Adolescence::
Adolescence is a time of great change; there is growth into adulthood and issues such as preparation for university or employment, driving, drinking, social/sexual relationships, marriage/conception to be considered, as well as a general increase of responsibility
Epilepsy has an impact::
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 stigmatising effect of 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 well.
Adolescence is an exciting but uncertain period::
If epilepsy presents for the first time in adolescence, this adds greatly to complexities of this period.
Well-established epilepsy may vary over the course of adolescence, increasing the uncertainty when so many other changes are taking place.
In managing epilepsy in adolescence it is important to consider specific syndromes and causes because these may require very different styles of treatment or management.
Impact of epilepsy::
It is also vital to consider the impact of epilepsy on the life of the adolescent, and to minimise the isolation and stigmatisation that the teenager may feel at a time when being part of an approving peer group is so important.
These factors, together with the issues such as alcohol, driving, sport, contraception, genetic implications and safety versus independence', imply that the management of epilepsy in adolescence requires skill and sensitivity.
Independence versus safety::
Denying that the epilepsy exists means that the patient takes risks, such as refusing to take medication or other precautions.
There are some specific management dilemmas in adolescents with epilepsy.
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
Listen, counsel, inform; avoid giving advice::
The dilemma of declaring epilepsy on job/college applications may need to be discussed
Adolescents do not like being told what to do.
The doctor should try to encourage questioning and provide information, emphasising that the individual is in control of his or her own life.
Behaviour::
Caring for teens with epilepsy requires special patience and understanding.
For children entering their teens with good self-esteem and a sense of independence, the impact of epilepsy can be minimal.
But epilepsy can aggravate or create problems of low self-esteem, dependency, or behavioral difficulties in adolescents
Overprotection::
Parents may be overprotective and hesitate to encourage their teens to take responsibility for their own care.
If the teen is to make a successful transition into adulthood, however, he or she must learn that the epilepsy is their own and does not belong to the parent or the doctor.
Lifestyle choices::
Teens need information about their epilepsy so they can make appropriate lifestyle choices and assume responsibility for their seizure medicines, with parental supervision.
Associated disorders::
About 40% of individuals with epilepsy between the ages of 4 and 15 have one or more additional neurological disorders.
The most common ones are mental retardation, speech-language disabilities, and specific learning disabilities.
In fact, learning disabilities are more prevalent in individuals with epilepsy (approaching 50%) than in the general population
Cognitive problems::
One of the most notable effects of cognitive functioning in children with epilepsy is memory impairment.
This impairment can range from poor concentration and minor forgetfulness to gross clouding of consciousness and disorientation.
Epilepsy might impact on learning in other ways.
Daytime seizures can affect learning by reducing alertness and by interfering with short-term information storage and abstraction.
Frequent and uncontrolled seizures impair learning new information due to the amount of time that the individual is unaware of the environment.
Night-time seizures can disrupt the consolidation of memory and affect language functions.
Cognitive problems::
Cognitive impairments can also be a side effect of the various anticonvulsant medications used to treat epilepsy.
Anticonvulsant medications have been associated with learning difficulty, behavior changes, and memory impairment.
The drug most commonly implicated with altered behavior is phenobarbital, which can cause hyperactivity and memory impairment.
Almost all anticonvulsant medications have some adverse effects on cognition, learning, and mood.
Seek information on the following::
High risk of the unsupervised bath/swimming
Effect of irregular sleep
Alcohol
Driving
Sport
Employment
Contraception
Genetic implications
Advantages/adverse effects of specific antiepileptic drugs (AEDs).
Some epilepsies of 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.
Possible Negative Effects of Epilepsy on the Adolescent::
There may be varying degrees of denial by the individual concerned which may lead to a lack of compliance with medical advice.
Overprotection by parents may cause some adolescents to become less socially skilled and therefore less confident.
Social restrictions may lead to social isolation which can increase feelings of anxiety or depression and have a detrimental effect on psychological well-being.
Teenagers with epilepsy may believe they have less control over their lives compared to their friends, and this may cause anxiety, depression and poor self-esteem.
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