Still important but not directly life-threatening, childhood epilepsy also negatively affects educational achievement and, regardless of the age of onset, has an impact on the person’s eventual employment level. About one third of children with epilepsy receive special educational support, and IQ increases linearly as a function of age of onset (from 83 for adults whose seizures began in infancy to 102 for those with adult onset). Equally serious, and probably not unrelated to the person’s educational experiences, a person’s ability to find employment is greatly reduced by epilepsy. In a 1973 survey, almost one half of persons with epilepsy reported that they had been turned down for a job because of their epilepsy, and 30% reported that they had lost at least one job because of seizures. Various studies over this century have shown that the unemployment rate among working-age persons with epilepsy is between 2 and 7 times the rate of unemployment in the general population. In general, an employer has the right to ask a prospective employee if he or she has any medical condition that will interfere with successful carrying out of the duties, so the reduction in employment opportunities may not be entirely the product of a prejudice against epilepsy itself. Loss of the ability to drive a car is mentioned by most persons with epilepsy as a major loss (the period of being seizure-flee before driving again differs from place to place; e.g., in Michigan, it is 6 months, in Ontario, Canada, I year).
Seizures are not just unpleasant and embarrassing experiences for the person with seizures. Epilepsy entails a significant increase in morbidity and mortality. Particularly important for the mental health clinician is the increased risk for serious depression (around 5 % across all kinds of epilepsy and 3 to 4 times the national average; among persons with epilepsy, suicide is listed as cause of death in 7 to 22% of deaths). Studies since the turn of the century have consistently shown that the life expectancy of persons with epilepsy is shorter than in the rest of the population; the death rate of children with epilepsy 0 to 5 years of age is 1.3 times greater than that of the general population; from 5 to 24 years of age, the rate is 6.6 times greater; and from 24 to 25 years of age, the rate is 3.7 times greater. During the period when persons with epilepsy were typically institutionalized, as many as 50% of them died of causes either directly or indirectly associated with their seizures. Among those whose deaths were directly attributed to seizures, about 12% died of status epilepticus (a continuous and uncontrollable seizure); many others died of the accumulative effects of multiple injuries sustained during seizures.
There has been much written about the so-called “epileptic personality,” some sensible and some bordering on the ridiculous. Lennox and Lennox in their 1960 book, Epilepsy and Related Disorders, point out that many of the personality characteristics supposedly associated with epilepsy are actually frequently seen in many institutionalized patients suffering from a variety of debilitating chronic physical illnesses. Therefore they cautioned against an overarching assumption that the epilepsy itself may cause a personality disorder. Nevertheless, the particular characteristics of epilepsy (sudden loss of consciousness and other bodily functions, uncertainty about when a seizure will occur and what danger it may engender, the attendant problems dealing with family and friends, etc.) make it likely that individuals with seizures will be at increased risk for psychological problems. Joseph A. Schwartz, a psychiatrist who often works with epilepsy patients, has found that consultation requests by neurologists mention personality disorders about 10 times more often for epilepsy patients than for patients with other neurological disorders. He has proposed that the problems experienced by persons with epilepsy be referred to as “social apraxia” in order to remove the moral opprobrium usually associated with the term personality disorder.
The performance of epilepsy patients on cognitive tests has been of great help in exploring the brain organization involved in perception, thinking, and reasoning. Memory functions of patients who have a seizure focus in the temporal lobe (or who have had an excision of part of their temporal lobe) have been particularly informative in breaking down memory functions into their component parts. A small number of patients have focal motor seizures that leave consciousness and cognitive abilities intact, but the vast majority of persons with epilepsy lose consciousness and are subsequently amnesic for the events that occurred during the episode. However, unlike the case of most psychiatric illnesses, these effects are discrete in time and the person can be entirely normal between seizures. Of significance for the mental health professional is that there can be lasting behavioral effects of the seizures (especially episodes of continuous seizure activity) and/or the effect of the brain damage that is the cause of the seizures in the first place. Factors to be considered when deciding whether a person is showing effects of a time-related decline in abilities include age of onset, the site of the focus or foci, treatment side effects (medication, surgery), effects of injuries sustained during a seizure (especially head injuries), and effects of status epilepticus or prolonged seizures with inefficient breathing. Age of onset has obvious effects on the acquisition of knowledge and on interpersonal relationships. Sometimes the effects of a seizure focus are direct (lowered attentional abilities), sometimes indirect (missing school for a schoolage child). Overall, significant brain reorganization is much more likely if the brain damage and seizures onset occurs before the age of 6 years than after that age, with puberty providing a likely upper limit for the period of useful plasticity.
