Social and Psychological Aspects of Epilepsy

Article excerpt

EPilepsy is the most common of all neurological disorders in children. Often the educational, social, and psychological impacts of epilepsy can be more detrimental than the condition itself. Despite tremendous medical advances in understanding and in the treatment of epilepsy, myths and misconceptions about seizure disorders abound and can present formidable barriers for the child with ep-ilepsy. Even when seizures are well con-trolled, children and adolescents with ep-ilepsy may not function as well as their peers.

Epilepsy may affect the self-image of the child and can result in anxiety, lack of confidence, even grief and depression. Children may withdraw from social situations and activities. Parents and teachers may have a tendency to overprotect the child with seizures, setting lower expectations and "excusing" lack of academic performance or misbehavior as a consequence of either the epilepsy or its treatment. This can limit the child's ability to develop appropriate relationships with other children, as well as contribute to the very emotional and behavioral problems they are trying to avoid.

There are many reasons why epilepsy may be associated with learning, social. and behavioral difficulties. In children with mild, well-controlled epilepsy, the least plausible explanation for difficulties is that seizures themselves are the culprit. Unfortunately, many parents and even some clinicians continue to assume a direct cause-and-effect relationship between seizures and other difficulties the child might have.

Parents should always distrust statements that begin with or include "all children with epilepsy...." Epilepsy is not a single disease. Seizures are symptoms of an underlying brain disorder. While a significant proportion of children with epilepsy have no other neurological problems, others have epilepsy due to brain abnormalities or injuries that certainly contribute to educational, psychological, and social difficulties.

In general, seizures themselves do not cause behavior problems, social maladjustment, or poor learning. However, attention disorders and learning disabilities can accompany epilepsy. These might actually be more influential on social and behavioral difficulties than the seizure disorder itself. For example, in a study of childhood epilepsy in Nova Scotia, Canada, children and adolescents were studied for an average of seven and a half years following a diagnosis of epilepsy. This study included all children diagnosed with epilepsy who lived within the province. Unfavorable social outcomes in young adults--dropping out of school, unemployment, social isolation, arrests, etc.--were unrelated to whether or not seizures were controlled, the seizure type, or EEG results. They were, however, strongly associated with coexisting learning disabilities at the time of the diagnosis of epilepsy. Other significant factors beyond attention disorders and learning disabilities that can influence social, educational, and psychological conduct are medications and social stigma.

Epilepsy and learning disabilities

Dyslexia and non-verbal learning disabilities are somewhat more common in children with epilepsy and may impair educational progress and the development of social skills. Subtle verbal communication difficulties may be more prevalent in some types of epilepsy, particularly those originating in the temporal lobe. While the child may speak and understand speech adequately for simple communication, more complex interactions, particularly in groups, may be a challenge. While dyslexia is often detected by school screening or suspected by parents when a child does not learn to read promptly, non-verbal learning disabilities (difficulties with math, logic, comprehension and social skills) are often overlooked, even by experienced clinicians and teachers. These non-verbal learning disabilities may impede a child's ability to interpret social cues such as facial expressions, intonation, and gestures. …