Although our manuscript was not meant to be an exhaustive literature review, I would like to thank Dr Duane for identifying additional seminal papers on the topic. As Dr Duane has pointed out, there is a substantial body of evidence calling for better neurological and neurophysiological phenotyping of individuals with neurobehavioral and neurocognitive disorders. Further prospective research is needed to enhance our understanding of the evolutionary nature of subclinical spikes to determine whether they represent transient developmental phenomena, surrogate markers of cortical anomalies, or prodromal indicators of future epilepsy. There is also a need to increase our knowledge concerning the neuropsychological profiles of children with subclinical spikes and disorders of learning and attention, the relative efficacy and sequence of nonpharmacological and pharmacological therapies, and the relationship of efficacy of antiepileptic drugs to spike suppression and/or neuroprotection.