Epilepsy and attention-deficit/hyperactivity disorder (ADHD) are highly comorbid in the pediatric population, with a comorbidity rate of ADHD among children with epilepsy ranging from 13% to 70% worldwide. The co-occurrence of epilepsy and ADHD can significantly exacerbate cognitive impairment, reduce quality of life and treatment adherence, and impose a heavy burden on families and society. To systematically review advances in the pathogenesis of this co-morbidity, this study searched high-quality clinical and basic research articles published between 2018 to 2026 in databases such as PubMed, Web of Science, and CNKI. The results indicate that the mechanisms underlying this comorbidity are complex and multifaceted, involving imbalances in neurotransmitter systems, shared genetic susceptibility factors, abnormalities in brain structure and functional networks, neuroinflammation and oxidative stress processes, as well as the synergistic interaction of multiple pathways such as the hypothalamic-pituitary-adrenal axis and mitochondrial dysfunction, ultimately leading to the disruption of the excitatory-inhibitory homeostasis of the central nervous system. This review integrates the pathogenesis, treatment strategies, and research controversies surrounding the co-occurrence of epilepsy and ADHD from multiple perspectives, aiming to provide a theoretical framework for precision diagnosis and treatment, early intervention, and future basic research.