Wednesday, April 01, 2009

Support is gold for people that live with seizures

Seizure disorders have plagued humans as far back as time knows. For those who have had a seizure, the dread of a recurrence can be very hard to live with.

Seizures can strike without warning and their onset, duration and termination are not under voluntary control.

Seizures have many known causes but also can occur when no cause can be found. To witness a full blown seizure can be quite a disturbing sight. Each seizure can cause new brain damage.

I have worked with people who have had to have brain surgery to remove part of the brain responsible for seizures and even have connections severed between the right and left halves of the brain in order to diminish the disease. These are severe cases.

On the other end of the spectrum are mild, brief seizures in which the individual will suddenly stop talking and just stare, with no awareness of what is happening around them. They rarely fall to the ground and don't convulse. Their eyes may roll back or their eyelids may flutter.

With children, these “petit mal” seizures are sometimes mistaken for daydreaming. With the more severe “grand mal” seizure, there may be drooling and loss of bladder or bowel control. After this, the patient will usually have a terrific headache and sleep for hours. It is when the seizure goes on for more than a few minutes that emergency measures must be taken to get the patient to a hospital.

In the November/December 2008 issue of Neurology Now, author Elizabeth Stump has given an excellent exposé of seizure disorders which have a biological cause and seizure disorders which have a psychological cause.

Studies are showing that seizures due to psychological distress are far more common than doctors or patients may be aware of, according to Neurology Now. Stress seizures are sometimes referred to as “pseudo seizures.” This is not a good term since it often conveys to patients and families that the seizure is not real. It suggests that the patient is faking. Experts believe that in stress seizures, disturbances are unconsciously converted into a neurological-like condition, i.e., a seizure. Exactly how psychological stressors are converted into physical symptoms such as seizures remains uncertain.
To differentiate biological versus psychological seizures, the video-E.E.G. (electroencephalogram which measures the electrical activity of the brain) is considered the gold standard. In evaluating for non-epileptic seizures, a continuous video-E.E.G. monitoring takes place over a few days. If the video shows obvious seizure behavior and the E.E.G. is normal, the diagnosis is non-epileptic stress seizure.

When there is seizure behavior on the video and abnormal E.E.G. recordings, an epileptic seizure is diagnosed. To complicate things further, there are some patients who have both types of seizures.

Treatments such as anti-epileptic drugs may be effective for biological based seizures but ineffective for patients who have stress seizures. Treatments, which are available for the latter, include psychotherapy to uncover unconscious conflicts, cognitive behavior therapy to address patient's attitude and response towards their seizures as well as stress reduction therapy. Sometimes, psychiatric medications are wise, which can treat the underlying or co-existing psychiatric conditions such as depression and anxiety.

It is quite difficult for the stress seizure patients to understand why their seizures happen and very hard to deal with the fear that they can happen again.

A hoped for attitude change is to try not to let the seizures control ones life. Thoughts like, “I have a seizure disorder, a seizure disorder does not have me” is most helpful. Further thought changing in the form of “I know that I am lucky to not have a fatal disease” is another form of attitude change that can be beneficial in psychotherapy.

Unfortunately, seizure patients, regardless of cause, are faced with serious limitations. For example, according to Michigan law, as in most states, seizure patients have to document six continuous months of being seizure free in order to regain driving privileges.

Those who have jobs requiring climbing on ladders and such will obviously have employment issues impacted. There is also the social stigma about seizures and the people who have them. Supportive psychotherapy can be helpful in working with the emotional and self-esteem side effects of seizure patients regardless of there cause. This is a kin to supportive therapy for any biological disorders which are difficult to diagnose, more difficult to treat, and often become lifelong.

(Resources: American Academy of Neurology Foundation Web site: , and The Brain Matters Patient Web site:

L.J. McCulloch is a Diplomate of the American Psychotherapy Association. He can be reached at Broe Rehabilitation Services, (248) 474-2763 ext. 22, a free standing facility which assists people with neurological and other disorders.


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