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Psychosocial consequences of epilepsy

Epilepsy is a medical condition suffered by people of all ages, races, and sexes. Epilepsy may co-occur with other conditions, such as physical disability and cerebral palsy, anxiety and 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 many psychosocial repercussions for the individuals experiencing them. The psychosocial experiences of persons with epilepsy can lead to social withdrawal and social isolation. Emotional impairment is also prevalent with sufferers: 45 per cent scored high on a depression scale in one study. Disturbances in sexual functioning, such as decreased potency and libido in men and anovulatory cycles in women, have also been reported by researchers. This is because seizures, particularly those stemming in the limbic system, may have an influence on the hypothalamic pituitary axis. Another study found depressive symptoms in 40 to 60 per cent of individuals with various types of epilepsy, suggesting that depression is indeed commonplace.

Epilepsy and depression
Depression is commonly experienced by individuals suffering from epilepsy. One study found that 45 per cent of their sample scored high on a depression scale. Depression was found to be a powerful predictor of low quality of life in the sample. Although this study has made significant contributions to knowledge, it is worth noting that it strictly focussed on individuals with temporal lobe epilepsy. Nevertheless, a second study found depressive symptoms of 40 to 60 per cent in individuals with various types of epilepsy, suggesting that depression is indeed commonplace.

Another group of researchers recruited a community-based sample of 309 individuals with active epilepsy in the UK and investigated them with a newly-devised Subjective Handicap of Epilepsy (SHE) scale and Hospital Anxiety and Depression Scale (HADS). They found that one-third of the participants were significantly handicapped by this condition following their experiences of the aforementioned disorders. They also found that psychosocial handicap occurred even at low frequency of remission of the seizures; the severity was related to the frequency and duration (the higher the frequency and the greater the duration, the greater the severity). They further 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. One study identified panic disorder, posttraumatic stress disorder, generalised anxiety disorder, and obsessive-compulsive disorder as the commonest anxiety disorders encountered by these individuals. Available evidence suggests that the prevalence of anxiety disorders in individuals with epilepsy is higher than that of normal people both in the hospital and community. This has been blamed on the psychosocial, neurological, and pharmacological factors which the epileptic individuals are predisposed to. 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. However, the nature and extent of anxiety vary widely. For instance, one study notes that anxiety is not easily recognised in pediatric patients. This study also highlights the role of seizure severity in the development of anxiety disorders.

Epilepsy and employment
Employment-related issues are among the most common psychosocial experiences by individuals with epilepsy. One study 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 about how to relate to colleagues and employers afterwards. Another study 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. Another group of researchers have explained that those with epilepsy live under what they describe as a ‘Sword of Damocles’, being unable to predict when and where they may experience seizure and that this ‘uncertainty can render the individual with vulnerability in social situations’.

Considering the findings of other researchers cited above on the nature of embarrassing situations which seizures may bring about, it is easy to understand why individuals with epilepsy may experience psychological problems which may end up reducing their chances of getting a job. Yet another group of researchers have implicated seizure severity and the stigma that follows it as a contributory factor to reduced chances of employment. Nevertheless, they acknowledge a possible sampling bias in their review; that is, most of the studies on employment which they reviewed were based on ‘highly selected and clinical populations’.

However, the International League Against Epilepsy (ILAE, 2003) has 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, but 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 entry. Disturbances in sexual functioning, such as decreased potency and libido in men and anovulatory cycles in women, have also been reported by researchers. This is because seizures, particularly those stemming in the limbic system, may have an influence on the hypothalamic pituitary axis. 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. In women, decreased levels of bioactive testosterone may impact on sexual functioning.

Epilepsy and relationships
Developing relationships, particularly sexual or romantic relationships with others, by individuals with epilepsy is not often easy. One health manual observes 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’. The author 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. This is understood on the basis that some partners may find it difficult to cope with someone experiencing sexual dysfunction. However, the health manual notes that personality type of the potential partner plays a role in how he/she accepts or rejects an individual with epilepsy. The author observes that while an average person may reject someone with epilepsy, an individual with a caring or nurturing mind may find it attractive to accept someone with this condition. However, it remains debatable as to the extent to which a caring partner may accommodate such an individual, particularly in the case of serious sexual dysfunction.

Epilepsy and sports and physical activities
Epilepsy also impacts on one's ability to engage in certain physical activities. One study found that individuals with epilepsy participated in fewer sports activities than those without the condition. The researchers have linked this differential to poor strength, which is attributed to the intake of epileptic drugs administered to participants in the past. Further, they found that those with high seizure frequency engaged in physical activities relatively less than others. However, they found no evidence of seizure-related injuries during exercise. This latter finding is also supported by a separate, later report. In fact, this report found that the majority of sports and physical activities are safe for this group and even decrease their seizure frequency.

Epilepsy and driving
One other essential activity of daily living affected by epilepsy is driving. Epilepsy is one of several major medical conditions which licensing authorities find as grounds to restrict or prohibit prospective drivers in many parts of the world. 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 one's fitness to drive. However, potential effects of epilepsy on driving ability differ considerably based on the type of epilepsy experienced. Complex partial and tonic-clonic seizures are the types most commonly linked to crashes due to complete incapacitation during the ictal phase as well as during the post-ictal period.

Summary
In conclusion, 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.