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Epilepsy is a chronic, neurological, spectrum disorder that manifests through recurrent and uninitiated seizures, which can cause other health complications. The disorder is highly misunderstood, and as a result, patients are usually isolated, misjudged, and denied employment. Epilepsy is characterized by a wide range of causes, symptoms, and types of seizures. Government statistics have shown that the condition affects approximately 65 million people globally, with 3 million cases reported in the United States. Epilepsy is a chronic disease that causes seizures and that can be managed through medications, brain surgery, and a ketogenic diet.
Description of the Disorder
Epilepsy is characterized by unprovoked seizures that are either partial or generalized. As mentioned earlier, the disorder affects about 65 million people globally, and 3 million people in the United States (Pierce, 2018). It is more prevalent among young people and older adults. In addition, it is more common in males than females (Mayo Clinic Staff, 2019). Statistics show that 1 in every 26 people develop epilepsy at one point in their life.
Approximately 1 in 100 people in the United States report experiencing a seizure or an epilepsy diagnosis (Pierce, 2018). Seizures are more rampant among children and older people, and incidence varies with race and geographic region. In children, the disorder develops during the first year of life and its incidence decreases as the children approach puberty. The incidence of the disorder decreases and stabilizes, but increases after the age of 55. Risk factors among older people include stroke and Alzheimer’s disease.
Causes
The main cause of epilepsy has not been determined. However, research studies have identified several potential causes. These include traumatic brain injury, vascular diseases, brain tumors or cysts, infectious diseases, stroke, genetic disorders, and maternal drug use (Pietrangelo, 2017). Brain infections and a lack of oxygen during birth are also possible causes. In certain cases, research has shown that heredity is a causative factor.
The chances of developing epilepsy are higher in people with epileptic parents than in people with non-epileptic parents (Pierce, 2018). Research has suggested that in many cases, hereditary factors only play a minor role in the development of the disorder. A major consequence of genetics is the increased susceptibility to seizures due to certain environmental triggers (Spencer, 2017). The most common triggers for epilepsy are insufficient sleep, psychological stress, hormonal changes, missed medication, excessive alcohol consumption, and the use of recreational drugs (Mula, 2016).
Types and Risk Factors
Types of epilepsy that are associated with genetics include childhood absence epilepsy, juvenile absence epilepsy, autosomal dominant nocturnal frontal lobe epilepsy, familial temporal lobe epilepsy, and epilepsy with generalized tonic-clonic seizures (Pierce, 2018). The risk factors of epilepsy include age, dementia, family history, birth factors, cerebral palsy, brain tumors, autism spectrum disorder, history of head injuries, and seizures during childhood (Pietrangelo, 2017).
Signs and Symptoms
Signs of epilepsy include whole-body fatigue, headaches, staring spells, drowsiness, amnesia, and temporary confusion. The main symptoms are repeated seizures that differ based on the cause. They vary from person to person and can be divided into two groups, namely partial and generalized seizures. During a partial seizure, a patient does not lose consciousness, they experience dizziness, alterations of the senses, and twitching of limbs (Mula, 2016).
Classification of Seizures
The International League Against Epilepsy (ILAE) classifies seizures based on 3 key features, namely origin in the brain, additional features of seizures, and the level of awareness during an episode (Myers, 2016).
Based on origin, seizures can be focal, generalized, unknown onset, or focal to bilateral. Based on the level of awareness, seizures can be focal aware, focal impaired awareness, awareness unknown, or generalized. Some partial seizures involve the loss of consciousness, unresponsiveness, and blank staring. Generalized seizures affect the whole brain and can be grouped into various types: absence, tonic, myoclonic, atonic, clonic, and tonic-clonic seizures (Myers, 2016). Tonic-clonic seizures are characterized by loss of consciousness, shaking, loss of bowel control, and body stiffening (Mayo Clinic Staff, 2019).
