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Social problems in epilepsy
Last reviewed: 04.07.2025
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Social problems are among the most important for patients with epilepsy. Although doctors mostly talk to patients about the frequency of seizures, side effects of medications, and examination results, patients often want to discuss completely different issues: for example, how to overcome the feeling of rejection that occurs due to seizures, how seizures will affect the possibility of acquiring a profession, being reinstated at work, or going to school. Patients want to know how seizures will affect their social life and independence, the prospect of marriage, family life, whether they can have a child, whether they can get a driver's license, etc. There are a number of fears, misconceptions, and stigmas associated with epilepsy. Many people still have ideas that epilepsy is associated with insanity and even possession by the devil. Successful treatment of epilepsy, therefore, requires discussing the entire range of social problems with the patient.
The question of whether epileptic patients can drive a car is a problematic one. Obviously, patients with frequent epileptic seizures should not drive a car, but in case of rare seizures, under certain conditions, driving may be permitted. Different states in the USA have different requirements for the duration of the seizure-free period that gives the right to obtain a driver's license - from several months to 2 years. The shorter the time interval that allows epileptic patients to obtain permission to temporarily drive a vehicle, the more reliable the patient's reports of seizures can be. Patients with epileptic seizures may also be given permission to drive a car if their seizures occur exclusively at night or if a precursor symptom constantly appears a certain time before the seizure, which allows them to park the car safely. Almost all states in the USA require the patient to notify the appropriate administrative authorities about the disease. The need to obtain a certificate from a doctor often leads to the patient hiding the true frequency of seizures from him, which leads to inadequate treatment.
[ Employment with epilepsy
Most people with epilepsy are productive full-time workers. If seizures are uncontrolled, patients are prohibited from activities that require driving, operating potentially life-threatening or dangerous machinery, using caustic chemicals, or staying at height or underwater for long periods of time. In 1990, the Americans for Disabilities Act prohibited discrimination against people with epilepsy in employment. If a person with epilepsy cannot perform his or her job because of seizures, he or she must be offered another job that matches his or her qualifications.
Schooling and Epilepsy
Children with epilepsy can cope successfully with the school curriculum, although in some cases certain difficulties arise, which may be related to an unfavorable social environment, unfriendly attitude of peers, low self-esteem or low expectations. Learning difficulties may also be caused by an underlying disease that damages the brain. Another important factor that has an adverse effect on learning is antiepileptic drugs. Barbiturates are especially unfavorable in this regard.
Pregnancy and Epilepsy
Women with epilepsy can become pregnant, give birth, have healthy children, and participate fully in raising them. However, pregnancy can be associated with high risks, both from the seizures themselves and from the need to take antiepileptic drugs. The risk of having a child with a developmental anomaly in women with epilepsy is several percent higher than the average for the population. Some developmental anomalies are probably related to the seizures themselves or the antiepileptic drugs.
Monotherapy is preferred to reduce the risk during pregnancy. There is controversy about which drug is safest during pregnancy. There are no controlled studies to resolve this issue. Fetal hydantoin syndrome associated with phenytoin is well known. Barbiturates may also cause malformations. Dysraphic status may be associated with valproic acid and carbamazepine. The best strategy during pregnancy is to use a single drug that is most effective in treating the seizure type. Since folic acid has been shown to have some effect in preventing fetal malformations in mothers without neurological disease, it is reasonable to recommend its use at a dose of 0.4-1.0 mg/day to all women who are able to become pregnant.
Injuries during epileptic seizures
Although the goal of treatment is to help people with epilepsy live as full a life as possible, people should be warned about the possibility of injury during seizures. Infrequent seizures (e.g., petit mal seizures, occurring less than once every three months) usually do not require any restrictions. However, frequent seizures require caution around water, including bathing (sitting up in the shower is safer), heights (climbing stairs for a short time is usually safe), some moving machinery, and other potentially dangerous situations. This risk exists both at home and at work. Safety recommendations should be individualized for each individual.