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Despite the prevalence of seizure disorders in children, little is known about how youngsters with epilepsy understand the cause of their disorder. Fifty children and adolescents with idiopathic seizure disorders, between 5− and 16-years-old, were questioned about the etiology of seizure episodes and of seizure disorders, as well as their understanding of physical causality, general illness causality, and brain functioning. Responses were scored for their conceptual complexity according to scales paralleling Piaget's stages of cognitive development. Older children had more cognitively sophisticated concepts of epilepsy than did younger children. Overall, however, children scored significantly lower on questions about their seizure disorders than on questions assessing their understanding of physical causality, general illness causality, and brain functioning. Many children had misconceptions about seizure disorders and lacked disease-related information; only 41% of the children identified epilepsy as a disease involving the brain. These findings underline the need for including educational intervention in the comprehensive care of pediatric seizure disorders.