Diagnosis
It is recommended that any occurrence of a seizure should be reported to a physician immediately. Some seizures are indications of underlying diseases that patients could be unaware of, and therefore, posing the risk of serious complications. Doctors determine the tests to conduct by evaluating a patient’s medical history and symptoms (Boling, 2018). In certain cases, physicians conduct neurological examinations to determine the motor abilities and mental functioning of patients. Certain blood tests are carried out to indicate the patient’s blood glucose levels, the presence of infectious disease, and the functioning of organs such as the liver and kidney (Boling, 2018). The tests used in diagnosis include CT scan, MRI, single-photon emission computerized tomography, and electroencephalogram (EEG) (Boling, 2018).
Treatment
Treatment plans depend on the severity of symptoms and the type of disorder. The most common treatment remedies include anti-epileptic drugs, brain surgery, vagus nerve stimulation, and ketogenic diets (Pierce, 2018). Anti-epileptic medications can either eliminate or lower the number of seizures (Boling, 2018). Patients need to take the drugs as prescribed by physicians to guarantee their effectiveness.
A vagus nerve stimulator prevents seizures while brain surgery alters the region of the brain that is associated with epilepsy (Spencer, 2017). Research is undergoing to determine the effectiveness of deep brain stimulation in the treatment of the disorder. Major medications used include valporic acid, lamotrigine, topiramate, ethosuximide, and levetiracetam (Pietrangelo, 2017). In children, a diet low in carbohydrates and high in fats is recommended for the reduction of seizures.
Prognosis
A report released by Mayo Clinic showed that the majority of epileptic individuals must undergo uninterrupted treatment to manage the condition (Spencer, 2017). Continuous treatment allows patients to live their lives normally and avoid injuries that might arise from sudden episodes. Epilepsy prognosis is influenced by several factors: the existing treatment plan, genes, pattern of seizures, age, and health history (Pierce, 2018).
Other factors that affect prognosis include preexisting neurological issues, vascular disorders, family history, and infections. The success of treatment is higher in children than in older people. Research suggests that the chances of complete recovery are higher in people who develop the condition before they attain the age of 12 (Pierce, 2018). Common complications associated with epilepsy include liver inflammation, emotional challenges, falls, and weight gain (Mayo Clinic Staff, 2019). The mortality rate is higher in adults because of the influence of underlying health conditions such as anoxia, stroke, CNS infection, and severe metabolic derangements.
Psychological Implications of Epilepsy
Parents and teachers have lowered expectations of children with epilepsy, which may be detrimental to their success. This sends a message that the children have lower potential compared to others who are non-epileptic. Therefore, they learn to accept the lessened expectations and embrace unrealistic beliefs regarding their potential (Spencer, 2017). The early diagnosis of epilepsy in children has been associated with personality and behavior challenges. The embarrassment and stigma that are associated with experiencing a seizure in public are constant sources of pain and shame for children (Pierce, 2018).
As a result, they become withdrawn and antisocial, and they suffer low self-esteem. People with epilepsy lose confidence because of the unpredictable nature of seizures. They can happen anywhere and at any time. Children might also exhibit symptoms such as anxiety, depression, aggression, and hyperactivity (Spencer, 2017). Parents are usually overprotective, and as a result, prevent their children from having experiences that promote healthy psychosocial development.
These effects can be addressed by educating the public regarding the causes of epilepsy, its symptoms, and the side effects of treatment remedies. Teachers and parents need to help children manage their disorders and understand the cognitive effects of medications (Spencer, 2017). In addition, psychotherapy and counseling can be used to resolve these issues in older people.
Social Implications of Epilepsy
People with epilepsy are usually victims of social stigma and prejudice because of the mystery that surrounds the disorder. Many individuals do not understand the condition and its manifestations. Or instance, in traditional societies, epilepsy was perceived as a form of possession by evil spirits. Epilepsy hinders people from living normal lives because of the risk of seizures (Pierce, 2018).
A diagnosis of epilepsy can have legal implications in two main areas. First, it can be used to determine an individual’s fitness to drive. Second, it can be used in the establishment of intent in cases involving criminal activities that occur during a seizure. Different jurisdictions have varying laws that regulate the awarding of driving licenses to people with epilepsy. Denial of a driver’s license is widespread because people who experience seizures can be a danger to themselves and others on the roads.
