Introduction

About 1 in 30 people in Nepal develop epilepsy at some stage in their life. It most commonly starts in childhood and in people aged over 60. However, epilepsy can begin at any age. In general, seizures are well controlled by treatment in about 4 in 5 cases. There are different types of epilepsy. Other leaflets in this series include: 'Epilepsy - Partial Seizures', 'Epilepsy - Childhood Absence Seizures', 'Epilepsy - Could It Be?', 'Epilepsy - Living With Epilepsy', 'Epilepsy - Treatments', 'Epilepsy - Tonic-clonic Seizures', 'Epilepsy - Dealing With a Seizure', 'Epilepsy - Contraception/Pregnancy Issues', 'Epilepsy and Sudden Unexpected Death'.

What is a seizure?

A seizure is a short episode of symptoms caused by a burst of abnormal electrical activity in the brain. Typically, a seizure lasts from a few seconds to a few minutes. (Older words for seizures include convulsions and fits.)

The brain contains millions of nerve cells (neurons). Normally, the nerve cells are constantly sending tiny electrical messages down nerves to all parts of the body. Different parts of the brain control different parts and functions of the body. Therefore, the symptoms that occur during a seizure depend on where the abnormal burst of electrical activity occurs. Symptoms that may occur during a seizure can affect your muscles, sensations, behaviour, emotions, consciousness, or a combination of these. The different types of seizures are discussed below.

What is epilepsy?

If you have epilepsy, it means that you have had repeated seizures. If you have a single seizure, it does not necessarily mean that you have epilepsy. About 1 person in 20 has a seizure at some time in their life. It may be the only one that occurs. The definition of epilepsy is more than one seizure. The frequency of seizures in people with epilepsy varies. In some cases there may be years between seizures. At the other extreme, in some cases the seizures occur every day. For others, the frequency of seizures is somewhere in between these extremes.

Epilepsy can affect anyone at any age. Around 456,000 people in the Nepal have epilepsy.

Epileptic seizures arise from within the brain. A seizure can also be caused by external factors which may affect the brain. For example, a high fever may cause a febrile convulsion. Other causes of seizures include: lack of oxygen, a low blood sugar level, certain drugs, poisons, and a lot of alcohol. Seizures caused by these external factors are not classed as epilepsy.

Different types of epilepsy and seizures

Seizures are divided into two main types - generalised and partial. (There are also other uncommon types of seizure.) If you have epilepsy you usually have recurrences of the same type of seizure. However, some people have different types of seizure at different times.

Generalised seizures

These occur if the abnormal electrical activity affects all or most of the brain. The symptoms tend to be general and involve much of your body.

There are various types of generalised seizure:

• A tonic-clonic seizure is the most common type of generalised seizure. With this type of seizure your whole body stiffens, you lose consciousness, and then your body shakes (convulses) due to uncontrollable muscle contractions.
• Absence seizure is another type of generalised seizure. With this type of seizure you have a brief loss of consciousness or awareness. There is no convulsion, you do not fall over, and it usually lasts only seconds. Absence seizures mainly occur in children.
• A myoclonic seizure is caused by a sudden contraction of the muscles, which causes a jerk. These can affect the whole body but often occur in just one or both arms.
• A tonic seizure causes a brief loss of consciousness, and you may become stiff and fall to the ground.
• An atonic seizure causes you to become limp and to collapse, often with only a brief loss of consciousness.

Partial seizures

Partial seizures are also called focal seizures. In these types of seizures the burst of electrical activity starts in, and stays in, one part of the brain. Therefore, you tend to have localised (focal) symptoms. Different parts of the brain control different functions and so symptoms depend on which part of the brain is affected:

• Simple partial seizures are one type. You may have muscular jerks or strange sensations in one arm or leg. You may develop an odd taste, or pins and needles in one part of your body. You do not lose consciousness or awareness.
• Complex partial seizures are another type. These commonly arise from a temporal lobe (a part of the brain) but may start in any part of the brain. Therefore, this type is sometimes called temporal lobe epilepsy. Depending on the part of the brain affected, you may behave strangely for a few seconds or minutes. For example, you may fiddle with an object, or mumble, or wander aimlessly. In addition, you may have odd emotions, fears, feelings, visions, or sensations. These differ from simple partial seizures in that your consciousness is affected. You may not remember having a seizure.

