Seizure (cont.)
How Does Epilepsy Affect Daily Life?
Most people with epilepsy lead outwardly normal lives.
Approximately 80 percent can be significantly helped by modern therapies, and
some may go months or years between seizures. However, the condition can and
does affect daily life for people with epilepsy, their family, and their
friends. People with severe seizures that resist treatment have, on average, a
shorter life expectancy and an increased risk of cognitive impairment,
particularly if the seizures developed in early childhood. These impairments may
be related to the underlying conditions tha cause epilepsy or to epilepsy
treatment rather than the epilepsy
itself.
Behavior and Emotions
It is not uncommon for people with epilepsy, especially children, to develop
behavioral and emotional problems. Sometimes these problems are caused by
embarrassment or frustration associated with epilepsy. Other problems may result
from bullying, teasing, or avoidance in school and other social settings. In
children, these problems can be minimized if parents encourage a positive
outlook and independence, do not reward negative behavior with unusual amounts
of attention, and try to stay attuned to their child's needs and feelings.
Families must learn to accept and live with the seizures without blaming or
resenting the affected person. Counseling services can help families cope with
epilepsy in a positive manner. Epilepsy support groups also can help by
providing a way for people with epilepsy and their family members to share their
experiences, frustrations, and tips for coping with the disorder.
People with epilepsy have an increased risk of poor self-esteem, depression,
and suicide. These problems may be a reaction to a lack of understanding or
discomfort about epilepsy that may result in cruelty or avoidance by other
people. Many people with epilepsy also live with an ever-present fear that they
will have another seizure.
Driving and Recreation
For many people with epilepsy, the risk of seizures restricts their
independence, in particular the ability to drive. Most states and the District
of Columbia will not issue a driver's license to someone with epilepsy unless
the person can document that they have gone a specific amount of time without a
seizure (the waiting period varies from a few months to several years). Some
states make exceptions for this policy when seizures don't impair consciousness,
occur only during sleep, or have long auras or other warning signs that allow
the person to avoid driving when a seizure is likely to occur. Studies show that
the risk of having a seizure-related accident decreases as the length of time
since the last seizure increases. One study found that the risk of having a
seizure-related motor vehicle accident is 93 percent less in people who wait at
least 1 year after their last seizure before driving, compared to people who
wait for shorter intervals.
The risk of seizures also restricts people's recreational choices. For
instance, people with epilepsy should not participate in sports such as
skydiving or motor racing where a moment's inattention could lead to injury.
Other activities, such as swimming and sailing, should be done only with
precautions and/or supervision. However, jogging, football, and many other
sports are reasonably safe for a person with epilepsy. Studies to date have not
shown any increase in seizures due to sports, although these studies have not
focused on any activity in particular. There is some evidence that regular
exercise may even improve seizure control in some people. Sports are often such
a positive factor in life that it is best for the person to participate,
although the person with epilepsy and the coach or other leader should take
appropriate safety precautions. It is important to take steps to avoid potential
sports-related problems such as dehydration, overexertion, and hypoglycemia, as
these problems can increase the risk of seizures.
Education and Employment
By law, people with epilepsy or other handicaps in the United States cannot
be denied employment or access to any educational, recreational, or other
activity because of their seizures. However, one survey showed that only about
56 percent of people with epilepsy finish high school and about 15 percent
finish college -- rates much lower than those for the general population. The
same survey found that about 25 percent of working-age people with epilepsy are
unemployed. These numbers indicate that significant barriers still exist for
people with epilepsy in school and work. Restrictions on driving limit the
employment opportunities for many people with epilepsy, and many find it
difficult to face the misunderstandings and social pressures they encounter in
public situations. Antiepileptic drugs also may cause side effects that
interfere with concentration and memory. Children with epilepsy may need extra
time to complete schoolwork, and they sometimes may need to have instructions or
other information repeated for them. Teachers should be told what to do if a
child in their classroom has a seizure, and parents should work with the school
system to find reasonable ways to accommodate any special needs their child may
have.
Pregnancy and Motherhood
Women with epilepsy are often concerned about whether they can become
pregnant and have a healthy child. This is usually possible. While some seizure
medications and some types of epilepsy may reduce a person's interest in sexual
activity, most people with epilepsy can become pregnant. Moreover, women with
epilepsy have a 90 percent or better chance of having a normal, healthy baby,
and the risk of birth defects is only about 4 to 6 percent. The risk that
children of parents with epilepsy will develop epilepsy themselves is only about
5 percent unless the parent has a clearly hereditary form of the disorder.
