Adolescence is a period of social, physical and psychological change that can be difficult to cope with, even for healthy teenagers. Teenagers with epilepsy therefore have unique needs that need to be specifically targeted. We performed an observational study of all referrals to a monthly teenage transitional care epilepsy clinic over a 3-year period (2006 to 2008) which receives input from a paediatric and an adult neurologist, both with a special interest in epilepsy. The retrospective notes review was a re-examination of our study of the period 1997 to 2001. Ten variables were measured including epilepsy classification, reason for referral and changes made by the consultation. 178 consultations were scheduled (121 new patients and 57 follow-ups); forty patients “did not attend” (23% of appointments). 84% were already taking antiepileptic medication. Seven teenagers were changed from sodium valproate to either lamotrigine or levetiracetam: all these were female. All teenagers received age appropriate lifestyle advice and twenty had a psychological or psychiatric co-morbidity documented (seven of whom were eventually not diagnosed with epilepsy). Although age-appropriate lifestyle advice is important, encouraging the teenager to take responsibility for their epilepsy; ensuring the correct diagnosis and most appropriate choice of drug (particularly in women) is imperative. Despite this need, bespoke teenage epilepsy clinics are still a rarity in the UK.