Children who experience the onset of epilepsy during the first years of life are at a high risk of neurodevelopmental delay, learning disorders, or intellectual disability. Epilepsy has negative impact on the maturation of cognitive functions in children. Starting from the first months of life, there is a progressive increase in the appearance and maturation of synapses. These synapses gradually organize into diffusely distributed neural networks. The formation of synapses and the organization of neural networks are strongly influenced by genetic factors, although extrinsic factors also play a significant role. Paradoxically, prolonged seizures occurring in the first years of life are less likely to result in neuronal loss and hippocampal injury compared to what is observed in adults. However, the occurrence of recurrent seizures can reduce neurogenesis, leading to abnormal patterns of white matter networks. Neuroimaging studies in children with
epilepsy have shown evidence of microstructural white matter damage, which is significantly influenced by early seizure onset. Evidence of the impact of white matter and its impact on the phenotype of childhood epilepsies will be discussed.