Adolescent seizures and epilepsy syndromes

Area of Science:

• Neurology
• Epileptology
• Adolescent Medicine

Background:

• Epilepsy syndromes emerging in adolescence present a significant neurological challenge with long-term implications.
• The influence of puberty and hormonal changes, particularly menarche, on seizure activity remains poorly understood despite observed menstrual cycle relationships.
• Hormonal effects on seizure activity are hypothesized to involve neurotransmission, with estrogen potentially activating and progesterone potentially inhibiting epileptiform discharges via gamma-aminobutyric acid (GABA) pathways.

Purpose of the Study:

• To review and synthesize current knowledge on epilepsy syndromes with adolescent onset.
• To highlight the diagnostic and therapeutic importance of recognizing specific adolescent-onset epilepsy syndromes.
• To discuss the potential impact of hormonal changes during puberty, such as menarche, on seizure control.

Main Methods:

• Literature review and synthesis of existing research on adolescent-onset epilepsy.
• Analysis of the relationship between hormonal fluctuations (estrogen, testosterone, progesterone) and seizure activity.
• Examination of the characteristics, diagnosis, and treatment of common adolescent-onset epilepsies, including idiopathic generalized epilepsies and temporal lobe epilepsy.

Main Results:

• Idiopathic generalized epilepsies, particularly juvenile myoclonic epilepsy (JME), are the most common epilepsy syndromes with adolescent onset.
• Progressive myoclonic epilepsies and temporal lobe epilepsy associated with hippocampal sclerosis are also significant considerations in this age group.
• Hippocampal sclerosis is identified as a common cause of intractable temporal lobe epilepsy in children and adolescents, potentially underdiagnosed.

Conclusions:

• Accurate diagnosis of epilepsy syndromes beginning in adolescence is critical for appropriate treatment and prognosis.
• Epilepsy surgery demonstrates excellent safety and efficacy for intractable temporal lobe epilepsy in adolescents.
• Further research into hormonal influences on seizure activity during puberty is warranted to optimize management strategies.