Several specific epileptic syndromes begin during adolescence, including juvenile myoclonic epilepsy, juvenile absence epilepsy, epilepsy with tonic-clonic seizures on awakening, and some forms of partial epilepsies. These syndromes need careful attention in terms of drug treatment because adolescence is a complex period socially and behaviourally and the adverse effects of drugs during this period could prove problematic. Whether all epilepsies that begin during adolescence require treatment is a difficult issue. In 10% of adolescents, a seizure may remain isolated. Furthermore, the avoidance of precipitating factors could be a sufficient therapeutic strategy in some patients. Instructions should be given regarding the potentially seizure-triggering effect of certain behaviours, e.g. sleep deprivation and the consumption of alcohol (ethanol) and recreational drugs. If drug treatment is required, the choice of drug will depend on the identified epileptic syndrome and the efficacy and adverse effect profile of the drug.