Impact on Wellness
Memory and Thinking
On Epilepsy Foundation of Michigan’s 2008 Needs Assessment Survey, 90% of respondents indicated that memory and thinking problems limited their quality of life. The impact of these problems on quality of life was even greater than the impact of seizures. The following factors associated with epilepsy can all affect memory and thinking:

  • medication side effects
  • effects of seizures (before, during, and after)
  • abnormal electrical activity in the brain between seizures (interictal epileptiform discharges)
  • structural changes in the brain associated with epilepsy
  • stress and depression
  • sleep problems
 
Memory and other cognitive problems can interfere with school performance, employment, medication compliance, social interactions, and daily functioning. In some cases, these problems can continue to get worse as long as an individual continues to have seizures. 
 
A neuropsychological evaluation may help you to learn more about your memory and thinking problems and give you ideas on how to cope with them. Be sure to share your memory concerns with your doctors as well. Understanding the causes of your memory and thinking problems will help your healthcare team to address factors that can be changed (e.g. sleep, depression, medication side effects, and seizures) and suggest strategies to compensate for problems that can’t be changed (e.g. structural changes to the brain).
 
When memory can’t be improved, a variety of assistive devices and approaches may be helpful in managing memory problems, including mnemonic strategies (tools to help with memorization), organizational skills, notebooks, recording devices, alarms, smart phones, computers, sticky notes, and much more. Patient and supportive friends and family members can also be a tremendous help.
 
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Social Activities and Relationships
A number of epilepsy-related factors can contribute to social isolation, including the following:
 
  • fear of having a seizure
  • lack of transportation
  • stigma
  • not feeling well
  • lack of employment
  • lack of money
  • depression
 
Epilepsy can also strain relationships with family members and friends. Having social activities that you enjoy and having supportive, rewarding relationships contributes a great deal to quality of life. The following are some tips for strengthening relationships and becoming more socially active:

  • Don’t be afraid to ask for help. Epilepsy can be challenging, and allowing loved ones to help you can strengthen your relationships and make your life easier.
  • Express your gratitude to loved ones, and be supportive when they need help.
  • Address conflicts through respectful discussion and problem solving.
  • Listen actively, and try to see things from the other person’s perspective.
  • Seek family or individual counseling from a mental health professional if social problems persist.
  • Volunteer, join a club, or take a class.
  • Find a hobby that you love and meet others who share this interest.
  • Educate those around you about epilepsy. This may reduce their fears and your worries.
  • Maintain existing friendships (e.g. take the initiative and suggest activities, call to let them know you’re thinking about them, etc.)
  • Join a support group, online forum, or social networking site.
  • Participate in an Epilepsy Foundation of Michigan event.
 
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Emotional Well-Being
The impact of epilepsy on emotional well-being can be significant. Fear of seizures, anxiety, depression, family conflict, and struggles with independence are all common among adults and children with epilepsy. In some cases, individual and family coping mechanisms are enough to handle these problems, but in other cases, professional help may be needed.
 
Depression
Adjusting to a new diagnosis or living with any chronic illness can cause feelings of depression. With epilepsy, however, there is a good chance that this will develop into clinical depression, a serious but treatable medical condition. In fact, up to 30% of people with epilepsy (and up to 50% of those with intractable epilepsy) will develop clinical depression at some point in their lives. This is not just because living with epilepsy can be difficult, although that certainly contributes to it. The increased prevalence is also likely due to a shared underlying biological process that plays a role in both epilepsy and depression.
 
Despite how common depression is in people with epilepsy, it often goes undiagnosed and untreated. While the appearance of depression in people with epilepsy is often the same as in those without epilepsy, in many cases it may not fit the standard diagnostic criteria. In epilepsy, depression may be associated with symptom-free periods, may be strongly tied to seizure activity, and may have other unique features. In any case, it can still have a negative impact on seizure control, sleep, school or work performance, and quality of life. It also increases the risk of suicide. 
 
