Social problems in epilepsy
Last reviewed: 23.04.2024
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Social problems are among the most important for patients with epilepsy. Although the doctors talk mainly about the frequency of seizures, the side effect of medicines, the results of the surveys, patients often want to discuss very different issues: for example, how to overcome the feeling of rejection arising from seizures, how seizures will affect the possibility of acquiring a profession, restoring at work, schooling. Patients want to know how seizures affect their social life and independence, the prospect of marriage, family life, whether they can give birth to a child, whether they can get a driver's license, etc. There are a number of fears, misconceptions, stigma associated with epilepsy. Until now, many have the idea that epilepsy is associated with insanity and even instilling the devil. Successful treatment of epilepsy, thus, requires discussion with the patient of the whole complex of social problems.
The question of the possibility of driving a car with epilepsy is one of the most problematic. It is obvious that patients with frequent epileptic seizures should not drive a car, but with rare seizures under certain conditions, driving can be permitted. In different states of the United States there are different requirements for the duration of an unassailable period, giving the right to a driver's license, from several months to 2 years. The shorter the time interval, allowing patients with epilepsy to obtain permission for temporary driving, the more one can believe the patient's reports of seizures. Patients with epileptic seizures may also be given permission to drive in the event that seizures occur exclusively at night or if, at a certain time before the seizure, there is a symptom-precursor, which gives them the opportunity to park the car in a safe parking lot. In almost all states of the United States, the patient is obliged to notify of the disease of the relevant administrative authorities. The necessity of obtaining a certificate from a doctor often leads to the fact that the patient hides from him the true frequency of seizures, which leads to inadequate treatment.
[Employment in epilepsy
Most people with epilepsy are engaged in productive activities for a full working day. In case of uncontrolled seizures, the patient is not allowed to perform activities that require driving, work with potentially life-threatening or traumatic mechanisms, corrosive chemicals, prolonged stay at altitude or under water. In 1990, the Americans for Disabilities Act prohibited discrimination against patients with epilepsy during employment. If a person with epilepsy can not cope with work because of seizures, he must be given another job in accordance with the qualifications.
Schooling and epilepsy
Children with epilepsy can successfully cope with the school curriculum, although in some cases there are certain difficulties that may be associated with an unfavorable social environment, peer malice, low self-esteem or low expectations. Difficulties in learning can also be caused by a major disease that damages the brain. Another important factor that has an adverse effect on learning is antiepileptic drugs. Barbiturates are especially unfavorable in this respect.
Pregnancy and epilepsy
Women with epilepsy can become pregnant, have children, have healthy children and participate fully in their upbringing. Nevertheless, pregnancy can be accompanied by a high risk associated with both seizures themselves and the need for antiepileptic drugs. The risk of a child with an abnormal development in women with epilepsy is several percent higher than the average for the population. Some developmental anomalies are probably associated with seizures themselves or antiepileptic drugs.
To reduce the risk during pregnancy, monotherapy is preferable. There is disagreement on the question of which drug can be considered the safest in pregnancy. There are no controlled studies that would solve this problem. Well-known hydantoin syndrome of the fetus, associated with the use of phenytoin. Anomalies of development can be caused by barbiturates. Dysraphic status can be associated with the use of valproic acid and carbamazepine. The best strategy during pregnancy is to use one drug that is most effective in treating this type of seizure. Since it has been shown that folic acid can to some extent prevent fetal development abnormalities in mothers who do not have a neurological disease, it is advisable to recommend its intake in 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 ensure that the lives of people with epilepsy are as complete as possible, caution should be exercised against the possibility of injury during seizures. With rare seizures (for example, in the case of small seizures that occur less frequently than every three months), the need for any restrictions usually does not arise. However, with frequent seizures, care should be taken with regard to water, including taking a bath (it is safer to take a shower when sitting), heights (short stairs are usually safe), some moving mechanisms and other potentially dangerous situations. This risk exists both at home and at work. Recommendations regarding the safety of the patient, in each case should be individualized.