The diagnosis of epilepsy has severe consequences on families because the negative experiences faced by an epileptic person extend to other members. Family factors such as domestic violence, divorce, and abuse worsen the condition due to a lack of sufficient physical and psychological support. Family members should help their loved ones to manage the condition by taking them to doctor appointments and administering drugs.
Public attitudes and misconceptions about epilepsy negatively affect people with the disorder. For example, many people avoid relationships and social interactions for fear of being judged (Spencer, 2017). In workplaces, employers might view and treat them differently. In that regard, their well-being is affected because they cannot speak freely and they are misunderstood and underestimated (Pierce, 2018). This challenge can be mitigated through the implementation of policies that promote equality and prevent bullying, the creation of work environments that aid in the management of epilepsy, and the education of employees and employers regarding the disorder.
Vocational and Educational Considerations
People with epilepsy face numerous challenges at school and in the workplace. Discrimination from colleagues and peers, lack of support, and dependency on others are major obstacles to their happiness. Rates of absenteeism are high and students perform poorly due to low rates of school attendance. Employees need to understand the conditions of their employees and offer support because the Americans with Disabilities Act (ADA) considers epilepsy as a disability. Teachers should help epileptic children catch up with others after being absent from school as poor attendance increases academic difficulties and lowers performance.
Vocational Rehabilitation Considerations
Vocational rehabilitation counselors can help epileptics obtain skills that employers consider when hiring. These include the assessment of people’s knowledge and skills, educating people on strategies to mitigate disabilities, career advice, and managing specialized training programs. These skills can help individuals lead productive lives, both professionally and personally. Counselors should consider the severity of their patients’ disabilities, course, and stability to determine the knowledge and skills that they need (Spencer, 2017).
They should also consider the functional limitations and abilities associated with specific abilities because different types of seizures have varied manifestations and effects. One of the main outcomes of vocational rehabilitation is to prepare people with epilepsy for employment (Spencer, 2017).
Rehabilitation counselors help epileptics find appropriate jobs that accommodate their disabilities. Moreover, they train them to communicate effectively so that they can educate other people about their conditions and highlight their capabilities rather than their disabilities (Pierce, 2018). Employers should talk to candidates with epilepsy to understand their disorder and how it might affect their work.
Conclusion
Epilepsy is a neurological disorder that is characterized by seizures that originate from the brain. It affects approximately 65 million people in the world and it is most prevalent among men, children, and older people. The major symptom is recurrent seizures that can be either generalized or partial. Epilepsy is caused by brain injury, infectious diseases, stroke, genetic disorders, vascular diseases, brain tumors or cysts, maternal drug use, brain infections, and a lack of oxygen during birth. Treatment is mainly aimed at eliminating or lowering the incidence of seizures. Treatment options include medications, brain surgery, a ketogenic diet, and vagus nerve stimulation.
Epilepsy lowers the self-esteem and self-confidence of patients because of the stigma and shame associated with seizures. Rehabilitation counselors can help epileptics gain skills that are needed for employment. The challenges that people with epilepsy face can be mitigated through counseling, psychoanalysis, and the creation of awareness regarding the disorder.
References
Boling, W. W. (Ed.). (2018). Diagnosis and surgical treatment of epilepsy. New York, NY: MDPI.
Mayo Clinic Staff. (2019). Epilepsy. Web.
Mula, M. (Ed.). (2016). Neuropsychiatric symptoms of neurological epilepsy. New York, NY: Springer Science.
Myers, M. S. (2016). Symptoms of diseases with suggested herbal treatment opinions. New York, NY: MS Myers.
Pierce, S. (2018). Diseases and disorders: Epilepsy, coming to terms with chronic seizures. New York, NY: Lucent Press.
Pietrangelo, A. (2017). Everything you need to know about epilepsy. Web.
Spencer, D. C. (2017). Navigating life with epilepsy. New York, NY: Oxford University Press.
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