Sometimes a partial seizure develops into a generalised seizure. This is called a secondary generalised seizure.

What causes epilepsy?

Unknown cause (idiopathic epilepsy)

In many cases, no cause for the seizures can be found. The abnormal bursts of electrical activity in the brain occur for no known reason. It is unclear why they start, or continue to occur. Genetic (hereditary) factors may play a part in some cases. People with idiopathic epilepsy usually have no other neurological (brain) condition. Medication to control seizures usually works very well.

Symptomatic epilepsy

In some cases, an underlying brain condition or brain damage causes epilepsy. Some conditions are present at birth. Some conditions develop later in life. There are many such conditions. For example: a patch of scar tissue in a part of the brain, a head injury, stroke, cerebral palsy, some genetic syndromes, growths or tumours of the brain, and previous infections of the brain such as meningitis, encephalitis. The condition may irritate the surrounding brain cells and trigger seizures.

Some underlying conditions may cause no other problems apart from seizures. In other cases, the underlying condition may cause other problems or disabilities in addition to the seizures.

These days, with modern scans and tests, a cause can be found for some cases previously thought to be idiopathic (unknown cause). For example, a small piece of scar tissue in the brain, or a small anomaly of some blood vessels inside the brain. These may now be found by modern brain scanning equipment which is more sophisticated than in the past.

What triggers a seizure?

There is often no apparent reason why a seizure occurs at one time and not at another. However, some people with epilepsy find that certain triggers make a seizure more likely. These are not the cause of epilepsy, but may trigger a seizure on some occasions.

Possible triggers may include:

• Stress or anxiety.
• Some medicines such as antidepressants, antipsychotic medication (these lower the seizure threshold in the brain).
• Lack of sleep, or tiredness.
• Irregular meals (or skipping meals) which may cause a low blood sugar level.
• Heavy alcohol intake or using street drugs.
• Flickering lights such as from strobe lighting or video games.
• Menstruation (periods).
• Illnesses which cause fever such as flu or other infections.

Get help and support from hundreds of other people like you in our discussion forums:

How is epilepsy diagnosed?

You should see a doctor if you have had a possible seizure or similar event. Sometimes it is difficult for a doctor to confirm that you have had a seizure. The most important part of confirming the diagnosis is the description of what happened. Other conditions can look like seizures - for example, faints, panic attacks, collapses due to heart problems, breath-holding attacks in children.

Therefore, it is important that a doctor should have a clear description of what happened during the event. It may be that a person who witnessed your seizure may be able to give a more accurate description of what happened during your seizure.

There is no one test to confirm a diagnosis of epilepsy. However, tests such as brain scans, electroencephalogram (EEG - brainwave recordings) and blood tests may help to make a diagnosis.

• A brain scan - usually a magnetic resonance imaging (MRI) or computed tomography (CT) scan - shows the structure of different parts of the brain. This may be performed in some people.
• EEG. This test records the electrical activity of the brain. Special stickers are placed on various parts of the scalp. They are connected to the EEG machine. This amplifies the tiny electrical messages given off by the brain and records their pattern on paper or computer. The test is painless. Some types of seizure produce typical EEG patterns. However, a normal recording does not rule out epilepsy, and not all EEG abnormalities are related to epilepsy.
• Blood tests and other tests may be advised to check on your general well-being. They may also look for other possible causes of the event.

Although helpful, tests are not foolproof. It is possible to have epilepsy with normal test results. Also, if an abnormality is found on a brain scan, it does not prove that it causes seizures.

However, tests may help to decide if the event was a seizure, or caused by something else. It is unusual for a diagnosis of epilepsy to be made after one seizure, as the definition of epilepsy is recurrent seizures. For this reason a doctor may suggest to wait and see if it happens again before making a firm diagnosis of epilepsy.

What are the treatments for epilepsy?

Medication

Epilepsy cannot be cured with medication. However, with the right type and strength of medication, the majority of people with epilepsy do not have seizures. The medicines work by stabilising the electrical activity of the brain. You need to take medication every day to prevent seizures. Deciding on which medicine to prescribe depends on such things as: your type of epilepsy, your age, other medicines that you may take for other conditions, possible side-effects, whether you are pregnant or if planning a pregnancy.

One medicine can prevent seizures in most cases. A low dose is usually started at first. The dose may be increased if this fails to prevent seizures. In some cases two medicines are needed to prevent seizures.

