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TAKING OVER EPILEPSY FROM THE PAEDIATRIC NEUROLOGIST

2003; BMJ; Volume: 74; Issue: 90001 Linguagem: Inglês

10.1136/jnnp.74.suppl_1.i37

1468-330X

Phil E M Smith,

Adolescent and Pediatric Healthcare

he 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. c THE TEENAGER WITH EPILEPSYEven 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: c 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.c Deviations from peer group norms hold great importance for teenagers: epilepsy can be disastrous for self esteem and self identity.c 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 CLINICTaking over a patient's care offers opportunities to reassess the diagnosis by reviewing the history, and to ensure appropriate investigations are to hand.This is best done in the setting of a specialist teenager epilepsy clinic.Developing teenagers often find paediatric clinics embarrassing and inappropriate.A transitional arrangement offers the benefit of consulting both an adult and a paediatric neurologist, supported by an epilepsy specialist nurse. 3The general principles of a teenager epilepsy consultation are listed in box 1.Two main patient groups are referred to this type of clinic: c Patients presenting with blackouts beginning as teenagers (referred from general or hospital practice) where the main initial issue is diagnosis.c Patients with ongoing and often complex epilepsy from childhood (referred from general paediatrics or paediatric neurology) where the main issue is ongoing management of the epilepsy.The following should be addressed at first contact: c Is the diagnosis of epilepsy correct?c If the diagnosis is epilepsy, which type is it?c Is the current epilepsy management appropriate?c Is there appropriate knowledge and understanding of the condition, its prognosis, and its lifestyle implications?In particular, will the seizures interfere with completion of education, training for a career/job, or qualification for a driving licence, and are there special social circumstances that need to be addressed? IS THE DIAGNOSIS OF EPILEPSY CORRECT?A correct diagnosis is essential for the appropriate management of any patient with blackouts.Despite major advances in the technology for investigating blackouts, the most important investigation remains the taking and re-taking of the clinical history.