The incidence of newly diagnosed seizures is lower in adolescents than in younger children. Although focal epilepsy is still the most common epilepsy classification in adolescents, the etiologies of new-onset seizures are slightly different than earlier in childhood. For symptomatic focal seizures, acquired lesions (eg, head trauma, tumors, mesial temporal sclerosis) predominate over congenital or perinatal causes. Similarly, the epilepsy syndromes seen in this age group are different than earlier in childhood. More often, generalized epilepsy syndromes are seen and benign focal epilepsies resolve by this time. Because of the increased incidence of acquired focal epilepsies (over benign focal epilepsy syndromes), neuroimaging is recommended for adolescents with suspected focal-onset seizures and for those in whom the onset cannot be determined.
The effects of epilepsy on daily life are also different in this age group compared to in younger children.1-3 These effects result from the differences in prognosis in adolescent-onset epilepsy syndromes, the developing self-reliance in this age group, and the sexual maturation that occurs through this period. Each influences the treatment and counseling given to adolescents with epilepsy.
SPECIAL CONSIDERATIONS FOR TEENS
Transitioning to Adulthood
As children mature into adults, they assume responsibility for themselves. Of course, this is also true for children with medical conditions such as epilepsy.4 As part of the care of an adolescent with seizures, it is important to facilitate this transition. Factors that contribute to successful transitions of care from pediatric to adult providers include an adolescent’s comfort with managing medication, obtaining medication refills, and scheduling appointments; knowledge of important epilepsy-related information (eg, seizure frequency); comfort talking to care providers; and some understanding of health insurance.5 Encourage adult caregivers to allow the adolescent to progressively take responsibility for their care. Begin by encouraging the patient to be responsible for taking their own medications. A pill reminder box can provide a way for parents to inconspicuously monitor adherence. Address the conversation about care to the adolescent and let them lead the discussion about their care. As time progresses, ask parents to step out of the room while you discuss issues of care with the patient. Because the parents are still legally the people who are responsible for the healthcare decisions, they have to be included, but for older adolescents, try to do so after you have had a chance to discuss issues with the patient (alone) first.
An important part of independence for this age group is driving. Driving laws are not uniform from state to state. Most require a period of seizure freedom before people with epilepsy are allowed to drive, with a median seizure-free period in statute laws of 6 months. Adolescent drivers are already one of the age groups at highest risk for motor vehicle accidents. The increased risk related to epilepsy in this age group is unknown, but people with uncontrolled ...