Puberty and Epilepsy
Why seizures, hormones and epilepsy care can change during adolescence
Puberty brings major physical, hormonal, emotional and social changes. For a young person with epilepsy, it can also be a time when seizure patterns, treatment needs and everyday challenges change.
This does not mean that puberty automatically makes epilepsy worse.
Research does not show a simple rule that seizures increase during puberty. Some people notice little or no difference, some improve, and others experience changes in seizure frequency or type. The effect depends on the individual and on the epilepsy syndrome involved.
Puberty is also the age when several epilepsy syndromes commonly first appear, so a change during adolescence is not always caused directly by hormones.
What happens during puberty?
Puberty is controlled by changes in hormone systems involving the brain, pituitary gland, adrenal glands and reproductive organs.
Levels and patterns of hormones such as oestrogen, progesterone and testosterone change as the body develops.
These hormones do much more than control physical development. They can also interact with the nervous system.
Research has shown that reproductive hormones can influence how excitable brain cells and networks are, but the relationship is complicated. It is too simplistic to describe one hormone as always increasing seizures and another as always preventing them.
The effect can vary according to hormone concentration, seizure type, brain region, epilepsy syndrome and the individual person.
Can puberty change seizure frequency?
It can in some people, but not predictably.
Older research examining epilepsy through puberty found that puberty itself did not generally produce a consistent worsening of epilepsy. More recent clinical guidance recognises that individual seizure patterns may nevertheless change during adolescence, particularly as reproductive hormone cycles develop.
This means that a young person whose seizures change around puberty should not simply be told that it is "just hormones".
A significant change deserves proper review.
Doctors may need to consider several possible explanations, including:
development of an age-related epilepsy syndrome
changing sleep patterns
missed medication
illness
stress
menstrual-cycle-related changes
medication effects
changes in seizure type
or progression of the person's existing epilepsy.
Some epilepsies commonly begin during adolescence
Puberty and adolescence overlap with the typical age of onset of several recognised epilepsy syndromes.
Juvenile myoclonic epilepsy
Juvenile myoclonic epilepsy, usually called JME, commonly begins during the teenage or young-adult years.
The International League Against Epilepsy describes a typical onset between about 10 and 24 years, although the accepted range is wider.
Myoclonic seizures are a defining feature. These are very brief shock-like muscle jerks, often affecting the arms.
Generalised tonic-clonic seizures may also occur, and some people experience absence seizures.
Seizures are often particularly associated with waking and insufficient sleep.
Juvenile absence epilepsy
Juvenile absence epilepsy (JAE) usually begins between approximately 8 and 20 years of age, with a peak around 9 to 13 years.
Absence seizures cause brief interruptions of awareness. Generalised tonic-clonic seizures can also occur.
Because staring or brief lapses in awareness can be mistaken for daydreaming, inattention or behaviour, absence seizures may sometimes go unrecognised at first.
Other adolescent-onset generalised epilepsies
Epilepsy with generalised tonic-clonic seizures alone can also begin during adolescence or early adulthood.
This is one reason why a first seizure during the teenage years should be properly investigated rather than automatically attributed to hormones, stress or lack of sleep.
Sleep becomes particularly important
Adolescence often brings changes in sleep.
Young people may go to bed later because of schoolwork, social activity, gaming, phones, work or simply because their natural sleep pattern shifts during adolescence.
For many people with epilepsy, insufficient sleep can make seizures more likely.
This is particularly important in juvenile myoclonic epilepsy, where seizures frequently occur after waking and lack of sleep is a recognised trigger.
Regular sleep does not guarantee seizure control, but persistent sleep deprivation is worth discussing with the epilepsy team if seizures are changing.
Puberty, periods and seizures
For girls, puberty eventually brings menarche — the first menstrual period — followed by developing menstrual cycles.
As cycles become established, oestrogen and progesterone levels fluctuate throughout each month.
Some people with epilepsy notice that their seizures repeatedly become more frequent at particular stages of their menstrual cycle.
When seizures show a recurring relationship with menstrual-cycle phases, this may be described as catamenial epilepsy.
Not every person with epilepsy experiences this, and a temporary seizure increase around one period does not by itself establish a catamenial pattern.
Keeping a record of both seizures and menstrual dates can help identify whether a repeated pattern exists.
Related Information Hub pages:
Menstruation and Epilepsy
Catamenial Epilepsy
Contraception and Epilepsy
Epilepsy itself can affect reproductive health
The relationship between epilepsy and hormones works in both directions.
Hormones may influence seizures, but epilepsy and some antiseizure medications can also affect reproductive and endocrine systems.
Research has identified associations between epilepsy and menstrual irregularities in some people, although the causes can involve epilepsy type, medication, hormones and other health factors.
Irregular or absent periods should therefore not automatically be assumed to be a normal consequence of epilepsy. They may deserve medical assessment.
Medication during puberty
Puberty is not a reason to stop or alter epilepsy medication without medical advice.
Young people should continue taking antiseizure medication exactly as prescribed unless their epilepsy specialist changes the treatment.
NICE recommends an individualised treatment strategy that takes account of factors including the person's age, sex, seizure type, epilepsy syndrome, benefits and risks of treatment and personal circumstances.
As a young person grows and their circumstances change, regular medication reviews become important.
This is also the stage when conversations about reproductive safety may need to begin — before pregnancy is ever being considered.
