Issues for people with epilepsy

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Epilepsy is a condition defined by unprovoked or reflex seizures, often occurring without warning. The condition impacts much of a patient's life, including personal safety, memory, and views by others. Those who have active seizures live with the fact that they can have a seizure at any time. Those whose seizures are controlled by medication live with the underlying side effects and the need to remember to take the medication at the correct times.

Contents

Mental health

Cognition

Most people with epilepsy have normal cognition levels at most times. When not during or immediately proceeding a seizure, a person with epilepsy generally is physically and mentally capable of everything a person without epilepsy can do.

A seizure can be disruptive to the process of normal life. During the seizure, depending on the type, the patient may be totally or partially unconscious, and out of commission to perform normal activities. Following the seizure the patient may be confused and disoriented for a period of time. The patient may also require rest after the seizure. [1]

Following a seizure, many people do not have memory of a period of time immediately before the seizure.

Depression

Depression is very common among people with epilepsy, with rates as high as 20% for those whose seizures are successfully controlled, and 60% for those with uncontrolled seizures. Suicide is ten times as likely for people with epilepsy than it is for others. [2]

Personal safety

Personal safety is a major concern for persons with epilepsy. When sudden loss of consciousness occurs without warning, the patient is at risk for personal injury and possibly causing injury to others through loss of control or awareness of one's own body.

Many activities of daily living can be dangerous for people with epilepsy, such as bathing, cooking, or walking up or down steps. These can be remedied by taking showers as opposed to tub baths, cooking with a microwave oven rather than an open flame, and living on a ground level. [3]

Certain high-risk sports, such as swimming, scuba diving, or snorkeling are considered dangerous for people with epilepsy. But they pose a level of danger for all participants. They can be equally safe for people with epilepsy and others if carried out with proper safety precautions. [4]

Driving

The operation of a motor vehicle can be hazardous for people with epilepsy because the driver can lose consciousness behind the wheel, and therefore, control of the vehicle, putting themselves and the public at risk. For those whose seizures are successfully controlled, many of the medications have side effects that cause drowsiness, also impacting driving. As a result, many countries and states place restrictions on driving such as a necessity to be seizure-free for a period of time before being allowed to drive.

Social issues

Epilepsy can have tremendous social issues for patients.

Social acceptance from others is a common challenge. Though persons with epilepsy are otherwise just like anyone else, there are stigmas associated with epilepsy that can affect one's acceptance among others.

Depression is common due to impaired social acceptance. [1]

Employment

Many people with epilepsy have trouble with employment due to safety performing job duties, loss of work time during and after seizures, and transportation to and from a place of employment.

Children with epilepsy


The social stigma can stand in the way, as the child is more prone to bullying. [5]

Epilepsy can force a child to be left out of activities common for children to be involved in, such as sports. [6]

Epilepsy can affect a child's education. The child may be forced to miss a lot of school due to seizures. The seizures can impair a child's ability to memorize learning materials.

Related Research Articles

<span class="mw-page-title-main">Epilepsy</span> Group of neurological disorders causing seizures

Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. An epileptic seizure is the clinical manifestation of an abnormal, excessive, purposeless and synchronized electrical discharge in the brain cells called neurons. The occurrence of two or more unprovoked seizures defines epilepsy. The occurrence of just one seizure may warrant the definition in a more clinical usage where recurrence may be able to be prejudged. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical activity in the brain. These episodes can result in physical injuries, either directly such as broken bones or through causing accidents. In epilepsy, seizures tend to recur and may have no immediate underlying cause. Isolated seizures that are provoked by a specific cause such as poisoning are not deemed to represent epilepsy. People with epilepsy may be treated differently in various areas of the world and experience varying degrees of social stigma due to the alarming nature of their symptoms.

<span class="mw-page-title-main">Seizure</span> Period of symptoms due to excessive or synchronous neuronal brain activity

An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with loss of consciousness, to shaking movements involving only part of the body with variable levels of consciousness, to a subtle momentary loss of awareness. Most of the time these episodes last less than two minutes and it takes some time to return to normal. Loss of bladder control may occur.

<span class="mw-page-title-main">Lamotrigine</span> Medication used for bipolar disorder, epilepsy, & many seizure disorders

Lamotrigine, sold under the brand name Lamictal among others, is a medication used to treat epilepsy and stabilize mood in bipolar disorder. For epilepsy, this includes focal seizures, tonic-clonic seizures, and seizures in Lennox-Gastaut syndrome. In bipolar disorder, lamotrigine has not been shown to reliably treat acute depression; but for patients with bipolar disorder who are not currently symptomatic, it appears to be effective in reducing the risk of future episodes of depression.

