Page 417 - ILAE_Lectures_2015

The broad area of ‘independence versus safety’ is difficult for an individual who is trying to
establish independence and a smooth transition to adulthood but may need to rely on others
to some extent to maintain safety. The specific issue of drowning in the bath must always be
discussed in this context. The issue of independence versus safety also impinges on a number
of other areas.

Adolescents do not like being told what to do. The doctor should try to avoid giving advice
but should instead encourage questioning and provide information, emphasising that the
individual is in control of his or her own life. The following are suggested guidelines:

 If possible, talk to the adolescent first, ignoring the parents initially.
 Ask the adolescent to introduce the parents to you.
 Explain to the adolescent what will happen during the consultation.
 Present talking to the parents as ‘a necessary evil’ and explain why this is necessary to

the adolescent.
 Write to the adolescent rather than the parents.
 Ask the adolescent’s permission to send copies of letters to the parents.

In addition the following practice points should apply:

 Check the diagnosis.
 Characterise the syndrome.
 Provide accurate prognostic information.
 Treat with appropriate medication.
 Provide information on the following:

- high risk of the unsupervised bath
- effect of irregular sleep
- alcohol
- driving
- sport
- employment
- contraception
- genetic implications
- advantages/adverse effects of specific antiepileptic drugs (AEDs).
 Listen, discuss, inform; avoid giving advice.

Diagnosis

There are several epilepsy syndromes which should not be missed. The following may present
in adolescence:

 Juvenile myoclonic epilepsy (JME)
 Juvenile absence epilepsy (JAE)
 Epilepsy with generalised tonic-clonic seizures on awakening
 Benign partial seizures in adolescence
 Photosensitive epilepsy
 Reading epilepsy
 Subacute sclerosing panencephalitis
 Epilepsy from cortical brain tumours.

In addition, seizures from substance abuse or from neuronal antibodies should be considered.