Conference ProceedingsOutcome of childhood-onset epilepsy from adolescence to adulthood: Transition issues

- Some causes of childhood epilepsy have different health concerns in adulthood. In TSC, childhood concerns focus around seizures and cognition while in adults, the focus shifts to kidney and lung disease as well as anxiety disorders.
- Some causes of childhood epilepsy evolve in complex patterns. Dravet syndrome shows different seizure severity in adulthood with increasing concerns about mobility.
- Some epilepsy syndromes present in childhood, may persist into adulthood or morph into other syndromes such as childhood absence epilepsies.
- Children with structural etiologies who become seizure-free with our without surgery may still have emerging psychopathology in adulthood that impairs their quality of life.
- There is increasing concern based on one cohort of children with epilepsy followed for 45-50 years that the risk of stroke and dementia is increased in adulthood.

This is the second of three papers that summarize the second symposium on Transition in Epilepsies held in Paris in June 2016. This paper addresses the outcome for some particularly challenging childhood-onset epileptic disorders with the goal of recommending the best approach to transition. We have grouped these disorders in five categories with a few examples for each. The first group includes disorders presenting in childhood that may have late- or adult-onset epilepsy (metabolic and mitochondrial disorders). The second group includes disorders with changing problems in adulthood (tuberous sclerosis complex, Rett syndrome, Dravet syndrome, and autism). A third group includes epilepsies that change with age (Childhood Absence Epilepsy, Juvenile Myoclonic Epilepsy, West Syndrome, and Lennox-Gastaut syndrome). A fourth group consists of epilepsies that vary in symptoms and severity depending on the age of onset (autoimmune encephalitis, Rasmussen's syndrome). A fifth group has epilepsy from structural causes that are less likely to evolve in adulthood. Finally we have included a discussion about the risk of later adulthood cerebrovascular disease and dementia following childhood-onset epilepsy. A detailed knowledge of each of these disorders should assist the process of transition to be certain that attention is paid to the most important age-related symptoms and concerns.