There are two distinct steps in the process of diagnosing epilepsy. First, the neurologist or general physician has to be convinced that the spells, which are almost always described secondhand by someone not well trained in observation, are characteristic of epilepsy and not some other illness, organic or otherwise. Abnormal EEGs are very helpful in confirming that the seizures probably have a physiological (organic) rather than psychogenic cause, but epileptiform brain activity (i.e., EEG abnormalities characteristic of epilepsy) can also be found in individuals without seizures, and some persons with epilepsy have an apparently normal EEG between seizures. In rare cases, the seizure focus is too deep in the brain to be discerned by scalp electrodes, and the EEG will remain normal even during a seizure. If the spells are determined to be epileptic in nature, their cause needs to be found as that will dictate the appropriate treatment (e.g., medication or surgery). Sometimes the seizure is the first manifestation of the presence of a brain tumor. In this case, the malignancy of the tumor will need to be determined so the benefits of surgery can be weighed. If the seizure occurs in childhood, both the child and the family will need to be educated about epilepsy and the importance of following a medication regimen. In some patient groups, the cessation of seizures under medication control for 2 to 5 years may mean that the medications can be safely stopped without a return to seizures (stopping the medication too soon can lead to a resumption of seizures, which may now be harder to stop, possibly because of kindling effects as described earlier).
Epilepsy is a complicated issue for the analysis, because the student is supposed to study the cause and effect of the disorder, the types of epilepsy, its symptoms, treatment and complexities which can be observed on the way of treatment. The student is able to prepare an effective term paper if he looks though several original cases on epilepsy and studies the patients’ symptoms, the character of the disorder and the approach towards their treatment. One should collect enough facts for the research in order to observe the issue on epilepsy from all possible sides and make the research useful for the student’s background knowledge.
The young professional has the chance to complete a well-formatted term paper which would satisfy the professor’s requirements if he follows a piece of advice written in a free example term paper on epilepsy online. Such papers are quite helpful for the inexperienced students, because they illustrate the approach towards writing, formatting and composition of the text. A free sample term paper on epilepsy is able to provide students with efficient assistance which would improve the quality of their assignments.
Jessica lives in a storey-house with her current partner of six years, Martin. Jessica`s parents live overseas where her mother has been posted for work. Jessica is an only child. She works as a real estate agent selling homes and covers a large geographic area involving long and irregular work hours. This can involve her driving long distances and for long periods of time. Jessica enjoys her work and the challenges of being independent at work and at home. Despite being advised by her GP that she must not drive after suffering this recent seizure, Jessica continues to do so.
Following the follow-up appointment with the GP, the GP was concerned about Jessica`s seemingly poor acceptance of her medical diagnoses and her compliance with the treatment regime for both her diabetes and epilepsy. Jessica indicated she did not need any more prescriptions for her anticonvulsants at the moment.
Jessica is not particularly careful about monitoring her blood sugar levels. She says she often forgets, and tends to check when she “feels fuzzy”.
As this is your first visit to Jessica in her home, justify and discuss the immediate plan of care for her.
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While these are social problems rather than neurological ones, the fact remains that it will be impossible to truly find a solution to epilepsy without both educating of the ignorant and further investigating the mysteries of the brain.
, the entry for epilepsy in a dictionary website, an entry in a medical encyclopedia regarding epilepsy, an entry in a medical encyclopedia regarding seizures, a page charting different epilepsy medications, a page answering questions about pregnancy as related to epilepsy, an information page of the World Health Organization website