Parents who are worried that their epilepsy may be hereditary may wish to
consult a genetic counselor to determine what the risk might be. Amniocentesis
and high-level ultrasound can be
performed during pregnancy to ensure that the baby is developing normally, and a
procedure called a maternal serum
alpha-fetoprotein test can be used for prenatal diagnosis of many conditions if
a problem is suspected.
There are several precautions women can take before and during pregnancy to
reduce the risks associated with pregnancy and delivery. Women who are thinking
about becoming pregnant should talk with their doctors to learn any special
risks associated with their epilepsy and the medications they may be taking.
Some seizure medications, particularly valproate,
trimethadione, and phenytoin,
are known to increase the risk of having a child with birth defects such as
cleft palate, heart problems, or finger and toe defects. For this reason, a
woman's doctor may advise switching to other medications during pregnancy.
Whenever possible, a woman should allow her doctor enough time to properly
change medications, including phasing in the new medications and checking to
determine when blood levels are stabilized, before she tries to become pregnant.
Women should also begin prenatal vitamin supplements -- especially with folic
acid, which may reduce the risk of some birth defects -- well before pregnancy.
Women who discover that they are pregnant but have not already spoken with their
doctor about ways to reduce the risks should do so as soon as possible. However,
they should continue taking seizure medication as prescribed until that time to
avoid preventable seizures. Seizures during pregnancy can harm the developing
baby or lead to miscarriage, particularly if the seizures are severe.
Nevertheless, many women who have seizures during pregnancy have normal, healthy
babies.
Women with epilepsy sometimes experience a change in their seizure frequency
during pregnancy, even if they do not change medications. About 25 to 40 percent
of women have an increase in their seizure frequency while they are pregnant,
while other women may have fewer seizures during pregnancy. The frequency of
seizures during pregnancy may be influenced by a variety of factors, including
the woman's increased blood volume during pregnancy, which can dilute the effect
of medication. Women should have their blood levels of seizure medications
monitored closely during and after pregnancy, and the medication dosage should
be adjusted accordingly.
Pregnant women with epilepsy should take prenatal vitamins and get plenty of
sleep to avoid seizures caused by sleep deprivation. They also should take
vitamin K supplements after 34 weeks of pregnancy to reduce the risk of a
blood-clotting disorder in infants called neonatal coagulopathy that can result
from fetal exposure to epilepsy medications. Finally, they should get good
prenatal care, avoid tobacco, caffeine, alcohol, and illegal drugs, and try to
avoid stress.
Labor and delivery usually proceed normally for women with epilepsy, although
there is a slightly increased risk of hemorrhage, eclampsia,
premature labor,
and cesarean section. Doctors can administer antiepileptic drugs intravenously
and monitor blood levels of anticonvulsant medication during labor to reduce the
risk that the labor will trigger a seizure. Babies sometimes have symptoms of
withdrawal from the mother's seizure medication after they are born, but these
problems wear off in a few weeks or months and usually do not cause serious or
long-term effects. A mother's blood levels of anticonvulsant medication should
be checked frequently after delivery as medication often needs to be decreased.
Epilepsy medications need not influence a woman's decision about
breast-feeding her baby. Only minor amounts of epilepsy medications are secreted
in breast milk, usually not enough to harm the baby and much less than the baby
was exposed to in the womb. On rare occasions, the baby may become excessively
drowsy or feed poorly, and these problems should be closely monitored. However,
experts believe the benefits of breast-feeding outweigh the risks except in rare
circumstances.
To increase doctors' understanding of how different
epilepsy medications affect pregnancy and the chances of having a healthy baby,
Massachusetts General Hospital has begun a nationwide registry for women who take antiepileptic drugs
while pregnant. Women who enroll in this program are given educational materials
on pre-conception planning and perinatal care and are asked to provide
information about the health of their children (this information is kept
confidential). Women and physicians can contact this registry by calling
1-888-233-2334 or 617-726-1742 (fax: 617-724-8307).
Women with epilepsy should be aware that some epilepsy medications can
interfere with the effectiveness of oral contraceptives. Women who wish to use
oral contraceptives to prevent pregnancy should discuss this with their doctors,
who may be able to prescribe a different kind of antiepileptic medication or
suggest other ways of avoiding an unplanned pregnancy.
Next: Are There Special Risks Associated With Epilepsy? »
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