The decision when to start medication may be difficult. A first seizure may not mean that you have epilepsy, as a second seizure may never happen, or may occur years later. The decision to start medication should be made by weighing up all the pros and cons of starting, or not starting, the medicine. It is unusual to start treatment after a first seizure. A common option is to wait and see after a first seizure. If you have a second seizure within a few months, more are likely.

Medication is commonly started after a second seizure that occurs within 12 months of the first. However, there are no definite rules and the decision to start medication should be made after a full discussion with your doctor.

The type of treatment you will be given often depends on the type of seizures you have and also if you are taking any other medication.

Some points about medication for epilepsy include the following:

• Ask your doctor how long treatment is likely to be advised. This will vary from case to case. If you have not had seizures for several years, you may wish to try stopping medication. However, this depends on your particular type of epilepsy, as some types will need medication for life. Your life circumstances may influence the decision about stopping medication. For example, if you have recently regained your driving licence, the risk of losing it again for a year if a seizure occurs may affect your decision. However, if you are a teenager who has been free of seizures for some years, you may be happy to take the risk.
• Although the list of possible side-effects for each medicine seems long, in practice, most people have few or no side-effects, or just minor ones. Ask your doctor which side-effects are important to look out for. If you develop a troublesome side-effect it may be dose-related, or may diminish in time. Alternatively, a switch to another medicine may be advised.
• Medicines which are used for other conditions may interfere with medication for epilepsy. If you are prescribed or buy another medicine, remind your doctor or pharmacist that you take medication for epilepsy. Even things like indigestion medicines may interact with your epilepsy medication, which may increase your chance of having a seizure.
• Some medicines for epilepsy interfere with the contraceptive pill. A higher-dose pill or an alternative method of contraception may be needed.
• Tell your doctor if you intend to become pregnant. Pre-conception counselling is important for women with epilepsy.
• If you have epilepsy and take medication, you are exempt from prescription charges for all your prescriptions. You need an exemption certificate. You can get this from your pharmacist.

Other treatments for epilepsy

• Surgery to remove a small part of the brain which is the underlying cause of the epilepsy. This is only a suitable option if your seizures start in one small area of your brain (this means it is only possible for a minority of people with epilepsy). It may be considered when medication fails to prevent seizures. However, there are risks from operations. Only a small number of people with epilepsy are suitable for surgery and, even for those who are, there are no guarantees of success. Surgical techniques continue to improve and surgery may become an option for more and more people in the future.
• Vagal nerve stimulation is a treatment for epilepsy, where a small generator is implanted under the skin below the left collar bone. The vagus nerve is stimulated to reduce the frequency and intensity of seizures. This can be suitable for some people with seizures that are difficult to control with medication.
• The ketogenic diet is a diet very high in fat, low in protein and almost carbohydrate-free which can be effective in the treatment of difficult-to-control seizures in children.
• Complementary therapies such as aromatherapy may help with relaxation and relieve stress, but have no proven effect on preventing seizures.

What is the outlook (prognosis) for people with epilepsy?

The success in preventing seizures by medication varies depending on your type of epilepsy. For example, if no underlying cause can be found for your seizures (idiopathic epilepsy), you have a very good chance that medication can fully control your seizures. Seizures caused by some underlying brain problems may be more difficult to control.

The overall outlook is better than many people realise. The following figures are based on studies of people with epilepsy, which looked back over a five-year period. These figures are based on grouping people with all types of epilepsy together, which gives an overall picture:

• About 5 in 10 people with epilepsy will have no seizures at all over a five-year period. Many of these people will be taking medication to stop seizures. Some will have stopped treatment having had two or more years without a seizure whilst taking medication.
• About 3 in 10 people with epilepsy will have some seizures in this five-year period, but far fewer than if they had not taken medication.
• So, in total, with medication, about 8 in 10 people with epilepsy are well controlled with either no, or few, seizures.
• The remaining 2 in 10 people experience seizures, despite medication.
• A very small number of people with epilepsy have sudden unexplained death. The exact cause of this is unknown, but may be related to a change in the breathing pattern or to abnormal heart rhythms during a seizure. However, this is rare and the vast majority of people with epilepsy fully recover following each seizure.