Absence seizures are one of several kinds of generalized seizures. In the past, absence epilepsy was referred to as "pyknolepsy," a term derived from the Greek word "pyknos," signifying "extremely frequent" or "grouped".These seizures are sometimes referred to as petit mal seizures ; however, usage of this terminology is no longer recommended. Absence seizures are characterized by a brief loss and return of consciousness, generally not followed by a period of lethargy. Absence seizures are most common in children. They affect both sides of the brain.

<span class="mw-page-title-main">Myoclonus</span> Involuntary, irregular muscle twitch

Myoclonus is a brief, involuntary, irregular twitching of a muscle, a joint, or a group of muscles, different from clonus, which is rhythmic or regular. Myoclonus describes a medical sign and, generally, is not a diagnosis of a disease. These myoclonic twitches, jerks, or seizures are usually caused by sudden muscle contractions or brief lapses of contraction. The most common circumstance under which they occur is while falling asleep. Myoclonic jerks occur in healthy people and are experienced occasionally by everyone. However, when they appear with more persistence and become more widespread they can be a sign of various neurological disorders. Hiccups are a kind of myoclonic jerk specifically affecting the diaphragm. When a spasm is caused by another person it is known as a provoked spasm. Shuddering attacks in babies fall in this category.

<span class="mw-page-title-main">Ketogenic diet</span> High-fat dietary therapy for epilepsy

The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate dietary therapy that in conventional medicine is used mainly to treat hard-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates.

<span class="mw-page-title-main">Status epilepticus</span> Medical condition

Status epilepticus (SE), or status seizure, is a medical condition consisting of a single seizure lasting more than 5 minutes, or 2 or more seizures within a 5-minute period without the person returning to normal between them. Previous definitions used a 30-minute time limit. The seizures can be of the tonic–clonic type, with a regular pattern of contraction and extension of the arms and legs, or of types that do not involve contractions, such as absence seizures or complex partial seizures. Status epilepticus is a life-threatening medical emergency, particularly if treatment is delayed.

<span class="mw-page-title-main">Temporal lobe epilepsy</span> Chronic focal seizure disorder

In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. Temporal lobe epilepsy is the most common type of focal onset epilepsy among adults. Seizure symptoms and behavior distinguish seizures arising from the medial temporal lobe from seizures arising from the lateral (neocortical) temporal lobe. Memory and psychiatric comorbidities may occur. Diagnosis relies on electroencephalographic (EEG) and neuroimaging studies. Anticonvulsant medications, epilepsy surgery and dietary treatments may improve seizure control.

Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures arising in the frontal lobes of the brain, that often occur during sleep. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form in that both forms are characterized by partial (focal) seizures.

Sudden unexpected death in epilepsy (SUDEP) is a fatal complication of epilepsy. It is defined as the sudden and unexpected, non-traumatic and non-drowning death of a person with epilepsy, without a toxicological or anatomical cause of death detected during the post-mortem examination.

Dravet syndrome, previously known as severe myoclonic epilepsy of infancy (SMEI), is an autosomal dominant genetic disorder which causes a catastrophic form of epilepsy, with prolonged seizures that are often triggered by hot temperatures or fever. It is very difficult to treat with anticonvulsant medications. It often begins before one year of age, with six months being the age that seizures, char­ac­ter­ized by prolonged convulsions and triggered by fever, usually begin.

Multiple subpial transections is a surgical treatment modality for epilepsy used in scenarios wherein epileptogenic brain regions cannot be removed safely. The surgeon makes a series of shallow cuts (transections) into the brain's cerebral cortex. These cuts are thought to interrupt some fibers that connect neighboring parts of the brain, but they do not appear to cause long-lasting impairment in the critical functions that these areas perform.

Geschwind syndrome, also known as Gastaut-Geschwind, is a group of behavioral phenomena evident in some people with temporal lobe epilepsy. It is named for one of the first individuals to categorize the symptoms, Norman Geschwind, who published prolifically on the topic from 1973 to 1984. There is controversy surrounding whether it is a true neuropsychiatric disorder. Temporal lobe epilepsy causes chronic, mild, interictal changes in personality, which slowly intensify over time. Geschwind syndrome includes five primary changes; hypergraphia, hyperreligiosity, atypical sexuality, circumstantiality, and intensified mental life. Not all symptoms must be present for a diagnosis. Only some people with epilepsy or temporal lobe epilepsy show features of Geschwind syndrome.

