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Thursday, November 7, 2013

The mental Health problems of Epilepsy

There is so much myth concerning epilepsy such that seeking timely and appropriate medical attention may be delayed, which invariably contributes to psychiatric complications.
Some folks hold the belief that when there is a seizure; the saliva coming out of such patients could actually infect anyone that comes into contact with it.
Caregivers often keep such patients at home without seeking medical help or patronise alternative care that could invariably worsen the clinical condition especially when the seizure is not effectively controlled, resulting in brain damage.
An epileptic seizure is a clinical manifestation presumed to result from an abnormal and excessive discharge of a set of neurons in the brain; usually after two or more discrete and unprovoked seizures.
The broad division of epilepsy family lies between the focal epilepsies arising from a known or suspected cause and the generalised epilepsies. Epilepsy can be classified taking into consideration the known cause, age of onset, the region of the brain affected and the seizure subtype.
The two broad divisions following  seizure subtypes are: the partial seizures usually with a focal onset which may become generalised; and the generalised seizures that involve both hemispheres of the brain simultaneously with attendant motor manifestations and impaired consciousness.
The inference is that epilepsy occurs when the constituent elements of the brain – the neurons – discharge abnormally with attendant manifestation traceable to the region of the brain where those neurons are located.
Heralding an attack, there is the prodromal phase usually characterised by mood changes, impaired memory and concentration and some anxiety which may last for days.
For intelligent caregivers, this may be a proactive signal to ascertain compliance with medical care. There is also theaura which rarely lasts more than a few seconds characterised by sensations arising from the stomach, abnormal perception in the sense of taste and smell; tasting and seeing things other folks may not perceive in clear consciousness.
The next critical phase is the actual ‘seizure attack’ which could be automatism characterised by involuntary behaviour when the individual assumes  the control of posture and muscle  tone and performs simple or complex movements without being aware of what is happening.
But when it is generalised, a brief stiffness in the muscles, associated salivation, loss of bladder control, a fall which may cause injury forms the basis for restricting epileptics from operating machineries or driving until seizure free.
There is also the absence seizures characterised by abrupt cessation of ongoing activity, a vacant stare, and a period of unresponsiveness lasting from a few seconds to half a minute.
In childhood and adolescence, inherited disorders of metabolism, birth complications, infection, consequences of febrile convulsion may be implicated while in middle life; trauma and tumor are most common. In the advanced years, stroke and degenerative disorders are predominant.
Only one quarter of cases of epilepsy are known while the remaining belongs into the recognisable epilepsy syndromes. A seizure site may be identified in some cases but the actual cause may be unknown although genetic factors may be very important.
In some instances, the cause may be the abuse of some drugs especially alcohol, overhasty withdrawal of some medications and head injury from okada commercial accidents. Psychiatric complications arise majorly due to brain damage secondary to poor seizure control, the stigma of the illness itself following restriction in job opportunities and some other discriminatory in social contracts including marriage and inappropriate use of drugs to control the seizures.
When patients do not come early for treatment, there is brain damage with behavioural manifestations referable to the particular region. The notion of an ‘epileptic personality’ is obsolete but some affectation of personality development may arise following brain damage, rather than the epilepsy.
The attendant learning difficulties will lead to limited educational opportunity, adult unemployment and socio-economic disadvantages. There is increased evidence of psychotic illness among epileptic patients especially when the focus of the seizures starts in the temporal lobe, especially in the left side.
There may be behavioural disturbances often confusional in nature, or mood related which may remit spontaneously after a seizure attack.
A diminution in sexual interest and impaired sexual performance are quite common. There is an association between epilepsy and criminal activity especially among males possibly operating through low intelligence, impaired social development and poverty.
The adverse social, educational, and economic disadvantages that confront people with epilepsy may give rise to anxiety and depression.
Suicide is increased almost five-fold among patients with epilepsy which emphasises the crucial role of effective control to prevent brain damage.
Wrong use of medication by the non-specialist doctors to control seizures may also be responsible for some mental health problems which reinforces the fact that appropriate specialist doctors should attend to epileptic patients for effective seizure control.
Adeoye Oyewole

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