Why reproductive safety may need discussing early
Some antiseizure medicines carry important reproductive or pregnancy-related risks.
This does not mean that a young person should stop their medication.
Stopping antiseizure medication suddenly can itself be dangerous.
Instead, medication choices and reproductive risks should be discussed with the epilepsy specialist so that treatment remains appropriate as the young person gets older.
In the UK, specific safety measures apply to medicines including valproate and topiramate.
Current MHRA rules state that valproate should generally only be started in someone under 55 when two specialists agree that other treatments are ineffective or unsuitable, or that the reproductive risks do not apply.
Topiramate also has specific pregnancy-prevention requirements for women and girls who could become pregnant.
These rules can change, so current specialist and MHRA advice should always be checked.
Growing independence can affect epilepsy care
Puberty is not only about hormones.
Teenagers gradually take more responsibility for things that parents or carers may previously have managed, including:
remembering medication
ordering prescriptions
recognising seizure triggers
explaining their epilepsy to other people
attending appointments
making decisions about school or college
socialising independently
sleep routines
alcohol as they become older
relationships
contraception
driving
and eventually moving from children's to adult epilepsy services.
NICE recommends involving young people directly in discussions about their epilepsy in a way that matches their developmental age and understanding.
Information should include medication adherence, seizure triggers, safety, seizure type, the person's epilepsy syndrome and epilepsy-related risks.
Moving from children's to adult epilepsy services
Transition should not simply mean reaching a certain birthday and suddenly being transferred to another clinic.
NICE recommends a planned, individualised transition between children's and adult epilepsy services.
The young person should increasingly be involved in understanding their condition and making decisions about their care.
Important subjects during transition may include:
seizure control
medication
side effects
memory and cognition
emotional wellbeing
education
employment
relationships
sexual and reproductive health
pregnancy risks
SUDEP
driving
independence
and knowing who to contact if problems develop.
Young people with complex epilepsy, learning disabilities or poorly controlled seizures may need transition planning to begin earlier.
School, concentration and memory
Epilepsy during adolescence can affect much more than seizures.
Some young people experience difficulties with:
attention
concentration
memory
tiredness
medication side effects
missed lessons
anxiety about having a seizure publicly
embarrassment or stigma
or reduced confidence.
These problems should not automatically be dismissed as teenage behaviour.
NICE recognises psychological, cognitive, behavioural and developmental issues as an important part of epilepsy care.
Support may be needed at school or college as well as in the clinic.
When should a change be discussed with the epilepsy team?
A young person or their parent or carer should consider contacting the epilepsy team if:
seizures become more frequent
seizures become longer or more severe
a different type of seizure appears
previously controlled seizures return
morning jerks or unexplained dropping of objects begin
staring episodes or unexplained lapses of awareness appear
seizures seem repeatedly connected with periods
medication side effects are becoming difficult
medication is regularly being missed
puberty or menstrual development seems unusual
or there are concerns about mood, learning, memory or behaviour.
New symptoms should not automatically be attributed to puberty.
Keeping a seizure record can help
A seizure diary can become particularly useful during adolescence.
Useful information may include:
seizure date and time
seizure type
duration
sleep the night before
illness
missed medication
stress
alcohol where relevant
menstrual-cycle dates
possible triggers
and recovery afterwards.
Patterns seen over several weeks or months may be much more useful than trying to remember everything during an appointment.
The important message
Puberty does not have one predictable effect on epilepsy.
Hormones can influence brain excitability, but adolescence also brings changes in sleep, lifestyle, independence, medication management and the types of epilepsy that may first emerge at this age.
For some people, seizures remain stable. For others they change.
A significant change should be investigated rather than automatically being blamed on puberty.
Good epilepsy care during adolescence means looking at the whole person — seizures, treatment, hormones, sleep, education, emotional wellbeing, independence and the transition into adult life.
Sources and further reading
This page was developed using information and research from:
NICE — Epilepsies in children, young people and adults (NG217).
Current NICE guidance covering diagnosis, treatment, information, safety and transition to adult services. The guideline was last updated in January 2025.
International League Against Epilepsy / EpilepsyDiagnosis.org.
Diagnostic information for juvenile myoclonic epilepsy, juvenile absence epilepsy and other epilepsy syndromes beginning during adolescence.
Epilepsy Society — Women, girls and epilepsy.
Information on hormones, puberty and reproductive stages, updated July 2026.
Epilepsy Action — Juvenile myoclonic epilepsy and juvenile absence epilepsy.
UK information covering adolescent-onset epilepsy syndromes and recognised seizure triggers.
American College of Obstetricians and Gynecologists — Gynecologic Management of Adolescents and Young Women With Seizure Disorders.
Clinical review covering puberty, menstruation, seizures and reproductive health in adolescents with epilepsy.
Tettenborn B, et al. Women with epilepsy: Evidence-based counseling across the lifespan. Epilepsia. 2026.
A recent review covering adolescence, reproductive health, hormones and antiseizure medication across the lifespan.
Medicines and Healthcare products Regulatory Agency (MHRA).
Current UK reproductive-safety guidance for valproate and topiramate.
Information reviewed: September 2026.
This page provides general educational information. It does not replace individual advice from a neurologist, paediatrician, epilepsy specialist nurse, pharmacist or other healthcare professional.
