Modern management of epilepsy: Adolescents

Epilepsy most commonly starts in the first two decades of life. Adolescence is a time of great change both in the epilepsy itself and in a number of other areas. Growth into adulthood, issues of preparation for university or employment, driving, drinking, preparation for marriage/conception and a general increase of responsibility add to the complexity of this time of life. Epilepsy affects all these areas to a significant degree. The incidence of several epilepsy syndromes peaks in adolescence. These include juvenile myoclonic epilepsy, juvenile absence epilepsy, epilepsy with grand mal on awakening, benign partial seizures of adolescence and reading epilepsy. Photosensitivity also appears to peak around puberty and needs to be managed well to avoid both unreasonable risks and unnecessary restrictions. Early diagnosis and correct management of the epilepsy and the specific epilepsy syndrome are the main factors in minimizing the difficulties. Epilepsy may change in the early adolescent years, with seizures starting and stopping or altering in form, all of which add to the uncertainty. Denial of the epilepsy may lead to risk-taking which may include be provided on the high risk of the unsupervised bath, the effect of irregular sleep, alcohol, driving, sport, employment, genetic implications, advantages/adverse effects of specific antiepileptic drugs and the role of surgery. The doctor should listen, counsel and inform. Adolescents generally do not appreciate being given advice. They should be empowered by the doctor to make informed decisions and encouraged to take control in a situation which they may view as implying devastating loss of control, unless it is managed wisely.