Special needs of the adolescent with epilepsy

Adjustment to the inherent changes of adolescence is a challenge for many children, even healthy ones. Epilepsy may make successful adjustment even more difficult by disrupting self-control, adversely affecting the ability to conform to one's peers, and interfering with independence. Epilepsy and its treatment may affect education, employment, use of alcohol and illicit drugs, sexual activity, and pregnancy. These issues, in turn, may affect seizure control. Matching the medicine to the patient is particularly important in teenagers, a group of patients with special needs. Common seizure syndromes presenting in adolescence are briefly reviewed and used to illustrate key issues that may arise in the selection of an antiepileptic medication (AED). Compliance, interaction with other medications including oral contraceptive medications, cosmetic effects, teratogenicity, and impact on behavior are all factors to be considered. Newer medications may have some advantages over older compounds in this regard, and evidence of their utility is reviewed in the specific context of the epilepsy syndromes. In addition to prescribing medication, other important parts of the therapeutic management involve education, counseling, support, and advocacy. To identify issues and to provide appropriate counseling, it is beneficial to devote some of the office visit to an independent interaction with the patient, apart from the parents. One study questionnaire indicated that nurse specialists may be particularly valuable in supporting and meeting the needs of patients in this age group. Some centers have developed elegant methods of helping the patient make the transition from child neurology to adult neurology.