Melanie Cole (Host): Being an adolescent can be challenging enough and being an adolescent while dealing with epilepsy can be even tougher. My guest is Dr. Jennifer Langer, she is board certified neurologist and neurophysiologist who specializes in caring for adolescents with epilepsy. Welcome to the show Dr. Langer, first give us a brief explanation if you would about what epilepsy is and how it affects adolescents.

Dr. Jennifer Langer (Guest): Sure, thanks so much for having me. So, first epilepsy means a tendency towards having unprovoked seizures and by unprovoked, I mean seizures that are not caused by drugs or alcohol or medicine, it means a tendency that brain has towards having seizures. There are only two broad categories of epilepsy, the first is a generalized epilepsy meaning seizures are detected everywhere in the brain at the same time versus a focal or partial epilepsy where seizures start in one area and adolescents can have either type. For an adolescent, epilepsy can really occur in two ways, the first is it can occur as children and continue to have seizures through adolescence and young adulthood so that 50% of kids with epilepsy will not outgrow their seizures and they will continue into that time period. The second possibility is that epilepsy and seizures start in adolescence and those patients can be a little bit different.

Melanie: So really when children reach adolescence, as we said at the beginning, it is pretty tough time anyway, what are some of the unique challenges that a child that has been diagnosed with epilepsy might face.

Dr. Langer: Absolutely, so I think back to my own period of adolescence and I think all of us can and it is a challenging time for everybody. There are physical changes, emotional changes and social changes that happen and there is a new issue that teens face, they face peer pressure, they face issues with driving, in sport, the new social challenges like drinking, sex, and things like that. It is also really critical time where identity forms and all these things can be made more difficult and more challenging by having a chronic disease, particularly a chronic disease like epilepsy.

Melanie: If you have epilepsy as an adolescent, are you allowed to drive, what are the restrictions there?

Dr. Langer: So good question, the restrictions first of all are state specific. In the State of Virginia, adolescents or adults and even who has had a seizure cannot drive for six months after that seizure, so your ride has implications on starting drivers ed, on getting learner’s permit and then feeling independent being able to drive by themselves.

Melanie: What about seizure awareness, as an adolescent, I mean you have a lot of friends, you know hopefully and there are people around and at the school, is there a seizure awareness that you think the adolescent needs to make people aware of so that if this happens, people know what to do because it can be quite frightening.

Dr. Langer: Sure, I always encourage my adolescents to let their friends know they have epilepsy, particularly if they have more frequent seizures and I think it is important to number 1, it reduces the stigma associated with epilepsy, so the more information we get out to teens and we get after the schools, the more people know about epilepsy and the less frightened they are about encountering someone with epilepsy or not knowing what to do if a seizure occurs, so I always tell my teens to let their friends and family know if they have a seizure, the best thing that their friends and family can do is stay calm, to make sure they were in a safe place, lower them to the ground if it’s a convulsion, turn them on their side and just allow the seizure to continue while maintaining safety for the patient, never put anything in the person’s mouth, if they can time is often very helpful. Most seizures are short-lasting, less than two or three minutes, if a seizure lasts longer than that, then the rescue squad or EMS should be called.

Melanie: What do you focus on to help your patients, what are the main sort of management things that you really truly focus on?

Dr. Langer: Well, being primarily an epilepsy doctor, my main focus is in the treatment of epilepsy, so for all my patients, my goal is always seizure freedom and seizure freedom without side effects of medicines. For the small percentage of patients with epilepsy that are intractable, meaning their seizures are not well controlled with medicine, we often think of other approaches like epilepsy surgery, devices like a vagal nerve stimulator or diet treatment with a modified Atkins diet. So for me, the first focus is always in the treatment of epilepsy, but particularly in adolescents, there is also I think a really important additional focus and that is on quality of life, it is that we know like I said earlier is that in a teen with epilepsy, it is really hard, so we try to focus a lot on how we can make that better, so whether it is teaching teens about their epilepsy because they were diagnosed as a kid and really never had a discussion with their provider themselves on why they have epilepsy, what epilepsy means. We focus a lot on the importance of taking medicine and help teens troubleshoot for taking their medicine more consistently and we really help them focus on taking control of their epilepsy, so that as they grow older into adulthood, they are able to manage their disease by themselves and that takes knowledge and that also takes empowerment and then also focus on just somebody ins and outs of living with epilepsy.

Melanie: And why should patients come to UVA’s Adolescent Epilepsy Clinic for their care.

Dr. Langer: So, our adolescent clinic is the only clinic of its type in the region and that is because we really focus on adolescents as being different because adolescents are not kids with epilepsy and they are not adults with epilepsy and they have their own unique set of concerns and we focus on that. The clinic consists of myself, Mary Thompson who is a nurse practitioner and Debra Morley who is nurse coordinator and all of us bring a different area of expertise to the care of adolescents. In addition, we are housed inside an epilepsy center and the epilepsy center of UVA provides us with the ability to take care of patients who have really tough to control seizures and we have access to different diagnostic testing and treatment modalities that would be afforded at any large scale epilepsy center.

Melanie: And in just the last minute or so, your best advice for the parents listening and the adolescents that have epilepsy.

Dr. Langer: So, I think first thing first is you are not alone. Epilepsy in adolescents is probably the most common neurologic problem in adolescents because it is important to know that you are not alone, there are other teens out there and there are places you can go for help, so we are happy to see teens that help with the management of epilepsy and help deal with the other problems that come along with epilepsy and there are also some reasonable web based resources as well including information that we have at UVA and others like epilepsy.com that can provide some really good information for teens living with epilepsy.

Melanie: And you do advise them to let their friends know and take the stigma out of it and the school system so that everyone is aware and knows what to do in the case of a seizure but it mostly focuses on preventing those seizures in the first place, correct.

Dr. Langer: Absolutely.

Melanie: Thank you so much Dr. Jennifer Langer, board certified neurologist and neurophysiologist who specializes in caring for adolescents with epilepsy. You are listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. This is Melanie Cole. Thanks for listening.