Stress and childhood epilepsy

William B. Svoboda, MD, is a retired pediatric neurologist. He is the founder and former Director of Via Christi Epilepsy Center of Wichita, Kansas.

This series of articles about the effects of epilepsy on children's lives and personalities, and how parents can help their child achieve a happy, independent life, is based mostly on an interview with Dr. Svoboda that was conducted by Shawna Cutting, a writer for epilepsy.com.

I'm curious: How often does stress bring out seizures in children with epilepsy?
I think this effect is feared far more than it needs to be. If 20 children in a school have epilepsy, probably 18 of the parents will say that stress brings out epilepsy, but only 2 of them have ever seen such an event. It does happen, but not commonly. Actually, a little stress sometimes helps children. A child who is stressed just enough will be more alert and the seizure burst may be less. We find this effect especially with absence seizures.

This is not to say that stress can't be a problem for children with epilepsy. As a rule, they don't do well on tests that are strictly timed, especially if it's in a subject the child is having problems with. A child who becomes too stressed may have little subclinical seizures (seizures that don't have any symptoms). These cause the child to have more problems in that subject, and they can build up to a big seizure. In recent years we've gotten better at spotting these little subclinical discharges. They do interfere with mental functioning and seem to be an important factor.

If stress is a major issue for a certain child, what steps do you recommend?
First, we try to learn more about what kind of stress it is—is it situational stress, social stress, academic stress? Then we look at whether it can be avoided. If it's not a necessary stress, then why accept it? Are there alternatives? If it's unavoidable (we can't avoid everything), are there different ways to approach the stress? We also try to teach parents how to recognize when a child is getting uptight or nervous.

Then we teach kids to take a time out. Sometimes we have to teach sneaky ways to take a time out, like going to the bathroom. But most often both the teacher and the parents will be quite cooperative and will help the child. If homework is getting stressful, we suggest breaking it down into smaller blocks and doing something else for a short period. We emphasize "short"—not 10 minutes of homework and 2 hours of TV.

Can you tell us a success story?
Yes, kids can be taught to overcome stress. One girl just didn't seem to understand what people said to her—everyone complained that she didn't pay attention or listen to what they said. She told me, "They don't seem to understand me." She did quite well on all the routine language tests, but when we put her under a little stress on them, she became quite aphasic (unable to speak or use language). She also had a lot of social difficulty related to that because she didn't communicate well with others. Then she'd get stressed, and she'd have a seizure, break out in hives, or have both hives and seizures.

We were so successful with this girl's treatment that when a recession hit a few years later, she surprised everybody. She was the one who had a job when both her parents were out of work. And it wasn't a job in a special school or anything. She told me, "Well, I've learned how to step back, take a deep breath, and realize that the world isn't going to end."