Page 416 - ILAE_Lectures_2015

Chapter 42

Epilepsy in adolescence

FRANK M.C. BESAG

Child and Adolescent Mental Health Services, ELFT: East London NHS Foundation Trust,
Bedfordshire, and Institute of Psychiatry, London

Introduction

Although the incidence of epilepsy is high in adolescence and the prevalence of psychiatric
disorder is also higher than in childhood or adulthood, specific services for adolescents with
epilepsy are rarely provided and this subject receives surprisingly little attention in many
books on epilepsy. Adolescence is a time of great change; growth into adulthood and issues
such as preparation for university or employment, driving, drinking, social/sexual
relationships, marriage/conception, as well as a general increase of responsibility need to be
considered. Epilepsy impinges on all these areas to a significant if not major degree. In
addition, adolescents tend to be very body-conscious and do not like to be different from their
peer group. The stigma associated with a condition which implies loss of control and requires
the regular taking of medication is liable to have a very negative effect on the adolescent
unless the situation is managed well1. Denial of the epilepsy may result in some teenagers
taking risks, such as refusing to accept medication or other precautions.

The subject of epilepsy in adolescence has been covered in a number of reviews2-6.

Management dilemmas

There are some specific management dilemmas in adolescents with epilepsy. Although the
focus of both the initial interview and follow-up discussions should be on the adolescent,
because the history depends so much on the account of someone who has actually seen the
seizures it is generally also necessary to interview the parents. This situation needs to be
explained to the adolescent.

Sodium valproate remains one of the most effective antiepileptic drugs for juvenile
myoclonic epilepsy (JME). However, it may be associated with weight gain  a particularly
unfortunate adverse effect in body-conscious female patients, who may refuse to continue
taking the drug. There has been considerable debate in the literature about the apparent
association of polycystic ovary syndrome with this drug (see Chapter 44 on epilepsy in
women). In addition, the increased risk of neural tube defects, valproate syndrome and
cognitive deficits in children born to mothers taking valproate are issues of concern.

The dilemma of declaring epilepsy on job/college applications may need to be discussed.
Although it is important to be honest with a prospective employer, the declaration of epilepsy
may prevent short-listing. One option is to leave the appropriate place on the application form
blank and, after the candidate has been interviewed and the job has been offered, declare the
epilepsy in a positive way. This allows the applicant to explain how the epilepsy should not
interfere significantly with their ability to carry out the duties required, and to indicate what
measures would needed if a seizure were to occur at work.