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Behavioural and Emotional Changes in Persons with Epilepsy

 

 
 
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Can having epilepsy affect one's emotions and behaviour?

 

Concerns about the effect of having recurring seizures on an individual's emotional state and behaviour are often raised. The vast majority of persons with epilepsy have no more emotional baggage to carry than the next person. Some people who have seizures, though, may experience more extreme emotional changes or exhibit behaviours which are not considered socially acceptable.

 
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What causes such changes to emotions and behaviour?

 

In most cases such changes are caused by the strains of dealing with our society's often hostile attitudes toward disability in general and epilepsy in particular. Sometimes, though, medication and the seizures themselves may affect a person's emotional state and her or his behaviour. The following paragraphs will offer a brief discussion of each of the three main contributing factors to emotional and behavioural changes in persons with epilepsy: psychosocial circumstances, medication, and seizures.

 
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What are some common feelings that people with epilepsy experience?

 

For the person with epilepsy, a range of factors can combine to produce a heightened sense of anxiety, depression, low self-esteem, and feelings of isolation. While most people with the condition learn how to deal with these feelings, some may respond to such pressures by reacting in an overly aggressive, asocial, irritable, or introverted manner.

 
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Can the fear of having a seizure cause emotional and behavioural problems?

 

It is often the possibility of having a seizure, rather than the seizure itself, which may be handicapping to the person with epilepsy. Afraid of having a seizure in public and the very real possibility of injury, the person with epilepsy may seclude her- or himself. As a result a person may become very isolated.

As well, the person with seizures may be anxious about other people's reactions to a seizure. Many people who witness a seizure may react by being afraid and embarrassed by the situation. Since the individual who has seizures has no control over other people's reactions during a seizure, he or she may prefer to stay alone and in isolation.

 
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What effects can feeling "out of control" have?

 

One of the greatest concerns for the person who has recurring seizures, is the perceived loss of control which goes along with having seizures. Contemporary western culture has glorified the image of the controlled and independent adult. The unpredictability of having a seizure, as well as the very obvious loss of control during seizures clearly does not reflect this image. By thus "failing" to meet the basic standards of our culture, a person's sense of self-worth may well be affected. This sense of not being in control may also extend to include other aspects of a person's life.

 
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How does the public's misunderstanding of epilepsy affect people with epilepsy?

 

Being stigmatized for having epilepsy is also an important aspect. Popular misconceptions about epilepsy are still widespread. Again, other people's negative responses may considerably add to the stress of the person with epilepsy and may lead them to chose isolation over social interaction.

 
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How important is accepting one's own epilepsy?

 

Sometimes, if the condition is well controlled, and a person has only a few seizures, he or she may not feel compelled to deal with the condition. Then, the denial of the condition can compound feelings of anxiety. In a sense, the person does not get "used" to having seizures, and each seizure becomes yet another traumatic experience.

A person's own attitudes towards having seizures can also very much influence their emotional state. By not accepting the reality of having seizures, some persons may go through some length to hide it from the people around them. The anxieties of possibly being found out may reinforce the desire to socially isolate themselves.

 
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What other factors can increase emotional stress?

 

Another important factor for the person with epilepsy that can greatly increase stress and thereby emotional strain is economic hardship. High rates of unemployment and underemployment --more than 50% for persons with seizures-- severely restricts the income of many people with epilepsy. Thus they may have difficulty sustaining a household, not to mention the added expenses of anti-convulsant medication.

 
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Can anti-convulsant medication affect emotions and behaviour?

 

Most persons who take anti-convulsant medication to control their seizures do not experience serious and intolerable side effects from it. In some cases, however, the side effects from taking medication may affect an individual's behaviour and/or emotional state. Such changes may include an impairment of drive, mood, sociability, alertness, or concentration.

People who experience side effects in response to taking one single drug will generally find that these effects will disappear over the first few months. However, side effects may become a problem when the person is taking more than one kind of anti-convulsant medication, to control different types of seizures. It may be that the side effects of one medication are compounded by the side effects of another. If these effects are not well-tolerated, changes in behaviour and mood can occur. However, it has been found that, if the amount of medication an individual receives is reduced, these changes are reversed.

While it is important to be aware of the possible effects of medication, it should be recognized that they do not usually present a serious problem to adults with epilepsy as long as they are administered in the appropriate dosage.

 
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Can seizures themselves affect emotions and behaviour?

 

The place in the brain where seizures originate may also have an effect on a person's emotions and on her or his behaviour. Seizures with temporal lobe involvement, complex partial seizures (formerly known as psychomotor or temporal lobe epilepsy) are most commonly associated with behavioural changes. Such changes can include rapid fluctuations in mood, or over-attention to detail.

Studies reporting on this relationship, however, do not agree at all on its nature. While a consensus does exist that temporal lobe involvement in epilepsy can affect behaviour, researchers have not found that any prediction can be made either to the type of change which occurs, or to the certainty with which behaviour will change within the population of persons with complex partial seizures.

 
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Can head injuries affect emotions and behaviour?

 

Head injuries, which are sometimes the underlying cause for a person's seizures, can also be associated with behavioural and emotional changes. However, since these changes are separate from a person's epilepsy, they have not been addressed here.

 
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What is most likely to cause emotional or behavioural problems?

 

When considering the effect of having epilepsy on a person's emotional and behavioural state, it is important to remember that all the above factors may interact with each other to produce an overall set of pressures acting on the person. Most people with epilepsy have no more trouble dealing with their feelings than others who do not have seizures.

Even for those persons who do experience excessive emotional instability however, the cause for these lies most often in having to deal with an under- or misinformed society, rather than in the medical aspects of having epilepsy. The often hostile reactions which the person with seizures has to deal with, can lead her or him to withdraw and isolate her- or himself from society. As a result, the person with seizures may appear to be asocial or antagonistic.

 
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By Kristen Lamertz

Bouchard, I. "The Main Problems Encountered by People with Epilepsy: Description and Development." In Aiming at a Healthier Life. Montreal: Health and Welfare Canada, 1990.

Fenton, G.W. "Personality and behavioural disorders in adults with epilepsy." In Epilepsy and Psychiatry. Eds. E.H. Reynolds and M.R. Trimble. London: Churchill Livingstone, 1981.

Goldin, J.G., Margolin, RJ. "The Psychosocial Aspects of Epilepsy." In Aiming at a Healthier Life. Montreal: Health and Welfare Canada, 1990.

Goldstein, J., Seidenberg, M., Peterson, R. "Fear of Seizures and Behavioural Functioning in Adults with Epilepsy." In Journal of Epilepsy. Vol. 3, No. 2, 1990. pp.101- 106.

Masland, R.L., Aird, R.B., Woodbury, D.M. The Epilepsies: A Critical Review. New York: Raven Press, 1984.

Reynolds, E.H., Trimble, M.R. "Adverse Neuropsychiatric Effects of Anticonvulsant Drugs."In Drugs. Vol. 29, No. 6, June 1985. pp. 570-581.

 
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