The type, severity, and frequency of a person's seizures may affect the person's susceptibility to psychosocial problems. Although generalized tonic-clonic seizures usually raise the most fears and worries, partial seizures are usually harder to diagnose, treat, and manage. Persons with partial seizures are often given incorrect diagnoses, such as substance abuse, mental illness or retardation, or behavioral problems. Partial seizures, particularly simple partial seizures, are also often scarier for the person experiencing the seizure because of preserved awareness, perceptual distortions, experiential phenomena, or memory disturbances that may occur. These subjective perceptions about the seizure experience have been found to be more strongly related to psychologic and social adjustment than to the actual seizure type or frequency.17
The frequency of a person's seizures may play a role in the development or manifestation of psychosocial problems by affecting the patient's coping behaviors. Epileptiform discharges in temporolimbic structures may predispose the person to changes in behavior, either ictal or interictal. Cognitive changes may occur as a result of epileptiform discharges in areas of the brain responsible for various cognitive functions. Medication side effects, postictal disinhibition, or underlying neurologic problems may also affect a person's cognitive abilities.
The patient's emotional behavior may be affected if temporolimbic structures are involved during or between seizures. These structures are important to functions such as motivation, basic drives and instincts, and the generation and expression of feelings, memory, and learning. Memory disturbances in people with partial seizures may be related to epileptiform discharges or to the adverse effects of medications. Negative feelings, such as anxiety, fear, or a sense of impending doom, or even positive emotions can be manifestations of a seizure.
Fears of death and brain damage are common in people with epilepsy.18 They also fear getting injured and the worsening of their seizures over time. Status epilepticus is a life-threatening condition that is especially alarming to patients. Many persons who have epilepsy never experience an episode of status, whereas others have these episodes frequently. The clinician should explore the patient's history of status and discuss the feelings and thoughts that having this condition may raise. Again, misunderstandings about seizures and fear of death may affect the person's psychologic and social adjustment more than the seizure type or frequency.19
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