title: Treatment issues for children with epilepsy transitioning to adult care.
abstract: This is the third of three papers that summarize the second symposium on Transition in Epilepsies held in Paris in June 2016. This paper focuses on treatment issues that arise during the course of childhood epilepsy and make the process of transition to adult care more complicated. Some AEDs used during childhood, such as stiripentol, vigabatrin, and cannabidiol, are unfamiliar to adult epilepsy specialists. In addition, new drugs are being developed for treatment of specific childhood onset epilepsy syndromes and have no indication yet for adults. The ketogenic diet may be effective during childhood but is difficult to continue in adult care. Regional adult epilepsy diet clinics could be helpful. Polytherapy is common for patients transitioning to adult care. Although these complex AED regimes are difficult, they are often possible to simplify. AEDs used in childhood may need to be reconsidered in adulthood. Rescue medications to stop prolonged seizures and clusters of seizures are in wide home use in children and can be continued in adulthood. Adherence/compliance is notoriously difficult for adolescents, but there are simple clinical approaches that should be helpful. Mental health issues including depression and anxiety are not always diagnosed and treated in children and young adults even though effective treatments are available. Attention deficit hyperactivity disorder and aggressive behavior disorders may interfere with transition and successful adulthood but these can be treated. For the majority, the adult social outcome of children with epilepsy is unsatisfactory with few proven interventions. The interface between pediatric and adult care for children with epilepsy is becoming increasingly complicated with a need for more comprehensive transition programs and adult epileptologists who are knowledgeable about special treatments that benefit this group of patients.
authors.affiliation: Reference Centre for Rare Epilepsies, Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, University of Paris Descartes, Inserm U1129, Paris, France. Electronic address: rimanabbout@yahoo.com.
authors.forename: Rima
authors.initials: R
authors.lastname: Nabbout
authors.affiliation: Dalhousie University & IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Carol S
authors.initials: CS
authors.lastname: Camfield
authors.affiliation: Department of Medicine, University of Toronto Adult Epilepsy Genetics Program, University of Toronto, Toronto Western Hospital, Toronto, Canada.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Andrade
authors.affiliation: University Hospitals of Lyon (HCL) and DYCOG Team, Lyon Neuroscience Research Centre (CRNL), INSERM U1028, CNRS UMR 5292, Lyon, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Arzimanoglou
authors.affiliation: Pediatric Neurology, Necker-Enfants Malades Hospital, Inserm U1129, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chiron
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Joyce A
authors.initials: JA
authors.lastname: Cramer
authors.affiliation: NYU Comprehensive Epilepsy Center, New York, NY, United States.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: French
authors.affiliation: Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Eric
authors.initials: E
authors.lastname: Kossoff
authors.affiliation: Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, Department of Neuropsychiatry, South West London & St George's Mental Health Trust, Institute of Medical and Biomedical Sciences, St George's University of London, United Kingdom.
authors.forename: Marco
authors.initials: M
authors.lastname: Mula
authors.affiliation: Dalhousie University & IWK Health Center, Dalhousie University, Halifax, NS, Canada.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Camfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000927:Anticonvulsants / Q000627:therapeutic use; D002185:Cannabidiol / Q000627:therapeutic use; D002648:Child; D003226:Congresses as Topic; D055423:Diet, Ketogenic / Q000379:methods / Q000639:trends*; D004148:Dioxolanes / Q000627:therapeutic use; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D060305:Transition to Adult Care / Q000639:trends*; D016896:Treatment Outcome; D020888:Vigabatrin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D004148:Dioxolanes; D002185:Cannabidiol; D020888:Vigabatrin; C021092:stiripentol
keywords: Adult; Compliance; Mental health; Pediatric; Transition; Treatment