, 27 GTCS alone, 15,084 non-neurological chronic disease controls, and population controls. JAE had two times increased hazard for special needs education compared with age-matched population controls (hazard ratio 2.2, 95% CI = 1.1?4.6, p=0.03); this was not seen in JME. Compared with population controls, both JAE and JME had lower grade point average in secondary and high school (JME: 9th grade: – 0.5 points, 95% CI = −0.9 to −0.06, p=0.03; high school: – 0.6 points, 95% CI = −1.3 to −0.1, p=0.04), and 8% fewer JME and 15% fewer JAE attended high school. Both JME and JAE had higher hazard for redeeming sleep medication compared with non-neurological chronic disease; additionally, JAE had increased hazard for ADHD medicine redemptions.

Both JAE and JME had marginally poorer school performance; performance seemed worse in JAE than in JME. Both JAE and JME had increased use of sleep medication.