Psychosocial and psychological aspects

Psychosocial and psychological aspects

Questions from healthcare professionals

Q: I am working with a client who has epilepsy and anxiety. He is worried about having psychotherapy to manage his anxiety as feeling strong emotions may trigger a seizure. How can we best proceed so that we can work together on his anxiety yet at the same time manage the risk for potential seizures?

A: If anxiety is a seizure trigger for an individual with epilepsy, therapy to address the anxiety would seem indicated and should be pursued if at all possible. Approaching this may be best done as a graded programme starting off with issues that generate lower level emotional arousal.
At a practical level, it may be worth considering doing a risk assessment. Although most seizures do not need medical intervention, it is important that a therapist is able to tell what that individual's seizures look like and how to deal with them. This would be helpful for both the therapist to feel comfortable, and for the client to feel reassured that they are in safe hands.
Answered by Epilepsy Society's psychology department
June 2011

Q: Where can I find out more about epilepsy co-existing with amnesia, abuse and post-traumatic stress disorder?

A: You may be interested in the work of Mike Kopelman on psychogenic versus organic amnesic syndromes. The following references should be useful.
Kopelman MD. Retrograde memory loss. Handb Clin Neurol. 2008;88:185-202. Review. PubMed PMID: 18631691.
Wilson BA, Kopelman M, Kapur N. Prominent and persistent loss of past awareness in amnesia: delusion, impaired consciousness or coping strategy? Neuropsychol Rehabil. 2008 Oct-Dec;18(5-6):527-40. PubMed PMID: 18609007.
Kopelman MD, Bright P, Buckman J, Fradera A, Yoshimasu H, Jacobson C, Colchester AC. Recall and recognition memory in amnesia: patients with hippocampal, medial temporal, temporal lobe or frontal pathology. Neuropsychologia. 2007 Mar 25;45(6):1232-46. Epub 2006 Nov 30. PubMed PMID: 17140609.
Jenkins KG, Kapur N, Kopelman MD. Retrograde amnesia and malingering. Curr Opin Neurol. 2009 Dec;22(6):601-5. Review. PubMed PMID: 19745730.
June 2011

Q: Is a compulsion to spend money on unnecessary clothes a symptom of epilepsy (as it is in some mental health disorders)? Could it be associated with particular anti-epileptic drugs?

A: This is considered unlikely to be associated with epilepsy, and it is not something that we have heard of before.
January 2011

Q: Where can I find out more about the psychological and social impact of epilepsy on individuals?

A: There are several chapters from Epilepsy 2007 on our website which cover the social aspects of epilepsy, including 'The Patient's viewpoint' and 'Epilepsy clinic counselling'.
> View the menu of articles for social aspects of epilepsy 
You can also access research articles on this topic from the PubMed website (opens new window)
July 2009

Q: What are the driving regulations for people with epilepsy?

A: You can find all of the regulations regarding medical fitness to drive on the DirectGov website. 
September 2008

Q: Has anyone any experience/tips for managing urinary incontinence during seizures?

A: There is nothing specific used for managing urinary incontinence during seizures, as incontinence during seizures is not managed differently to any other incontinence. It may be helpful to make contact with ERIC.
February 2007

Q: What are the options for antdepressants in people with epilepsy taking AEDs, in particular carbamazepine?

A: The best option is SSRIs.
December 2006

Q: We are working with a person who has absence seizures, but we have never seen them happen. How will we konw when they have been free of seizures for a year and can reapply for their licence?

A: Although absences are generalised seizures, they can be very brief and even the person experiencing them may not be aware of them. If the person themselves isn’t aware, and nor are the people around them, it will be very difficult to tell if they become seizure-free. It may be worth discussing this issue with their neurologist.
December 2006

Q: Are there any restrictions, barriers or guidelines associated with students with uncontrolled epilepsy training to be staff nurses?

A: There are no national guidelines. Usually this would be looked at on an individual basis, taking into account the student’s type and frequency of seizures.
May 2005

Q: I read recently that people with epilepsy have less time off work, have fewer accidents and good loyalty records. Is there a research reference to support this? I also read that there is evidence that people with memory problems can be assured their memory will not continue to deteriorate. Is this true and what is the reference?

