By Temitayo Ogegbile, MD
Inova Fairfax Hospital for Children
Epilepsy is a common neurologic condition in young people, affecting approximately one percent of children and adolescents under the age of 15. Children with epilepsy are at higher risk for numerous medical problems, including neurodevelopmental disorders such as ADHD; cognitive deficits and learning disabilities; and physical morbidity related to seizure events such as fractures, head trauma, contusions and whiplash. They are also susceptible to side effects from anti-epilepsy medications, which can take a significant toll on psychosocial function and overall general development.
As physicians, we tend to focus on these specific tangible medical concerns, which of course are very important. However, the overall psychological well-being of the patient may be even more important. Studies have shown that patients with epilepsy are more likely to have impaired social development and poorer cognitive development compared to their peers. Particularly, they have decreased social competence, increased social problems and profound social isolation. A recent qualitative study found that many epilepsy patients describe numerous such concerns, including difficulty developing new friends, isolation due to fear of having seizures in public, and delinquent aggressive responses to teasing/bullying, which can lead to suspension from school. These patients are also more likely to develop moderate to severe depression as a result of their health problems.
Poor psychosocial development may contribute to a higher likelihood of future troubles, such as dropping out of high school or not pursuing higher education; unemployment; and failure to function independently in society as an adult. Patients with poor seizure control are more likely to have significantly worse psychosocial development compared to those with better seizure control. It has also been suggested that early diagnosis and treatment may reduce or delay the decline in psychosocial function and learning/cognitive difficulties. On the other hand, delays in diagnosis and inadequate treatment of the disease can be disruptive during crucial points in psychosocial development.
There is significant variability in the treatment response of different epilepsy syndromes. Some are easily treatable, while others are more intractable to treatment. Regardless of the type of epilepsy, once treatment is initiated, we must also assess the extent to which the patient’s psychosocial function is affected and continue to monitor psychosocial development. Not only is it essential to assess for improvement in the frequency and intensity of seizures, it is also important to assess the patient’s quality of life. Issues of self-perception, feelings of normalcy, independence levels, social interactions at school and depression should be explored. Patients may need the help of a psychiatrist or psychologist, and it is our responsibility to ensure that they are getting the most comprehensive care possible. The research supports this. A recent study indicated that patients with poor psychosocial function can show improvement in their quality of life and social development after about two years of adequate anti-epilepsy treatment.
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