Pharmacotherapy is only one facet of a comprehensive approach to epilepsy management. Such factors as cognitive, physical, and psychosocial functioning may be as important to the patient's overall quality of life as seizure control.

The psychosocial aspects of epilepsy are an important component of the disorder. Patients often have major concerns about health, independence, personal growth, relationships, well-being, and security. These issues can only be appreciated and addressed if the physician attempts to uncover the psychological and social problems that adversely affect the patient's quality of life.

This process begins with taking a complete psychosocial history, including information about:

  • previous psychiatric illnesses or treatments
  • education
  • employment
  • driving
  • insurance
  • interpersonal relationships
  • attitude towards having epilepsy

A number of questionnaires have been developed to supplement the psychosocial history and provide a quantifiable means of assessing and following patients as pharmacotherapeutic and psychosocial interventions are implemented.5

Uncovering a source of psychosocial stress may lead to an effective strategy to reduce the impact of that stress on the patient. This reduction in turn may help reduce seizure frequency. Patients with stress-induced seizures may be candidates for stress reduction, biofeedback, or relaxation training.

Resources to meet needs

Other important adjuncts to medical therapy in selected patients may include:

  • support groups
  • individual or family counseling
  • legal assistance in cases of job discrimination or other legal problems
  • vocational training
  • educational guidance

The physician plays a key role in connecting the patient to the network of health care and psychosocial professionals as specific needs arise. Numerous resources are available, often through a local epilepsy association, to assist the patient. If there is no local epilepsy group, the patient should be encouraged to contact the Epilepsy Foundation.

Cultural differences

Negative preconceptions about epilepsy within certain ethnic groups may make some patients reluctant to seek treatment. The physician should be aware of and sensitive to these cultural differences. The acknowledgment of alternative forms of healing and spiritual healers may be meaningful to members of some ethnic groups and may have a place in the overall treatment plan of selected patients.

Adapted from: Schachter SC. Treatment of seizures. In: Schachter SC, Schomer DL, eds. The comprehensive evaluation and treatment of epilepsy. San Diego, CA: Academic Press; 1997. p. 61-74. With permission from Elsevier (www.elsevier.com).

Authored By: 
Steven C. Schachter MD
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