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The Various Psychosocial and Physical Implications of Epilepsy
Epilepsy is a medical condition suffered by people of all ages, races and sex (Twung, 2009). Epilepsy may co-occur with other conditions, such as physical disability and celebral palsy, anxiety, depression, and other forms of mental illness. Epileptic seizures typically last around some seconds or a few minutes, but despite this, the condition comes with much psychosocial repercussions on the individuals experiencing it. The psychosocial experiences of persons with epilepsy can lead to social withdrawal and isolation as empirically found by Lehrner et al. (1999). They also found prevalence of emotional impairment as a major problem: 45 per cent scored high in depression scale. Disturbances in sexual functioning, such as decreased potency and libido in men and anovulatory cycles in women have been reported by researchers Mattson, R.H. & Cramer, J.A. . Epilepsy, sex hormones, and antiepileptic drugs. Epilepsia, 26, S40-S51. (Marshall, S.C. (2008).  The role of reduced fitness to drive due to medical impairments in explaining crashes involving older drivers.  Traffic Injury Prevention, 9, 291-298. (Mattson and Cramer, 1985; Harden, 2006).  This is because seizures, particularly those stemming in the limbic system may have an influence on hypothalamic pituitary axis.  Grabowska-Grzyb et al. (2006) found depressive symptoms of 40 to 60 per cent in individuals with various types of epilepsy, suggesting that depression is indeed commonplace.

Epilepsy and Depression
Depression is commonly experienced by individuals suffering from epilepsy. Lehrner et al. (1999) found that 45 per cent of their samples scored high in depression scale. The depression was found to be a powerful predictor of low quality of life found in the sample. Although this study has made significant contributions to knowledge, it is worth noting that the study strictly focussed on individuals with temporal lobe epilepsy. Nevertheless, Grabowska-Grzyb et al. (2006) found depressive symptoms of 40 to 60 per cent in individuals with various types of epilepsy, suggesting that depression is indeed commonplace. O’Donoghue et al. (1999) recruited a community-based sample of 309 individuals with active epilepsy in the UK and investigated them with the Subjective Handicap of Epilepsy (SHE) scale and Hospital Anxiety and Depression (HAD). They found that one-third of the participants were significantly handicapped by this condition following their experiences of the aforementioned disorders. They found that psychosocial handicap occurred even at low frequency of remission of the seizures, the severity was related to the high frequency and high duration. They also found that between one-third and one-half of the epileptic individuals were suffering from anxiety and depression as their high scores on the HAD scale showed. Issues surrounding anxiety will be independently explored under the next subheading.

Epilepsy and Anxiety
Just like depression reported above, anxiety is also commonplace in people with epilepsy. Vasquez and Devinsky (2003) identify panic disorder, posttraumatic stress disorder, generalised anxiety disorder and obsessive-compulsive disorder as the commonest anxiety disorders encountered by these individuals. Available evidence suggest that the prevalence of anxiety disorders in individuals with epilepsy is higher than that of normal people both in the hospital and community (Scicutella, 2001). This has been blamed on the psychosocial, neurological and pharmacological factors which the epileptic individuals are predisposed to (Vasquez and Devinsky, 2003). It has been found that the fear of having a seizure and the inability to predict where it may occur, are among these major factors leading to anxiety disorders (Thompson, 2000). However, the nature and extent of anxiety vary widely. Vasquez and Devinsky (2003), for instance, note that anxiety is not easily recognised in pediatric patients. They also highlight the role of seizure severity in the development of anxiety disorders.

Epilepsy and Employment
Employment-related issues are among the very common psychosocial experiences by individuals with epilepsy. A study by Bishop and Allen (2001) based on data from the United States and Puerto Rico found that epileptic individuals not only live in fear of experiencing seizures at work but also how to relate to colleagues and employers afterwards. A study by Jacoby (1992) found that 32 per cent of the participants felt that epilepsy reduced their chances of getting a job while 39 per cent believed that employers were not comfortable recruiting individuals with epilepsy due to the perceived dangers of seizures at a workplace. McCagh et al. (2009: 2) have explained that those with epilepsy live under what they describe as ‘sword of Damocles’, being unable to predict when and where they may experience seizure and this ‘uncertainty can render the individual with vulnerability in social situations’. Considering the findings of O’Donoghue et al. (1999) and Twung (2009) above on the nature of embarrassing situations which seizures may bring about, it is easy to understand why individuals with epilepsy may experience the above psychological problems which may end up reducing their chances of getting a job. Smeets et al. (2009) themselves implicated seizure severity and the stigma that follows it as a contributory factor to reduced changes of employment. Nevertheless, they acknowledge a possible sampling bias in their review; that is, most of the studies on employment which they reviewed was based on ‘highly selected and clinical populations’ (ibid: 357). However, the International League Against Epilepsy (ILAE, 2003) have found that the psychosocial problems experienced by those with epilepsy, particularly as they relate to employment and relationships, are not usually a consequence of their seizures, rather the result of misconceptions about the disorder. Nevertheless, understanding employment difficulties experienced by people with epilepsy is not straightforward.

