BMJ 1998;317:960-961 ( 10 October )

Editorials
The teenager with epilepsy
Has special needs
Even for healthy teenaers! copin "ith e#erin a$%lthoo$ is a #a&or challene' (
chronic $isability s%ch as epilepsy si#ply

#anifies the proble#s of a$olescence! an$ the
penalties for sei)%res

at this ti#e are far #ore severe than in chil$hoo$' Epilepsy an$

its
treat#ent have a $irect bearin on #a&or aspects of lifestyle

s%ch as e$%cation an$
e#ploy#ent prospects! $rivin ability! the

%se of alcohol an$ recreational $r%s!
relationships! contraception!

prenancy! an$ parenthoo$' *elf conscio%sness is para#o%nt
an$

$eviations fro# peer ro%p nor#s ass%#e reat i#portance: epilepsy

can be
$isastro%s for an a$olescent+s self estee# an$ sense of

i$entity'
($olescents "ith epilepsy are often ca%ht bet"een pae$iatric an$ a$%lt #e$ical
$isciplines! "ith neither service specifically

a$$ressin their nee$s' ,he -iverpool ro%p
a$vocates #%lti$isciplinary

cons%ltations "ith a ne%roloist! pae$iatric ne%roloist! an$

specialist epilepsy n%rse'
1
.hatever the settin! the cons%ltation

#%st foc%s on the nee$s
an$ in$epen$ence of the teenaer! "ith

the parents ta/in a bac/ seat' 0f possible! part of
the cons%ltation

sho%l$ be "ith the teenaer alone: an opport%nity arises "hile

e1a#inin
the patient in a separate

c%bicle'
,he sa#e principles of clinical #anae#ent apply in a$olescence as in any ae ro%p!
b%t for the teenaer the proble#s are

#ore pressin an$ the lon ter# conse2%ences of
#is#anae#ent

#ore serio%s'
3
( correct $ianosis of blac/o%ts is essential'

,he
$ianostic process in teenae epilepsy #%st ta/e acco%nt of

three sit%ations' 4irstly! so#e
epilepsies! s%ch as &%venile #yoclonic

epilepsy! present in a$olescence an$ carry specific
i#plications

for #anae#ent'
3
*econ$ly! so#e chil$hoo$ onset epilepsies!

s%ch as benin
chil$hoo$ epilepsy "ith centrote#poral spi/es!

consistently re#it in a$olescence'
5

,hir$ly! co##on con$itions

s%ch as vasovaal syncope! psychoenic non-epileptic attac/
$isor$er!

an$ #iraine often present first in teenaers an$ #ay #i#ic

epilepsy'
Opti#al sei)%re control is central to #anain epilepsy' .hen anti-epileptic $r%s are
in$icate$ the i$eal is to prescribe

the lo"est effective $ose of a preparation "ith as fe"
si$e effects

as possible! iven as a once or t"ice $aily $ose' ( vioro%s approach

to
sei)%re control is &%stifie$ since interventions often have

proressively less i#pact as
epilepsy an$ its conse2%ences beco#e

establishe$' *%rery for epilepsy is #%ch
%n$er%se$ b%t potentially

c%rative in so#e patients "ith localisation relate$ epilepsies'

,he ar%#ent for s%rery in chil$ren an$ a$olescents is not &%st

that it is effective
6
; it can
also prevent the social! e$%cational!

an$ $evelop#ental han$icaps "hich! once
establishe$! #ay persist

even "ith oo$ control of

sei)%res'
1
7o#pliance "ith $r% treat#ent is a partic%lar proble# in a$olescence' (s at any ae! the
reasons incl%$e $enial of epilepsy!

concern over si$e effects! an$ co#placency abo%t
oo$ sei)%re

control' 4or teenaers there is also an intense peer press%re

to confor#
their tablets a re#in$er "ith each $ose that they are

$ifferent as "ell as rebellion aainst
parental involve#ent in

the #anae#ent of their epilepsy' *i$e effects are e1tre#ely
i#portant

at this ae since even #il$ conitive $ysf%nction #ay per#anently

har#
e$%cation an$ e#ploy#ent prospects' 7os#etic effects li#it

the %sef%lness of certain
antiepileptic $r%s (s%ch as phenytoin)

in yo%n

people'
*everal lifestyle iss%es #erit $isc%ssion' 8o%n "o#en ta/in en)y#e in$%cin
antiepileptic $r%s #%st be "arne$ abo%t potential

fail%re of oral contraceptives' 9ore
i#portantly! all "o#en of

chil$bearin ae ta/in antiepileptic $r%s nee$ to /no" of
their

possible teratoenicity' ,here is so#e evi$ence that folate re$%ces

this ris/ for
en)y#e in$%cin #e$ications
6
an$ valproate'
7
:iven that at least 30; of teenae
prenancies are %nplanne$!

