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TAKING OVER EPILEPSY FROM THE PAEDIATRIC NEUROLOGIST
  1. Philip E M Smith,
  2. Sheila J Wallace*
  1. The Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
  2. *Died in December 2002
  1. Correspondence to:
 Dr PEM Smith, The Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff CF14 4XW, UK;
 SmithPE{at}cardiff.ac.uk

https://doi.org/10.1136/jnnp.74.suppl_1.i37

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    The problems of coping with adolescence are greatly increased by an additional chronic disorder. This is particularly so for those with epilepsy, where there is social stigma and the need for potentially sedative and damaging medication. Epilepsy is the most common neurological condition among patients transferred from paediatric to adult care. Many of the problems encountered in the teenager with epilepsy are shared by those with other chronic disabilities.1,2

    This review considers the paediatric environment that the adolescent is leaving, the rationale for a teenage clinic, and the facets of this which make it a desirable facility.

    THE TEENAGER WITH EPILEPSY

    Even when relatively mild, the impact of epilepsy on the teenager and on other members of the family may be profound. Epilepsy has important differences from other chronic disorders, particularly that the disability is intermittent, and so can be hidden. The perceived need to conceal epilepsy, and concern about seizures occurring in public, can induce great anxiety. The consequences of missing epilepsy, or treating it inappropriately, can be disastrous in terms of impaired education, employment, and driving prospects, unnecessary medication, and diminished self esteem. Perhaps these factors are of greater importance for teenagers than for those in other age groups:

    • Developing independence is impeded, education is at a critical stage, employment and driving prospects are just being realised, and issues of relationships, contraception, pregnancy, and parenthood are becoming increasingly relevant.

    • Deviations from peer group norms hold great importance for teenagers: epilepsy can be disastrous for self esteem and self identity.

    • Social handicaps acquired in childhood and adolescence can remain with the individual even after seizures have been adequately controlled.

    Complete control achieved before adult social and vocational responsibilities can help to avoid these problems. A relatively aggressive approach to treatment, including early consideration of epilepsy surgery, is therefore justified.

    THE TEENAGER CLINIC

    Taking over …

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