Adolescents and epilepsy

Epilepsy in adolescents is under recognized and poorly described in the medical literature. Although these sometimes challenging patients require extra time and consideration, their care can be very rewarding. There are several important social issues adolescents with chronic disease face that influence treatment and that need to be discussed, often in private with the patient. Pediatricians and neurologists must be aware of specific epilepsy syndromes affecting teenagers, such as juvenile myoclonic epilepsy (JME), progressive myoclonic epilepsies, and juvenile absence epilepsy (JAE). Adolescents often benefit from treatments with infrequent daily dosing, limited laboratory monitoring, and minimal cosmetic and cognitive side-effects. Recognizing the high prevalence of comorbid migraine also influences medication choices. Nonpharmacologic options that allow for a sense of control and independence over their epilepsy, including vagus nerve stimulation, ketogenic diet, and epilepsy surgery, are very attractive to most adolescents. In this review, these issues affecting adolescents with seizure disorders will be discussed.