A trial without medication may be an option if you have not had any seizures over 2-3 years. If a decision to stop treatment is made, a gradual reduction of the dose of medication is usually advised over several months. You should never stop taking medication without discussing it with a doctor.

The above section on outlook (prognosis) relates just to seizures. Some underlying brain conditions which cause seizures may cause additional problems.

Most people with epilepsy live full and active lives, but may have to accept some changes to their lifestyle. For example, you must not drive for a period laid down by law. Below are further sources of information, help and support on all aspects of epilepsy.

woman with epilepsy

More than one million women and girls in the United States are living with seizure disorders. They face many unique challenges, from changes during the monthly cycle which may trigger seizures to concerns regarding pregnancy. Social factors leave them vulnerable to discrimination and abuse. Yet their plight and the manner in which they are affected has been largely ignored. As an important part of the Epilepsy Foundation Eastern PA’s role in advocating for all people with epilepsy, we are committed to addressing the unique health concerns of women with epilepsy.
Depression is a major risk for about one in three women with epilepsy.
Women with epilepsy face epilepsy-related reproductive difficulties throughout their lives, including increased rates of sexual dysfunction, infertility and seizures related to the menstrual cycle.
Despite risks, successful pregnancy is possible, but often inappropriately discouraged by health care providers.
Long-term use of some anti-epileptic drugs negatively affects bone health in women.

Man with epilepsy

Does epilepsy affect hormones?
Yes, epilepsy is associated with hormonal changes. For instance, experts estimate that approximately 40 percent of men with epilepsy (MWE) have low levels of testosterone, the hormone that stimulates the development of male sex organs, sexual traits and sperm. Both epilepsy itself and the antiepileptic drugs (AEDs) used to control seizures may be responsible for these hormonal changes.
How epilepsy induces hormonal changes:
Persistent seizures in adults may be associated with hormonal and neurological changes that contribute to sexual dysfunction.
Seizures can alter the release of hypothalamic and pituitary hormones.
Temporal lobe epilepsy, in particular, is known to have adverse effects on testicular endocrine function.
How AEDs cause hormonal changes:

• Studies show that AEDs directly affect brain regions that mediate sexuality.
• AEDs may cause sexual dysfunction by inducing secondary effects on reproductive hormones.
• Some AEDs change the concentrations of sex steroid hormones.

Do all AEDs have the same effect on hormones?
No. Some, but not all, AEDs have been linked to adverse hormonal effects.
Research suggests that the AEDs phenytoin, carbamazepine and phenobarbital adversely affect hormone levels by reducing the level of free testosterone which, in turn, reduces sexual desire.
Some good news regarding AEDs and hormonal effects does exist: Studies show that the AED lamotrigine may not have a negative impact on sexual function. In fact, in one study, lamotrigine was shown to have a favorable effect on sexual disorders in MWE who had partial seizures and were taking other AEDs.
What is the impact of hormonal changes?
Reduced testosterone, one hormonal effect frequently seen in MWE, can adversely affect one or more of the following: energy, mood, drive, sexual function, bone density and seizure control.
A large percentage of MWE have been found to have low levels of bioavailable testosterone (BAT), the portion of total testosterone available for use. Abnormally low BAT levels have been tied to sexual dysfunction.
Getting help
Endocrine specialists can help patients sort out the complex interactions between hormones, seizures and AEDs.
Sometimes identifying hormonal influences on seizure patterns may lead to a better understanding of treatment options for seizure control.
Although it is still considered experimental and must be monitored very closely, treatment with testosterone supplements have been shown to improve low testosterone levels in MWE.

Sexuality and Antiepileptic Drugs (AEDS)

What effect do AEDs have on sexuality?
The use of AEDs may result in one or more of the following adverse impacts on sexuality:

• Decreased libido: Some AEDs cause elevations in hormones that suppress sexual arousal and behavior.
• Sperm abnormalities: Some AEDs are associated with sperm abnormalities, including low semen volume, low sperm count and abnormal sperm motility. The following AEDs have been linked to sperm abnormalities: carbamazepine, oxcarbazepine and valproate.
• Reduced testicular volume: Some AEDs have been linked to reduced testicular volume
• Reproductive dysfunction: AEDs may cause alterations to androgens (substances that produce male characteristics and stimulate activity of male sex organs), thereby contributing to reproductive dysfunction.

