Page 476 - ILAE_Lectures_2015

Where the patient is overprotected at home there is a real danger that this may lead to illness
behaviour and increased dependency. A young adult may manifest difficulties in education,
social and personal relationships and in the workplace.

The main tasks of the patient are to:

 Overcome social slights and chance remarks
 Have confirmation of his/her self-worth
 Adjust positively to the condition and integrate it into their lives
 Over time pursue an active social and working life.

Public misconceptions about epilepsy include:

 The association of epilepsy with mental illness and learning disability
 The assumption that single seizures cause damage
 The idea that epilepsy is inherited irrespective of cause
 The assumption that epilepsy is always for life.

It is important that these issues are introduced and discussed by the patient’s physician at an
early stage. Without proper information patients and their families are left to cope with
unnecessary ‘taboo’ concepts, which add to their anxiety. The relative risks of disclosure and
concealment may arise with interpersonal relationships and especially when seeking
employment, where fear of rejection is marked.

In some countries, even today, people with epilepsy are not allowed to marry and are
considered to be uneducable, unemployable and a danger to the community. In the UK many
people still feel that revealing their condition will deter their employers who may view them
as unreliable and likely to cause accidents. Some therefore decide to remain silent and live in
fear of an attack and losing their job. A well-adjusted person should be able to tell anyone
with whom they come in regular contact about their condition. Explanations should be kept
simple and practical and public ignorance should not be assumed to be rejection.

Drug treatment for epilepsy may bring side effects causing problems for some patients. These
may include:

 Fatigue and lassitude
 Poor memory
 Concentration difficulties
 Unsteadiness
 Nausea
 Weight gain or weight loss
 Mood or psychological changes.

These symptoms may be difficult to tolerate in the long term and alternate drug and treatment
choices may be appropriate.

Refractory epilepsy means the patient will have to reassess how much risk is acceptable in
order to live an integrated life. Each individual must decide what precautions are sensible in
order to strike a reasonable balance between risk and precaution. Once a balance has been
found, a patient may then maximise their potential and develop their talents.