Psychosocial Risk Factors of Epilepsy

The history of epilepsy - probably the longest history in medical literature to which any single disease, unless it be malaria, can lay claim - might well be said to stand as a monument to human error, to human fallibility; as lamentable evidence of the unnumberedness of those whispers of fancy to which the human mind has ever listened with credibility (Bunker, 1965). Epilepsy, once termed the ‘sacred disease’, might more accurately be described as the most ancient disease. One of the fascinations, and part of frustration, inherent in epilepsy research is the multiplicity of forces that impinge on people with epilepsy. The modern view of epilepsy originated in the work of the mid-nineteenth century neuro-scientists, the most important among them being John Hughlings Jackson. At present, the word epilepsy is used to refer to a class of epileptic disorders characterized by recurrent epileptic seizures.

Epileptic seizures can be defined as the clinical manifestations of excessive and/or hypersynchronous, usually self-limited, abnormal activity of neurons, predominantly located in the cerebral cortex (Engel, 1995). These concepts of epilepsy, however, are by no means fixed, nor are they noncontroversial. Wide differences exist in the prevalence rates of epilepsy in Asian countries, from 1.28 to 9.78 per thousand (Mani and Rangan, 1990). A large number of potential risk factors for salient problems in living, are found among patients with epilepsy. Each patient with his or her own unique combination of potential risk factors, and, on clinical grounds alone, it appears difficult to identify those variables that actually represent causal factors. Patients with epilepsy frequently experience psychosocial difficulties, especially in the realms of familial and socio-occupational functioning. Interictal symptoms of epilepsy are influenced by the ictal event and other neuropsychiatric and psychosocial factors, such as coexisting psychiatric or neurological disorders, the presence of psychosocial stressors, and the premorbid personality traits.

Intrapersonal factors
Epilepsy, like some other chronic disorders with episodic manifestations (e.g., asthma) can lead to special stresses. Specifically, seizures can occur anytime, anywhere, with little or no warning. Further, the seizures are associated with significant embarrassment and loss of personal dignity. This unpredictability associated with the disorder has been hypothesized to alter the patient’s perceived locus of control. Patients with epilepsy have been found to manifest a more external locus of control than do healthy control subjects and those in other patient groups, e.g., diabetics (Matthews and Barabas, 1986). Individual’s perception and understanding of his/her illness forms another intrapersonal risk factor for epilepsy. Some patients act on the harboured misconceptions of their epilepsy in ways that are either self-defeating or dangerous, either of which would be expected to affect adversely the quality of their lives. Fear of seizures is a potent predictor of maladjustment in adults with epilepsy (Mittan, 1986).Patients vary enormously in their resources and strength in coping with epilepsy. Even though some individuals are able to proceed through life relatively unencumbered by their epilepsy, others feel resentful, believe that their lives have been ruined by epilepsy, and continually dread the occurrence of a seizure. It has been hypothesized that these characteristics are associated with the adequacy of emotional and social adjustment of the individual.

Extrapersonal factors
Individual with epilepsy may be treated quite differently by friends, family, and society in general because of their condition. This differential treatment may be well-meaning in some cases, hostile in others, but may be expected to alter the patient’s adjustment in either instance. Well-meaning parents may be extremely overprotective of their children with epilepsy. Their expectations for the child may be lowered and patterns of familial interaction altered (Ritchie, 1981). At school the child may be teased, harassed, and socially excluded, and the seizures may be feared by teacher. These alterations in development surely constitute potential risk factors for poor adjustment. Stigma and discrimination directed against individuals with epilepsy are the most obvious of the extrapersonal psychosocial risk factors: there is often clear abject social exclusion of the individual with epilepsy, difficulty in gaining entrance to various occupations, and discrimination in various other areas. Sociologists have begun to discuss stigma/discrimination in terms of real versus perceived, which may represent a mixture of explicit versus subtle stigma/discrimination, or, real versus imagined stigma. Individuals with epilepsy may at increased risk for a greater number of stressful life events. Additionally, given the financial stresses of this chronic medical condition and increased probability of employment difficulties, financial stress would clearly seem to be an added risk factor (National Commission for the Control of Epilepsy and its Consequences, 1978).


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