Post-traumatic epilepsy (PTE) is a form of acquired epilepsy that results from brain damage caused by physical trauma to the brain. A person with PTE experiences repeated post-traumatic seizures more than a week after the initial injury. PTE is estimated to constitute 5% of all cases of epilepsy and over 20% of cases of acquired epilepsy.

Post-traumatic seizures (PTS) are seizures that result from traumatic brain injury (TBI), brain damage caused by physical trauma. PTS may be a risk factor for post-traumatic epilepsy (PTE), but a person having a seizure or seizures due to traumatic brain injury does not necessarily have PTE, which is a form of epilepsy, a chronic condition in which seizures occur repeatedly. However, "PTS" and "PTE" may be used interchangeably in medical literature.

Epilepsy and driving is a personal and safety issue. A person with a seizure disorder that causes lapses in consciousness may put the public at risk in the event that a seizure occurs while they are operating a motor vehicle. Not only can a seizure itself cause an accident, but anticonvulsants often have side effects that include drowsiness. People with epilepsy are more likely to be involved in a traffic accident than people who do not have the condition, although reports range from minimally more likely up to seven times more likely.

Generally, seizures are observed in patients who do not have epilepsy. There are many causes of seizures. Organ failure, medication and medication withdrawal, cancer, imbalance of electrolytes, hypertensive encephalopathy, may be some of its potential causes. The factors that lead to a seizure are often complex and it may not be possible to determine what causes a particular seizure, what causes it to happen at a particular time, or how often seizures occur.

Epilepsy can affect employment for a variety of reasons. Many employers are reluctant to hire a person they know has epilepsy, even if the seizures are controlled by medication. If the employee has a seizure while at work, they could harm themselves depending on the nature of the work. Employers are often unwilling to bear any financial costs that may come from employing a person with epilepsy, i.e. insurance costs, paid sick leave etc. Many people whose seizures are successfully controlled by a medication experience a variety of side effects, most notably drowsiness, which may affect job performance. Many laws prohibit or restrict people with epilepsy from performing certain duties, most notably driving or operating dangerous machinery, thereby lowering the pool of jobs available to people with epilepsy. People with epilepsy are also prohibited from joining the armed forces, though they may work in certain civilian military positions.

<span class="mw-page-title-main">Epilepsy in children</span>

Epilepsy is a neurological condition of recurrent episodes of unprovoked epileptic seizures. A seizure is an abnormal neuronal brain activity that can cause intellectual, emotional, and social consequences. Epilepsy affects children and adults of all ages and races, it is one of the most common neurological disorders of the nervous system. As well as, this condition is more common among children than adults affecting about 6 out of 1000 US children that are between the age of 0 to 5 years old. The epileptic seizures can be of different types depending on the part of the brain that was affected, seizures are classified in 2 main types partial seizure or genralized seizure.

Drug-resistant epilepsy (DRE), also known as refractory epilepsy, intractable epilepsy, or pharmacoresistant epilepsy, is diagnosed following a failure of adequate trials of two tolerated and appropriately chosen and used antiepileptic drugs (AEDs) to achieve sustained seizure freedom. The probability that the next medication will achieve seizure freedom drops with every failed AED. For example, after two failed AEDs, the probability that the third will achieve seizure freedom is around 4%. Drug-resistant epilepsy is commonly diagnosed after several years of uncontrolled seizures, however, in most cases, it is evident much earlier. Approximately 30% of people with epilepsy have a drug-resistant form.

References

  1. 1 2 Epilepsy: Information for You and Those Who Care about You By Elaine Wyllie: page 122
  2. Epilepsy: Information for You and Those Who Care about You By Elaine Wyllie: page 124
  3. Epilepsy: Patient and Family Guide By Orrin Devinsky: pages 258
  4. Epilepsy: Patient and Family Guide By Orrin Devinsky: pages 257-58
  5. Epilepsy: The Ultimate Teen Guide By Kathlyn Gay, Sean McGarrahan: page 42
  6. Epilepsy: The Ultimate Teen Guide By Kathlyn Gay, Sean McGarrahan: page 44