Impact on sexuality varies among AEDs
When it comes to sexual function and reproductive hormone levels, not all AEDS have the same effect.
For instance, researchers have found that diminished libido and arousal are most pronounced in patients using sedating AEDs, such as barbiturates, although adverse effects on sexuality may also occur with any AED.
The AED lamotrigine appears to have a more favorable profile on sexual function and reproduction than several other AEDs. For instance, men taking enzyme-inducing AEDs have been shown to reach lower testosterone levels at an earlier age than men taking lamotrigine. Plus, a recent study found that, in men experiencing sexual disorders and taking prescribed AEDs for partial seizures, adding lamotrigine had a favorable effect on impotence.
The AED carbamazepine has been linked to significantly reduced levels of testosterone, when compared to the AED valproate. In recent studies, valproate treatment appeared to have no effect on sperm cell function in men with temporal lobe epilepsy.
Seeking help
If you are experiencing problems with sexual function, it is important to discuss them with your doctor. Your doctor may be able to prescribe alternative AEDs; many patients who experience sexual deficits with one medication will have normal sexual function with another. Plus, if you suffer from impotence, your doctor may prescribe medication to help you overcome it.

Libido

Does epilepsy affect libido?
Yes. Several recent studies document that men with epilepsy (MWE) experience lowered libido. The following scientific data support this statement.
One study found that between 50 percent and 70 percent of all MWE report decreased sexual function and/or libido.
One survey showed that 57 percent of MWE recently experienced erectile failure, compared to 18 percent of men without epilepsy.
A recent study demonstrated that approximately 40 percent of MWE possess bioavailable testosterone levels below the normal control range. This is a significant finding because researchers now know that bioavailable testosterone levels, rather than total testosterone levels, affect libido.
How does epilepsy affect libido?
The following factors can affect libido in people with epilepsy:
Exposure to antiepileptic drugs (AEDs)
AEDs produce direct effects on the brain regions mediating sexuality and may also cause sexual dysfunction by secondary effects on reproductive hormones. Some AEDs have a greater impact on libido than others. Recent data show that, among men with localization-related epilepsy, those taking enzyme-inducing AEDs had less gonadal efficiency than those taking lamotrigine. Men taking enzyme-inducing AEDs also reached abnormally low testosterone levels at an earlier age.
Diminished libido and arousal tend to be most pronounced in MWE taking sedating AEDs such as barbituates.
In studies comparing the adverse effects of various AEDS on sexuality, researchers found the AEDs carbamazepine and phenytoin to have a much more negative effect on libido than lamotrigine.
Changes in the brain due to seizures
Sexual desire requires appropriate function of specific regions of the cerebral cortex, especially frontal and temporal lobes. People with complex partial seizures seem more prone to problems with sexual desire, particularly when seizures originate in the temporal lobe. Moreover, research suggests that damage to the temporal lobe, common in people with partial epilepsy, affects the ability to recognize subtle cues that are integral to establishing intimacy.
Negative emotions
Sexual desire can be disturbed by psychological factors such as depression and anxiety. Although limited data exists on depression among people with epilepsy, statistics reveal that the suicide rate for people with epilepsy is 5 times greater than that of the general population, which strongly suggests that the rate of depression is also higher.
Fear that sexual activity will induce a seizure, particularly for those whose seizures are triggered by hyperventilation or physical exertion, may also have a negative impact on libido.
Are there ways to improve libido?
Researchers are experimenting with the use of testosterone in MWE to improve libido. Preliminary results are encouraging. Researchers note improved energy and sexual drive with the administration of testosterone, and decreasing frequency of seizures. Therefore, experts suggest that MWE experiencing decreased libido ask their doctor to order a test that will determine their level of bioavailable testosterone.
While the research on testosterone offers promise to MWE suffering from low libido, scientists caution that health care providers using testosterone to treat reduced libido in MWE should regularly monitor the following: behavioral changes (due to the possibility of developing anger or paranoia); blood count; liver function; lipid profile; and prostate-specific antigen (PSA) count, which is used to detect the presence of prostate cancer.
A recent survey indicates that very few MWE discuss sex with their physician, despite the prevalence of sexual problems among this population. By bringing these problems to the attention of a doctor, it’s possible that actions can be taken to combat them. For instance, a change in the type of AED may improve libido; so might the administration of testosterone.

