Blogpost- Interventions for patients of Epilepsy

27 November 2020 / By Social Media

According to WHO, Epilepsy is a chronic non-communicable disease of the brain that affects around 50 million people worldwide making it one of the most common neurological diseases globally. It is characterized by recurrent seizures, which are brief episodes of involuntary movement which will involve a part of the body (partial) or the whole body (generalized) and are sometimes accompanied by loss of consciousness and control of bowel or bladder function.

Seizure episodes result due to excessive electrical discharges in a group of brain cells. Different parts of the brain are often the location of such discharges. Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions. It also can vary in frequency, from less than 1 per year to several per day. Signs and symptoms include loss of awareness or consciousness, and disturbances of movement, sensation (including vision, hearing, and taste), mood, or other cognitive functions. Patients also tend to experience more physical problems (such as fractures and bruising from injuries related to seizures), as well as higher rates of psychological conditions, including anxiety and depression. Similarly, the risk of premature death in people with epilepsy is up to 3 times higher within the general population. The cause of the disease is still unknown in half of the cases however, it can be categorized as structural, genetic, infectious, metabolic, immune, and unknown. The treatment of epilepsy typically focuses on anticonvulsant medications, surgical interventions, and device implantations (Leeman & Schachter, 2017).

Various types of intervention programs have been suggested and tried, as comprehensive treatment demands far more than conventional medical treatments. Non-pharmacologic interventions effectively enhance the overall psychological well-being, pose less risk of side effects, avoid drug interactions, are of minimal cost, easily accessible, and may present an attractive option to pregnant women and those who are refractory to medications or medical trials. This includes Cognitive-Behavioural interventions such as relaxation therapy, cognitive-behavioral therapy (CBT), EEG biofeedback, mindfulness, and arousal-based approaches like mindfulness, yoga & meditation. CBT includes restructuring the maladaptive thought patterns, typically involves an assessment of psychological stressors maybe lowering the seizure threshold, education regarding epilepsy, mood regulation, resolution of conflicting thoughts & emotions, stress management, and lifestyle modification minimizing triggers. Mindfulness training can help patients in building greater awareness of bodily sensations and thoughts related to seizures which will allow for improved seizure anticipation, with acceptance serving as a coping mechanism for seizure-related symptoms. Biofeedback works with a goal to voluntarily reduce cortical excitation or increase peripheral sympathetic arousal to decrease seizure threshold. Psychoeducational interventions are yet another type that helps in the self-management of the patient, referring to adaptive health behaviors and activities that can be performed by patients to promote seizure control and enhance well-being. As epilepsy is both a medical diagnosis and a social label affecting life physiologically, psychologically, and socially, patients experience social stigma, have low self-esteem & self-worth, and a lower quality of life. Psychosocial problems (adjustment, self-image, unemployment, financial distress, insurance issues & stigma) have a direct & linear relationship with seizure severity, therefore, having a major impact on the patient & family. Therefore, the Psychoeducational approach focuses on behavioral adjustments including medication adherence, adequate sleep, good nutrition & stress reduction, and psychosocial adjustments include coping with the loss of independence and dealing with embarrassment & stigma, educating and disseminating knowledge about the disease to family and patients. Some other traditional/alternative treatment includes acupuncture, chiropractic, massage therapy, aromatherapy, homeopathy, herbal remedies (traditional Chinese medicine).

Therefore, to effectively treat the patients with epilepsy, an amalgamation of various intervention techniques depending on the severity and frequency of the diagnosis has to be applied. Recently, it has been widely acknowledged that comprehensive epilepsy treatment goes far beyond medication. Patients with epilepsy are discharged from the hospital without having any appropriate psychoeducation, representing a significant problem with the treatment, making the professionals realize that in addition to the medications other interventions have to be considered to help the patients fully. 

References

  • A. Mansooreh , D.N Nahid, Mohammad Ali Yadegary, Hamid Haghani, Effects of an educational program on self-management in patients with epilepsy, Seizure, Volume 22, Issue 1, 2013, Pages 48-52, ISSN 1059-1311, Retrieved from, (http://www.sciencedirect.com/science/article/pii/S1059131112002786)
  • C. DiIorio, B. Faherty, B. Manteuffel The development and testing of an instrument to measure self-efficacy in individuals with epilepsy Journal of Neuroscience Nursing, 24 (1992), pp. 9-13.
  • Leeman-Markowski, B. A., & Schachter, S. C. (2017). Cognitive and Behavioral Interventions in Epilepsy. Current neurology and neuroscience reports, 17(5), 42. https://doi.org/10.1007/s11910-017-0752-z
  • J. Engel, T. Pedley (Eds.). Epilepsy: a comprehensive textbook, Lippincott-Raven, Philadelphia (1997), pp. 2191-2201
  • J.K. Austin, H. Boer, Disruption in social functioning and services facilitating adjustment for the child and adult with epilepsy
  • J.M. Buelow, Epilepsy management issues and techniques, Neuroscience Nursing, 3 (2001), pp. 260-269
  • R. Kobau, C. Dilorio. Epilepsy self management: a comparison of self-efficacy and outcome expectancy for medication adherence and lifestyle behaviors among people with epilepsy. Epilepsy & Behavior, 4 (2003), pp. 217-225
  • Saxena, V. S., & Nadkarni, V. V. (2011). Nonpharmacological treatment of epilepsy. Annuals of Indian Academy of Neurology, 14(3), 148–152. https://doi.org/10.4103/0972-2327.85870

Retrieved from, https://www.who.int/news-room/fact-sheets/detail/epilepsy

Leave a Comment

*Please complete all fields correctly