Epilepsy in adolescents: diagnosis and treatment

Although seizures are one of the most common presenting neurologic problems in adolescence, the diagnosis and management of seizures in this population can be a challenge. Seizures can be secondary to an underlying illness or to a genetically based epileptic syndrome. The first task of the clinician is proper diagnosis and evaluation. The second task is to determine whether treatment with antiepileptic drugs (AEDs) is necessary and, if so, which AED is the most appropriate for the patient's epilepsy with the least impact on the adolescent's quality of life. The newer AEDs allow the clinician more flexibility to treat not only the epilepsy, but also any coexisting medical conditions in the patient. The impact of epilepsy on the quality of life of the adolescent cannot be overestimated. Epilepsy affects the adolescent's social life, peer interactions, educational and career decisions, driving ability, and reproductive life. Communication with the adolescent regarding the effect epilepsy can have on these issues is crucial to proper management of the patient. Although treating the seizures and all of the ramifications of the diagnosis is a challenge, the majority of adolescents can achieve the primary goals of therapy: seizure freedom and the maintenance of high quality of life.