Reproduction and Fertility

Does epilepsy have an adverse effect on a man’s reproductive function and fertility?
Yes, epilepsy does have an impact on reproductive function and fertility. Statistically, men with epilepsy (MWE) have a disproportionately high risk of reproductive dysfunction, which manifests as diminished potency and abnormal sperm characteristics and can decrease fertility. Specific findings regarding reproduction and fertility among MWE include the following:
One study found that MWE were only 36 percent as likely as their male siblings without epilepsy to father a pregnancy.
In a study comparing sperm in healthy males to sperm in MWE, researchers found that all MWE—regardless of whether they were taking antiepileptic medications (AEDs)—exhibit abnormalities in the structure and function of their sperm far more frequently than do healthy males.
How does epilepsy impact male reproductive function and fertility?
Research has found that, in many instances, epilepsy itself has an adverse effect on reproductive function and fertility. The type of epilepsy, age of onset and family history appear to have the biggest impact on reproductive dysfunction and infertility. Specifically, studies find that:
Men with early age onset of epilepsy (less than 10 years of age) are more reproductively disadvantaged than men who develop epilepsy at a later age.
Men with partial onset epilepsy are more reproductively disadvantaged than those with generalized onset epilepsy.
Temporal lobe epilepsy is linked to testicular endocrine dysfunction.
MWE who don’t have a family history of epilepsy are at a greater risk for reproductive dysfunction than MWE who do have a family history of epilepsy.
Do antiepileptic drugs (AEDs) have a negative impact on reproductive function and fertility?
Researchers have found that some AEDs are associated with reproductive dysfunction, which adversely affects fertility.
Valproate is linked to sperm tail abnormalities and reduced testicular volume.
Carbamazepine and oxcarbazepine may cause sperm abnormalities.
Seeking help for reproductive and fertility problems
It’s important to seek professional help if you are concerned about the effects of epilepsy and/or AEDs on your reproductive function and fertility. If you are unsure where to turn, ask your primary care provider to refer you to an appropriate medical professional.
Although epilepsy and many of the drugs used to control it can have adverse effects on reproductive function, thereby reducing fertility, refinements in diagnosing reproductive dysfunction and novel ways to treat it show promise. For instance, innovative means of obtaining a male hormone profile through noninvasive methods make it possible to determine each patient’s precise baseline hormone activity. With this information, clinicians can introduce individually appropriate hormonal (testosterone) therapies for patients, which have been found to improve fertility in MWE.

Bone Density and Epilepsy

For both men and women who have epilepsy, there is an increased risk of bone disease due to certain medications that have been linked to reduced bone health. These include Dilantin, Tegretol, Phenobarbital and Depakote. The newer drugs are expected to be better but there is not enough clinical data yet to completely understand their effects on bone health. Some epilepsy medications also reduce calcium absorption as well as active levels of Vitamin D which is important for overall bone health.
It is recommended that anyone who has been taking epilepsy medications for five years or more should have a DEXA scan. About 35 percent of patients under the age of 40 were found that have osteopenia or osteoporosis. This is a new recommendation and most physicians are unaware of it; therefore you may need to educate your physician on why DEXA scans are an important part of maintaining your health.
Bone Density Tests
The thickness of your bones, or bone density, can be measured in a few ways. A heel scan is a screening test. The best test is a DEXA scan (no needles and it only takes 10 minutes). The DEXA scan looks at your bone density at the lower back (lumbar spine) and hip. It will give you some bone scores. The most important is the T score. The T score compares your bones to other women at their peak bone mass.

Parenting

What are the chances that my children will have epilepsy?
As a man with epilepsy, your offspring are at a slightly higher risk than the general population for developing this disorder.
Recent studies show that offspring of men with epilepsy (MWE) have a 2.4 percent risk of developing it, as opposed to the general population, whose risk is estimated at 1 percent.
If both parents have epilepsy, the risk that their offspring will develop epilepsy increases, although estimates vary widely. Some statistics say the risk of developing epilepsy when both parents have it is about 5 percent, while others place it closer to 15 or 20 percent.
Will my children be at increased risk for other health problems because I have epilepsy?
Some research suggests that offspring of MWE may be at higher-than-normal risk for the following medical problems: neurofibromatosis, tuberous sclerosis and genetically determined epilepsies such as juvenile myoclonic epilepsy.
What special considerations do I need to keep in mind as a parent?
If your epilepsy is well-controlled, you face very few restrictions on caring for a child with epilepsy. However, if your epilepsy causes episodes of impaired consciousness and limited control of movement, you need to take special precautions when caring for a baby or a young child.
Keeping infants safe
Sleep deprivation and new parenthood often go hand-in-hand. Stress that is induced by sleep deprivation can aggravate seizures; sleep deprivation may also lead to missed medications. Be aware of these potential problems and develop a plan to reduce their impact.
Tips to use when caring for an infant:

