What is epilepsy?
Epilepsy is a type of neurological disorder characterized by recurrent seizures. In epilepsy, the normal pattern of activity of the nerve cells or neurons is disturbed, causing abnormal electrical activity in the brain. This can lead to the experience of a combination of symptoms such as strange emotions and sensations, thought disturbances, convulsions, muscle spasms, and loss of consciousness, commonly called as seizures. When a person has two or more seizure episodes, he is considered to be epileptic.1
There can be many causes of epilepsy. Anything that affects the normal neuronal activity of the brain, including trauma or illness, can lead to a seizure. If the source of seizure within the brain is localized, it is called a focal or partial onset seizure. If the source of seizure within the brain is distributed, it is called a generalized seizure.2
More than 50 million people – 2 % to 3% of the world’s population, are affected by epilepsy.3 Many more struggle with the physical and psychological effects of the disease. Currently available treatment options suppress seizures, thereby helping to control epilepsy; however a permanent cure is generally not possible. Besides, around 20% of all epileptics are refractory to any kind of treatment. Surgery may be considered in difficult cases.2
Impact on daily life:
Patients with epilepsy lead seemingly normal lives; however, the quality of life of patients themselves and their family and friends is significantly impacted. Patients with severe seizures who do not respond to treatment have reduced life expectancy. They also suffer from risk of cognitive impairment. Epilepsy proves detrimental by affecting various aspects of a patient’s life. These include emotions and behavior, driving and recreation, education and employment, pregnancy and motherhood.2
Emotions and Behavior:
Emotional and behavioral problems are common in patients with epilepsy. They are more likely to suffer from low-self esteem, depression and suicide. Children with epilepsy are particularly affected emotionally due to the negative impact of bullying, teasing, or avoidance in their peer circle. Psychosocial problems result due to frustration or embarrassment associated with epilepsy. There is also the constant fear of having a seizure again.2
Driving and Recreation:
A restriction on driving is commonly faced by epilepsy patients. Many states have specific rules regarding issuance of driver’s licences to epilepsy patients. This severly affects the patient’s independence. Participation in recreational sports such as skydiving or motor racing is also restricted in these patients.2
Education and Employment:
Though the state does not restrict employment to people with epilepsy or other handicaps, a large number of all adult epilepsy patients have been found to be unemployed. The percentage of patients who complete formal education is also found to be low. A restriction on driving can affect a patient’s chances of getting the right kind of job. Antiepilepsy medications may interfere with memory and concentration and thereby affect a patient’s professional and academic output.2
Pregnancy and Motherhood:
Severe seizures during pregnancy can affect the developing baby and lead to miscarraige. Some seizure medications are also known to cause birth defects. Increased precautions are recommended for an epilepsy patient before becoming pregnant and also during pregnancy.2
Epilepsy patients with poorly controlled seizures are associated with risk of death from four main causes: status epilepticus- commonly associated with non-compliance to anticonvulsant medication, suicide due to depression, psychosocial trauma from seizures, and sudden unexpected death in epilepsy. Certain comorbid disease conditions such as infertility, reduced sexual libido, and anxiety disorders are also seen at a higher rate among epileptics. A seizure is more likely to result in self-injury in an epileptic patient.2
Coping with epilepsy:
A lot of individual and state support is needed so that patients and their caregivers cope with epilepsy. Counseling services and patient support groups need to be accessed as they provide a platform for the expression of feelings, frustrations, and sharing of experiences. Children with epilepsy may have special needs. These require to be accommodated by people around them including, parents, teachers, and peer groups.2 Depression results from a significant effect on the quality of life of both younger and older epileptic patients. A conscious effort on the part of family and friends is required to navigate a patient away from the psychosocial effects of epilepsy.4 Low educational status and monthly income predispose women epileptic patients to rely more on religious methods for coping with the disease. These women and there caregivers need to be exposed to constructive strategies for better management of the disease.5
Freedom from seizures with minimal impact on quality of life should be the goal of anti-epileptic medication. Therapy decisions should be based on parameters which affect these goals, including potential adverse reactions of therapy.6
References:
Epilepsy Information Page. National Institute of Neurological Disorders and Stroke. Available at: http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm#What_is\. Accessed December 12, 2008.
What is epilepsy? The Foundation for Better Health Care. Available at: http://www.fbhc.org/Patients/Modules/ep_whatis.cfm\. Accessed December 12, 2008.
Epilepsy: aetiology, epidemiology, and prognosis. World Health Organization. Available at: http://www.who.int/mediacentre/factsheets/fs165/en/. Accessed December 15, 2008.
Canuet L, Ishii R, Iwase M, et al. Factors associated with impaired quality of life in younger and older adults with epilepsy. Epilepsy Res. 2008. [Epub ahead of print]
Sachin S, Padma MV, Bhatia R, et al. Psychosocial inpact of epilepsy in women of childbearing age in India. Epileptic Disord. 2008;10(4): 282-289.
Glauser TA, Sankar R; Co-chairs of the Leadership in Epilepsy, Advocacy, and Development and LEAD faculty *. Core elements of epilepsy diagnosis and management: expert consensus from the Leadership in Epilepsy, Advocacy, and Development (LEAD) faculty. Curr Med Res Opin. 2008;24(12):3463-3477.
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