Fortunately, depression is treatable. Antidepressant medications have been shown to be effective, and many options are available that don’t increase seizure activity and have very manageable interactions with antiepileptic drugs. Psychotherapy (e.g. cognitive behavioral therapy, interpersonal therapy) has also been shown to be effective. In many cases, a combination of both psychotherapy and antidepressants is the most effective approach.
 
If you have signs and symptoms of depression, it’s important to get evaluated by a mental health professional and, if necessary, get treatment. It’s not enough to just “deal with it” on your own. Parents of children with epilepsy need to be vigilant for signs of depression as well, even in young children. Often the primary symptom of depression in children is irritability rather than sadness, so it can easily be overlooked.
     
Stress
Stress is a normal part of life. Too much stress, however, is associated with the following:
 
  • impaired immune function and sleep
  • headaches and back pain
  • increased risk for several chronic health conditions, including heart disease, anxiety disorders, and depression
  • worsened symptoms of arthritis, gastrointestinal disorders, skin problems, and asthma.
  • reduced quality of life
  • increased seizure frequency
 
Managing stress is a key component to managing both seizures and your overall health. A number of relaxation techniques, such as yoga, progressive muscle relaxation, and mindfulness meditation, can be learned, practiced, and integrated into daily life. Such techniques have been proven to reduce stress and there is some initial evidence that they may reduce seizures as well. Ask your doctor if your health system offers classes on relaxation therapies, or visit your local library to find audio recordings on these techniques.
 
In addition to relaxation techniques, several other strategies can help with stress management, including the following:
 
  • Writing or keeping a journal
  • Enjoying hobbies and social activities
  • Improving your time management and organization; prioritizing your tasks
  • Exercising regularly, getting enough sleep, and healthy eating
  • Managing your thoughts (i.e. avoiding negative, distorted thinking)
  • Problem solving
  • Assertiveness training
  • Talking with others
 
If stress is affecting your daily life and interfering with your ability to function, consider getting professional help. A mental health professional (psychiatrist, psychologist, social worker, etc.) can provide treatment for anxiety disorders and can also assist those who just need help in managing stress.
 
The emotional impact of epilepsy is often better managed if you can talk with others who are coping with similar challenges. Epilepsy Foundation of Michigan offers several opportunities to do this. Please contact us to find out more.
 
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Physical Health
Epilepsy and its treatment can be associated with a number of physical symptoms other than just seizures. Furthermore, epilepsy increases the risk for several chronic health conditions, including heart disease, stroke, arthritis, asthma, severe headaches, lower back pain, neck pain, and cancer (2002 National Health Interview). People with epilepsy as a group also have worse physical health, more activity limitation, more falls, and less physical activity than the general population (2005 Michigan Behavioral Risk Factor Survey).
 
Common physical symptoms, some of which may be related to epilepsy and some of which may be medication side effects, include the following:
 
  • headaches
  • drowsiness
  • fatigue or weakness
  • unsteadiness or coordination problems
  • dizziness
  • muscle soreness
  • back and neck pain
  • weight gain
  • sleep disturbance
  • digestive problems (heartburn, nausea, vomiting, constipation, diarrhea)
 
Patients experiencing such symptoms should discuss these symptoms with both their neurologist and their general practitioner to determine if these are due to medication side effects, the effects of seizures and epilepsy, or another health condition. The healthcare team can then intervene by adjusting the treatment regimen, prescribing additional medications or therapies, or suggesting methods for coping with these symptoms. It is important to address these symptoms because they not only reduce quality of life, but many of them can also make it harder to practice healthy behaviors like exercising, getting enough sleep, and eating well. 

If you have been taking or expect to take antiepileptic medications for a long time, it's important to discuss potential long-term effects of these medications with your healthcare team. Long-term use of certain antiepileptic medications may increase the risk of obesity, bone loss, and other chronic health conditions. These risks need to be considered when selecting a medication, along with the treatment's effectiveness, side effects, and cost.


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