a phar#acoloical $ose of folate 6 # $aily see#s a sensible
a$$ition

to any antiepileptic

rei#en'
($vice on re%lar sleep is partic%larly i#portant in i$iopathic eneralise$ epilepsy! the
co##onest for# in teenaers' 7o#plete

abstinence fro# alcohol is %nnecessary! b%t
teenaers #%st reconise

its potential for interactin "ith $r%s an$ i#pairin sleep
2%ality

an$ so provo/in sei)%res' ,he infl%ence of recreactional $r%s

on epilepsy is
%n/no"n' ,he ris/ of e1pos%re to co#p%ter screens

an$ flashin lihts often concerns
patients an$ parents' <hotosensitive

epilepsies #ay present in the teenae years! b%t s%ch
e1pos%re

is har#less to #ost teenaers; a baseline electroencephalora#

is helpf%l in
refinin this a$vice' ( $isc%ssion of s%$$en %ne1pecte$

$eath in epilepsy is so#eti#es
appropriate an$ is to%che$ on in

a helpf%l patient infor#ation boo/let'
8

Epilepsy affects e$%cational an$ e#ploy#ent prospects! "ith career choices bein
inevitably restricte$ by the $ianosis'
9
4%rther restrictions i#pose$ by parents! s%este$
by peers! or

initiate$ by the patient are so#eti#es inappropriate' *%ch restrictions

can
threaten in$epen$ence! $eny opport%nities for frien$ship!

an$ enco%rae social isolation'
( co##on sense approach is nee$e$

to"ar$s leis%re an$ sports activities! both patient
an$ parents

often havin to accept livin "ith a $eree of ris/' ,he proble#s

face$ by
teenaers "ith epilepsy apply! often to a lesser e1tent!

across the rane of patients "ith
epilepsy' (s "e i#prove o%r

services for this v%lnerable ro%p! the lessons learnt can
only

benefit people "ith epilepsy as a

"hole'
Philip E M Smith! Consultant neurologist'
Epilepsy =nit! =niversity >ospital of .ales! >eath <ar/! 7ar$iff 745 5?.
1' (ppleton @E! 7ha$"ic/ A.! *"eeny (' 9anain the teenaer "ith epilepsy:
pae$iatric to a$%lt care' Seizure 1997; 6: 37-30B9e$lineC'
3
3' Desa 49' 9o$ern #anae#ent of epilepsy: a$olescents' Baillire's Clin Neurol
1996; 6: 803-830B9e$lineC'
3' ,i##ins <-! @ichens (' E%venile #yoclonic epilepsy. BMJ 1993; 306: 5-
6B9e$lineC'
5' F%rt) G! ,oo/ey <! @oss E' Epilepsy in yo%n people: 33 year follo" %p of the
Dritish national chil$ $evelop#ent st%$y' BMJ 1998; 316: 339-353B(bstractH 4ree
4%ll ,e1tC'
6' Ient%reyra E7! >iins 9E' 7o#plications of epilepsy s%rery in chil$ren an$
a$olescents' Pediatr Neurosurg 1993; 19: 50-66B9e$lineC'
6' Diale 8! -e"anthal 9' Effect of folic aci$ s%pple#entation on conenital
#alfor#ations $%e to anticonv%lsant $r%s' Eur J Obstet Gnaecol !eprod Biol
1985; 18: 311-316B9e$lineC'
7' El#a)ar 99(! ,hiel @! Ja% >' Effect of s%pple#entation "ith folinic aci$!
vita#in D6 an$ vita#in D13 on valproic aci$ in$%ce$ teratoenesis in #ice'
"unda#ental and $pplied %o&icolog 1993; 18: 389-395B9e$lineC'
8' <reston E' Epilepsy and t'e oung adult. -on$on: Epilepsy an$ the 8o%n ($%lt !
1996'
9' ,ho#pson <! O1ley E' *ocial aspects of epilepsy' 0n: -ai$la" E! @ichens (!
7ha$"ic/ A.! e$s' $ te&tboo( o) epilepsy. 5th e$' E$inb%rh: 7h%rchill
-ivinstone! 1993:661-705
3