A: People with epilepsy tend to have no more accidents or time off work than other employees. Those in employment rarely change jobs. These findings are described in a number of studies presented in 'Epilepsy and employment: Is there a problem?’ Proceedings of the employment sessions, 23rd International Epilepsy Congress, 1990, Prague. Edited by JE Chaplin, Chair IBE Employment Commission. We are not aware of any evidence or suggestion that memory problems experienced by people with epilepsy will not continue to deteriorate.
May 2006

Q: I work in an early intervention team. We have clients with epilepsy who have experienced post ictal psychosis requiring intensive nursing care due to risk of harm to self and aggression. A main part of our work with individuals and families involves relapse prevention in terms of recognising possible triggers and early warning signs. Is this realistic? Can you give any advice?

A: Post-ictal psychosis can sometimes be avoided by administering a course of medication such as clobazam or haloperidol after every seizure. It may be helpful to refer such clients to an epilepsy specialist or neuropsychiatrist who could assess the history and decide whether it would be appropriate to plan along these lines. It may be helpful to keep a seizure diary in order to identify possible triggers for the seizures – this website has more information on seizure diaries. Also see the chapter Ictal and post-ictal psychiatric disturbances in our articles section.
March 2005

Q: I am working with a person that had epilepsy from birth to late teens. He feels he has a very bad memory due to his past epilepsy and the medication that he took to control the seizures. To combat this he says he has had to become very organised using electronic diary, PC etc. Is there any evidence in this - could a person with previous history of epilepsy still have cognitive impairment 20 years after the impairment ceased?

A: It sounds as if this person may have a poor memory and a possible explanation is that brain regions important for memory are implicated. In childhood this may have also been the cause of his epilepsy. While his seizures are controlled the memory problems persist. Many people with temporal lobe epilepsy that is controlled by medication continue to have memory problems. If this is the case the memory problems are not due to a past disability but are the consequence of an ongoing disability - a memory problem. It should be possible to get a referral from the GP for a neuropsychological assessment to determine whether a memory problem exists. If it does then without recourse to organisational strategies his working efficiency is likely to reduce.
January 2005

Q: I have a student with epilepsy who is doing a catering course. What health and safety requirements need to be considered with regard to the kitchen and restaurant environment?

A: It would be useful to take account of the Health and Safety at Work Act when carrying out a risk assessment for the student. The individual nature of the student’s epilepsy should also be considered, such as the type and frequency of seizures, and whether there is a warning before seizures. The information pages on this website covering epilepsy and employment and epilepsy and safety may also be useful.
December 2004

Q: Are people with epilepsy allowed to ride bicycles on public roads?

A: We are not aware of any laws regarding people with epilepsy and cycling on public roads.
October 2004

Q: Is there a social group in London for people with epilepsy to join?

A: There are a number of support groups. There is one independent group in North-West London – contact details can be obtained from our epilepsy helpline on 01494 601400, between 10am and 4pm, Monday to Friday. There are also groups run by Epilepsy Action – details available by calling their helpline on 0808 800 5050.
August 2004

Q: I have a patient who is going to live and work in Spain. In the UK she has some protection via the DDA. What will apply when she is in Spain regarding her employment rights?

A: We don't have specific information regarding disability rights in individual countries. However you may be able to find what you are looking from one of the following:

European Union website

Spanish Embassy: 39 Chesham Place, London SW1X 8SB tel: 0870 005 6975

Spanish League Against Epilepsy, Dr. Ines Picornell Darder (president), Paseo de la Castellana 244 8B28045 Madrid tel: +34 91 53 39 769 fax: +34 91 53 39 769 email: neufce@hmtl.insalud.es
March 2004

Please note: Epilepsy Society is unable to provide a medical opinion on specific cases. Responses contain information relating to the general principles of investigation and management. Answers are not, and should not be assumed to be, direct medical advice.