Essay on Epilepsy
According to census estimates, one in 103 of the UK population have epilepsy and it is usually misdiagnosed in 20–31% of cases (Stokes et al. 2004). Sisodiya & Sander (2004) suggests that with an optimal treatment routine 70% of the population could become seizure free. However, the reality is less encouraging since Moran et al (2004) found that only 52% of people with epilepsy were living without seizures. This reflection considers my experience in caring for a service user with learning disability (LD) and suffers from epilepsy. Furthermore, it will focus on the bio-medical aspects of epilepsy and how it has affected my service user and the treatment available. In addition, it will explore the meaning of quality of life and the psychological factors experienced by the service user in their daily life. Names of individuals have been changed to adhere to confidentiality, NMC (2008).
Causes of epilepsy are well documented, for example birth trauma, head trauma/injury, brain infections, and inherited brain disease. However, causes vary between individuals. People with epilepsy are believed to have a low seizure threshold therefore this makes them prone to seizures. This threshold is said to be influenced by any factors that triggers the seizures (Gomersall 2009). Gomersall (2009) suggests that epilepsy can be triggered by a number of different factors for instance, menstruation, tiredness, stress, too much alcohol boredom, photosensitivity and low blood sugar. Epilepsy affects different lobes of the brain therefore the lobe affected will influence the type of seizure experienced by individuals. Lear-Kaul et al, (2005) studied autopsy reports to identify the association between scientific variables and sudden unpredicted death in epilepsy while Walczak et al, (2001) had an observational study on 16,463 patients in three epilepsy centres over an average period of 4 years; both studies found that mortality rates for people with epilepsy are two to three times higher than those in the general population. In comparison these figures show that the prevalence of the condition of epilepsy in the UK is lower compared to the USA. This is because the UK national guidelines recommend that all individuals with epilepsy should have free access to an epilepsy specialist nurse, whereas in the USA individuals have to pay for their health cost.
As part of my placement I cared for Mary who was forty years-old with Learning disabilities. She was diagnosed with epilepsy when she was 15 years old, Mary experienced a lot of seizures and was on more than one anti-epileptic drug. After visiting the hospital with her for a review of her medication, the doctor explained the patterns of her seizure which tended to occur during her menstrual cycle. This explanation is verified by Kim et al (2010) who investigated seizure frequency in 79 premenopausal women with epilepsy aged 15-44 years and discovered that over 46% of them had a greater occurrence of seizures during their menstrual cycle. In reflection I felt empathy for Mary as she had to contend with these catamenial seizures every month when she has her menstrual cycle. This challenged me to learn more on how to care for her as I understood her condition more.
Foundation for People with Learning Disabilities (2008) stated that seizures and its triggers may sometimes go unnoticed in people with LD as it can be difficult to distinguish from other behaviour associated with Learning Disabilities. In Mary’s case it was thought to be challenging behaviour rather than epilepsy, through this experience I have learnt that epilepsy and seizures can be challenging especially when it is with people with Learning disability.
According to Schmitz et al (2010) patients with epilepsy show a higher risk of depression compared to the general public. They also stated that women were mainly at risk compared to men due to sex hormones which are known to contribute to epilepsy and depression. This is supported by Epilepsy Research UK (2009) who state that depression is common in people with temporal lobe epilepsy (TLE) which affects 20-40% compared to 7-12% of the general public which according to their research is due to cytokine known as interlukinlbeta (ILIB) which increases among people with TLE.
Significantly, epilepsy is a public health concern: with severe physical and psychological consequences. Ba-Diop et al (2014) state that it is serious and can cause traumatic injury, premature death, and mental health illness such as stress or depression. In the UK public health emphasis is on individuals to maintain a healthy lifestyle in order to reduce health related conditions. Gates and Barr (2009) suggested that maintaining a healthy lifestyle in people with epilepsy is important for example exercise, diet, regular sleep pattern and controlled alcohol intake which will possibly reduce the stress. However, Daley et al (2009) suggested that only exercise reduce the symptoms of depression. Scientifically, depression is commonly treated with anti-depressants or psychotherapy. However, some people may prefer alternative approaches. Through caring for Mary I noticed that exercises helped her to cope with her depression. However, for patients with Mary’s condition it can be challenging for them to maintain a routine of exercises as a seizure can occur at any time (Kim et al., 2010). Therefore, places close to water should be avoided.
Some individuals prefer using complementary therapies rather than anti- epileptic drugs. These therapies are mainly acupuncture, aromatherapy, biofeedback, herbal treatment and homeopathy. Although these therapies are believed to work in some individuals, Nadkarni & Saxena (2011) recommend that they be used to complement anti-epileptic drugs due to lack of substantive scientific evidence that they can work on their own. Nonetheless, patients opt for alternative therapies because unlike medication they have no known side effects.
Due to Mary’s condition she was using different services for treatments to manage her epilepsy and disability which included anti-epileptic drugs as well as complementary therapies. Mary also used a drug called rectal diazepam when she was experiencing a series of seizures without fully recovering. National Institute for Clinical Excellence (2008) suggested that rectal diazepam is the fastest to be absorbed in the system compared to other oral medication. However, the drug has its own side effects despite being effective. It is a short-term effect drug that causes drowsiness and unsteadiness. It is thought that it causes anxiety and hallucinations on individuals (Stefan & Theodore, 2012). This can affect the patient’s mental health if left unchecked or if the patient had undetected mental health issues. A study conducted by Berman et al (2005) suggests that the side effects of diazepam caused suicidal and self-aggressive acts.
Another drug that Mary was prescribed was the Buccal Midazolam drug. According to Marshall (2007) the drug is as effective as the rectal diazepam. However, it is still unlicensed thus rectal diazepam remains the first option. Marshall (2007) states that although buccal midazolam is unlicensed doctors are allowed to prescribe the drug when they agree with the patient, family and carers or when they feel it is the best option for the patient. The research Marshall (2007) carried out shows that most families and carers prefer buccal midazolam compared to rectal diazepam. However, these findings could be biased as it does not mention the side effects of the drug and I suspect that its aim was to appraise the drug.
Through research I have learnt that epilepsy can be life threatening and seizures can lead to health complications. Therefore, it is vital for nurses to be in supply of drugs such as rectal diazepam and buccal midazolam when caring for patients with epilepsy.
One of my concerns while caring for Mary was her social interaction. Most individuals with epilepsy will face a range of concerns with their quality of life, for example social identity. Quality of life has been linked to a broad range of concerns. Jacoby, et al (2005) states that the stigma associated with having epilepsy is common to many cultures which normally results in individuals experiencing a negative effect on their social identity. Jacoby, et al (2005) believes that once a person’s social identity is destroyed it is almost impossible to reacquire the status of normality. This results in isolation of which people like Mary will struggle with self-esteem as asserted by Jacoby, et al (2005). Practically, this will be evident through diminishing social life, going out, fewer friends, and impeded life chances.
- Quote paper
- Yvette Mhlanga (Author), 2014, Epilepsy. Short Overview, Munich, GRIN Verlag, https://www.grin.com/document/293135