• Sit on the floor while feeding a baby. If you tend to fall on the same side during a seizure, position yourself to prevent yourself from falling on the baby.Dress, change and play with the baby on the floor.

• Avoid bathing a baby in a tub while you are alone.

• Avoid carrying your baby around the house, especially up and down stairs.

• Avoid hot drinks around your baby.

When your children are older
Your seizures will not go unnoticed by your children as they get older, so it’s important that you openly discuss your epilepsy with them. They will be comforted by knowing that you are not harmed by seizures; in fact, they may feel empowered if you can teach them how to get help if you remain unconscious after a seizure.
When discussing your epilepsy with your children:

• Keep it simple. Use words that your children understand.
• Be calm and positive.
• Explain that you won’t be hurt but may need some help during a seizure.
• When your children are old enough, teach them how to react during a seizure. Show them how to call 911 – in case you’re unconsciousness after a seizure.
• At your discretion, add details about your condition when children are older.

Self-Esteem

The connection between epilepsy and low self-esteem
There is no evidence that epilepsy per se causes low self-esteem. However, recent research suggests that people with epilepsy sometimes have difficulty forming relationships with others, possibly due to neurological damage to the temporal lobe. One study of patients with poorly controlled epilepsy found that 68 percent of subjects had no personal friends. People who lack the social support that friendships offer are likely to feel isolated; subsequently, these feelings of isolation may have a negative impact on self-esteem.
Experts also cite other possible reasons why people with epilepsy are prone to low self-esteem: family over-protection, which prevents individuals from developing independence and self-esteem; the perceived stigma that accompanies epilepsy and resultant negative self-image; and general personal dissatisfaction.
Low self-esteem in males with epilepsy (MWE) is particularly common during adolescence, a period of heightened self-consciousness that may be exacerbated by having epilepsy. Surveys indicate that adolescents whose epilepsy is well-controlled are less likely to suffer from low self-esteem than those who have frequent seizures.
Effects of low self-esteem
Low self-esteem can result in general dissatisfaction. It can also adversely affect specific aspects of life. For instance, low self-esteem may contribute to sexual problems, such as decreased libido. Low self-esteem may also be partially responsible for under-employment among MWE. A recent report by the Epilepsy Foundation documented that people with epilepsy have an unemployment rate of 25 percent. Among people whose seizures are poorly controlled, that rate approaches 50 percent.
Ways to improve self-esteem:
Controlling epilepsy
Controlling epilepsy may help improve self-esteem. One study found that in children with epilepsy who successfully underwent surgery, it not only alleviated seizures at a younger age, but also improved the psychosocial status of these individuals later in life.
Support Groups
Group interventions have proved beneficial as self-esteem boosters. For instance, a recent study demonstrated how adolescents with epilepsy benefited from a 6-week, structured psycho- educational group intervention. The intervention involved cognitive-behavioral strategies in which participants were encouraged to share their own experiences. Results showed that the intervention helped participants better understand their disease and engage in peer support. Post-intervention outcome measurements indicated an overall positive trend for quality of life improvement, suggesting that support groups would benefit MWE suffering from low self-esteem.
Stress management
Stress management has been linked to improvements in self-esteem and seizure control. Recent research indicates that, by increasing self-esteem, MWE may be able to manage stressful situations more effectively. Moreover, studies indicate that stress management may lead to improved seizure control in some MWE. Therefore, MWE who suffer from low self-esteem and anxiety may benefit by learning and practicing relaxation techniques. Examples of these techniques include aromatherapy, tai chi, reflexology and meditation.
Seeking professional help
If feelings of low self-esteem persist for a prolonged period of time or interfere with daily living, it is advisable to seek help from a trained professional, such as a clinical psychologist or a qualified counselor. A referral can be obtained through a primary care provider.