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Epilepsy and the Adolescent Female

The following article first appeared on the Epilepsy Foundation website, and is reprinted here with permission from the Epilepsy Foundation.

Puberty involves complex physiologic changes. It is also a time of emotional transition with the development of the desire for independence from parental supervision, increased interaction with peers and emerging sexuality. Adolescence for young women with epilepsy may be complicated by problems in adjusting to a chronic condition that is unpredictable and one that can affect social interactions.

Adolescence and Seizures
 Conclusions are difficult because there are methodologic differences in studies evaluating the effect of puberty on seizures, but there is general agreement that most seizure disorders are not altered by the onset of puberty.

Some researchers report a transient deterioration in seizure control secondary to rapid growth and suboptimal antiepileptic drug (AED) levels. More frequent laboratory evaluation of AEDs may be necessary until pubertal changes are complete.

Certain epileptic syndromes, such as juvenile myoclonic epilepsy and photosensitive epilepsy, characteristically develop around the onset of puberty. Other syndromes, such as childhood absence and benign rolandic epilepsy with centrotemporal spikes, tend to remit during adolescence.

Menarche and Seizures
Some women with epilepsy experience changes in seizure patterns at times of hormonal fluctuations: at menarche, over the menstrual cycle and with menopause. Catamenial epilepsy refers to seizure exacerbation related to the menstrual cycle. The most common pattern is an increased tendency for seizures just before, or at the onset of menstruation. This increased frequency is noted in women with epilepsy who have idiopathic epilepsy and in those with symptomatic seizures.

If menses-related seizures occur in adolescent women with epilepsy, a neuroendocrine consultation may be indicated to evaluate therapeutic interventions including progesterone therapy or adjunctive AEDs.

See also Hormone-Sensitive Seizures.

Adolescent Sexuality and Epilepsy
Adolescence involves intense peer interaction and socialization, and may include sexual experimentation. Health care providers should be active participants, with parents and educators, in providing information about sexuality and related issues, such as sexually transmitted diseases and contraception. Counseling should begin early in adolescence and repeated on subsequent visits.

All commonly used birth control methods, including hormonal contraceptives, barrier devices or substances, and timing techniques, can be used by women with epilepsy, but the choice of contraceptive method can be influenced by the AED that is used.

See also Contraception for Women with Epilepsy.

Adolescent Behavior and Epilepsy
Although normal adolescent behavior can be unpredictable and inconsistent, it is important to evaluate the impact of seizures and the possible side effects of AEDs on the behaviors of adolescents with epilepsy.

Seizures may affect cognition and emotional responses. If confusing behavior is stereotyped and interruptive of ongoing activity, it may be caused by seizures. If it is not possible to ascertain the etiology, EEG telemetry may be necessary.

Undesirable side effects of AEDs may also cause changes in cognition and physical abilities. Irritability, difficulty with balance or coordination, confusion and lethargy may occur if AED blood levels are too high for that individual. In adolescents, these symptoms are often blamed on substance abuse. Laboratory assessment at the time the behaviors are evident may help to confirm etiology.

Adolescents with epilepsy may have inaccurate perceptions about themselves and their seizure disorders. They may fear ridicule and rejection, and withdraw socially. Education about epilepsy, acceptance by supportive adults and selected peers, and realistic expectations will help young women with epilepsy to move into successful adult behavior patterns. Professional counseling may be necessary for some adolescents and their families.

Safety Issues for Adolescents with Epilepsy
Alcohol and drug abuse, destructive behaviors common among adolescents, may have especially negative effects on teens with epilepsy. Both alcohol and drugs act on the central nervous system and may make epilepsy worse.

A driver’s license is regarded by many adolescents as essential to freedom and independence. State laws vary, but adolescents with epilepsy may be denied this privilege unless their seizures are completely controlled. Health care providers may find medication adherence more dependable when obtaining a driver’s license is the desired outcome.

Sports with the potential of head injury should be undertaken with caution, since the risk of seizures is increased. Adolescents can be encouraged to participate in less risky activities. The use of protective head gear should be encouraged.

Activities that may result in injury if a seizure occurs should be carefully monitored, especially recreational activities involving water. Whenever feasible, showers should be encouraged over tub baths to avoid the potential hazard of drowning secondary to a seizure. Safety devices to prevent shower scalding are also available.

CONTACT
For additional information, contact the Women and Epilepsy Initiative of the Epilepsy Foundation at (800) 332-4050.

REFERENCES
Austin JK. Raising the daughter with epilepsy. In: Morrell M, ed. Women with epilepsy: A handbook of health and treatment issues. Cambridge, U.K.: Cambridge University Press. In press.

Crumrine P. Childhood and adolescence for the young woman with epilepsy. In: Morrell M, ed. Women with epilepsy: A handbook of health and treatment issues. Cambridge, U.K.: Cambridge University Press. In press.

Dean P, Austin JK. Adolescent psychosocial issues in epilepsy. Clin Nurs Pract Epilepsy. 1996;3:4-6.

Diamantopoulos N, Crumrine PK. The effect of puberty on the course of epilepsy. Arch Neurol. 1986;43:873-876.

Friedman IM, Litt IF, King DR, et al. Compliance with anticonvulsant therapy by epileptic youth. Relationships to psychosocial aspects of adolescent

 
IMPORTANT SAFETY INFORMATION

DIASTAT® AcuDial™ (diazepam rectal gel) is a gel formulation of diazepam intended for rectal administration in the management of selected, refractory patients with epilepsy, on stable regimens of AEDs, who require intermittent use of diazepam to control bouts of increased seizure activity for patients 2 years and older.

In clinical trials with DIASTAT®, the most frequent side effect was somnolence (23%). Less frequent adverse events reported were dizziness, headache, pain, vasodilation, diarrhea, ataxia, euphoria, incoordination, asthma, rash, abdominal pain, nervousness and rhinitis (1%-5%). Please see full DIASTAT AcuDial Prescribing Information.