What Psychosocial Interventions Are Appropriate For Patients Whose Epilepsy Has Not Been Confirmed

Many persons who have had one or more seizures struggle with their feelings about epilepsy even though they may not yet know whether they truly have the disorder. They may ask, "Do I have epilepsy? Will I need medication? May I drive? Am I the same person?" These are common questions, yet the answers will vary for each person, depending upon the number of seizures, the nature of the seizure(s), and the circumstances involved. If people question whether or not they have epilepsy, it is important to discuss their attitudes and beliefs about epilepsy and mental health issues, and what impact the diagnosis may have on their lives.

Although a single seizure is usually not diagnosed as epilepsy, a person who has had a seizure will have many of the same initial feelings and concerns as one whose epilepsy has been diagnosed. In particular, fears about seizures and of physical harm have been noted in parents and children with first seizures.1316 Thus, regardless of whether the person has a single seizure or many seizures, attention should be paid to the person's and the family's initial reactions, feelings, and concerns. For example, experiencing a first seizure can be particularly difficult for women who are planning to have children. Some may wish to put their plans to become pregnant on hold until the medical picture is clearer. Other patients may cope better by not embracing the idea of having epilepsy until it is clearly diagnosed. Some patients may have more difficulty coping or obtaining access to care if the terms seizure and epilepsy are not defined appropriately. Education and support tailored to the specific patient's and family's coping styles, supports, and needs are helpful.

Nonepileptic events may coexist with seizures in many patients with epilepsy. The clinician needs to explain carefully to patients the difference between epileptic and nonepileptic events. If patients are told that they are not having "real seizures," they may feel angry, distrustful, or invalidated. But the events are real regardless of the cause and must be addressed. Some patients will be relieved to learn that they may not have epilepsy. Others may be confused or disappointed that there is no medical reason that can be identified for the events. Many patients who have nonepileptic events may also have been abused physically, mentally, or sexually in the past. Or they may have experienced a traumatic event or loss. Exploring these traumatic events with patients in a psychotherapeutic setting may provide emotional relief and may reduce the frequency of the nonepileptic events.

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