Epilepsy in Emerging Adulthood: Clinical, Psychosocial, and Surgical Challenges
A recent study examined whether epilepsy has unique effects during emerging adulthood (ages 19–29), a developmental stage characterized by ongoing brain maturation, increasing independence, and major educational, vocational, and social transitions.
Emerging adulthood may be a distinct life stage rather than simply an extension of adolescence or adulthood, as the brain regions involved in executive function and emotional regulation continue to mature while individuals establish careers, relationships, and personal identities. The study analyzed 6,824 patients with epilepsy and a separate cohort of 240 epilepsy surgery patients, comparing individuals who were currently emerging adults, those whose epilepsy began during emerging adulthood, and younger and older age groups.
Emerging adults had the highest psychiatric burden of any age group, with higher rates of anxiety and depression, poorer quality of life, and greater self-reported disability. Substance use was also more common, particularly cannabis use, which exceeded rates seen in age-matched members of the general population. The authors suggest this may reflect a combination of social pressures, self-medication for psychiatric symptoms, and developmental risk-taking behaviors.
Emerging adults were also the least likely to be seizure-free for one year despite receiving similar or lower antiseizure medication doses than other age groups. Potential contributors include challenges transitioning from pediatric to adult care, reduced social support, greater responsibility for self-management, and differences in epilepsy characteristics.
Among patients who underwent epilepsy surgery, seizure outcomes were comparable to those of older adults. However, emerging adults spent a greater proportion of their lives waiting for surgery than any other age group, suggesting potential delays in referral and evaluation. The authors propose that epilepsy may have particularly significant consequences during emerging adulthood because it can interfere with education, employment, driving, relationships, social participation, and identity formation.
These findings support the view that emerging adults with epilepsy represent a distinct patient population and may benefit from targeted interventions, including improved transition programs from pediatric to adult care, integrated mental health support, earlier referral to comprehensive epilepsy centers, and more timely evaluation for epilepsy surgery.