Epilepsy and Sex
The implications of epilepsy on sexual functioning are another topic worth discussing in this essay. Disturbances in sexual functioning, such as decreased potency and libido in men and anovulatory cycles in women have been reported by researchers (Mattson and Cramer, 1985; Harden, 2006). This is because seizures, particularly those stemming in the limbic system may have an influence on hypothalamic pituitary axis (Mattson and Cramer, 1985). Lower bioactive levels of testosterone and increased levels of sex hormone-binding globulin, especially in conjunction with enzyme-inducing antiepileptic drugs may contribute to the problem in men (Harden, 2006). In women, decreased levels of bioactive testosterone may impact on sexual functioning (ibid).

Epilepsy and Relationships
Developing relationships, particularly sexual or romantic relationships with others by individuals with epilepsy is not often easy. Devinsky (2007) has observed that rejection is commonplace: ‘Some prospective partners will say no to the first date or the second date, and others may break up the relationship after an extended period’. He notes that the rejection becomes even more apparent in the case of individuals with uncontrolled and frequent seizures. The difficulty in relationships has a link to the sexual dysfunction in those with epilepsy which is detailed above (Cole, 2014). This is understood on the basis that some partners may find it difficult to cope with someone experiencing sexual dysfunction. However, Devinsky (2007) notes that personality type of the potential partner plays a role on how he/she accepts or rejects an individual with epilepsy. He observed that while an average person may reject one with epilepsy, an individual with a caring or nurturing mind may find it attractive to accept one with this condition. However, it remains debatable the extent to which such caring partner may accommodate this, particularly in the case of serious sexual dysfunction.

Epilepsy and Sports and Physical Activities
Epilepsy also impacts on one’s ability to engage certain physical activities. Wong and Wirrell (2006) found that individuals with epilepsy participated in a few sports activities than those without the condition. They link this poor strength to the intake of epileptic drugs administered to the participants in the past. Further, they found that those with high seizure frequency performed relatively less than others. However, they found no seizure-related injuries during exercise. This latter finding is also supported by Arida et al.’s (2008) report. In fact, Arida et al. found that majority of sports and physical activities are safe for this group and even decrease their seizure frequency.

Epilepsy and Driving
One other essential activities of daily living affected by epilepsy is driving. Epilepsy is one of the medical conditions which licensing authorities restrict or prohibit in many parts of the world (Devlin et al., 2012). Since epilepsy is characterised by seizures which then cause loss of consciousness and motor control, this has obvious and critical consequences for driving ability, hence, it is of principal concern with regards to determining the fitness to drive (Brouwer, 2002). However, potential effects of epilepsy on driving ability differ considerably based on the type of epilepsy being experienced. Complex generalised and partial tonic-clonic seizures are the types most commonly linked to crashes due to complete incapacitation during ictal phase as well as during post-ictal period (Gastaut and Zifkin, 1987; Devlin et al., 2012).

Summary
In conclusion, this essay has critically explored the various implications of epilepsy in different aspects of daily living. The psychosocial impacts of epilepsy on those experiencing it, its impacts on sexual hormones, employment, physical activities and driving have been critically explored. Epilepsy has continued to pose a barrier from mild to extreme in both psychosocial and physical activities on those experiencing it. Despite decades of research on how to improve the lives of epileptic persons, research studies have continued to indicate that there is still a long way to go in order to better improve the lives of individuals experiencing this condition. Recommendations are hereby made for increased efforts to find a lasting solution to the problems faced by individuals with epilepsy. An increase in research funding to researchers in this field will be a good place to start with. This can increase research capacity, thereby increasing the chances of finding a potential drug that can treat the condition or at least drastically reduce seizures, particularly the most frequent and severe types.

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