Epilepsy and Emotions

It is well known that children and adolescents with difficult-to-control epilepsy are at greater risk for serious emotional problems than children without epilepsy or children with well-controlled epilepsy. The following page discusses some of difficulties these children experience in regulating their emotions and addresses some approaches to dealing with their heightened emotional distress.

Self-esteem

Self-esteem is how a person sees herself, feels about herself, and values herself. It is the extent to which a person feels positive about herself. Self-esteem is important because how a person feels and thinks about herself influences how she acts and behaves. Self-esteem is influenced by internal thoughts that we have about ourselves, which often have been influenced by how those around us view us.

Self-esteem can be at risk in children with epilepsy because they may receive many messages focused on what they cannot do because of their seizures. Talking with your child about these feelings and changing the focus to what your child is able to do is a positive step toward combating a negative self-image. Building self-esteem can have beneficial effects in all areas of life, including relationships with peers and academic achievement.

Here are some ways you can help your child develop positive self-esteem:

• Show love by spending quality time with her. Use eye contact, physical contact, and loving words. Children who feel loved, comfortable, safe, and secure and who have an understanding of boundaries and limits are children with positive self-esteem.
• Respect her feelings and create an environment where expression of feelings is accepted.
• Respect her uniqueness and build on her strengths. Help her to feel competent by learning through both her successes and her mistakes. Balance your need for protection with her need to take risks.
• Encourage your child’s independence at home, at school, and in the community. Where necessary, advocate for your child so that others understand epilepsy and she is included in activities with her peers.
• Talk to your child about her epilepsy in an age-appropriate way. Highlight that epilepsy is only one aspect of who she is as a person, as opposed to a condition that defines her. When your child must cope with difficulties related to her epilepsy, emphasize the strength and bravery that it takes for her to get through these difficult times.
• Include your child as part of the epilepsy care team. This will show her that her opinion is valued and she is able to direct some aspects of her care.
• Create an environment where she can feel responsible, capable, and independent. Help her take on responsibilities, with adequate support systems in place to help her succeed.
• Encourage social contacts. Ensure a sense of belonging by creating opportunities for her to play with other children.
• If you feel there are issues you cannot help your child with, discuss them with the epilepsy care team and get professional help from a social worker or psychologist where necessary.

Anxiety

It is normal for children and teens to experience occasional fears, worries, or sadness. However, if these worries or fears continue for a long time and affect how the child interacts with others, they may meet the criteria for a type of problem called an anxiety disorder.

Although there have been few studies of anxiety in children with epilepsy, it is estimated that between 23% and 33% of children with epilepsy also have anxiety disorders. Children with epilepsy may experience anxiety because of:

• worry and uncertainty about seizures
• abnormal brain activity related to epilepsy
• side effects from drugs
• drug withdrawal

Increased anxiety can result from fear and worry surrounding the unpredictable nature of seizures (when and where a seizure might happen) and the potential for injury and embarrassment. In an effort to avoid risk of injury or potential embarrassment, children and teenagers may feel less confident about participating in social or physical activities with their peers, thus increasing their sense of social isolation.

Children with anxiety disorders may not talk openly about their worries, but may show their anxiety in different ways, such as:

• looking tense
• nervous mannerisms such as nail biting, leg jiggling, breath holding, or gulping
• concern about being on time
• reluctance to leave their parents and go to school, or to leave their teacher and go out to the playground
• constantly seeking approval and reassurance about their performance
• redoing tasks because they are not satisfied with their performance
• trying to avoid new or challenging situations

If your child seems unusually anxious:

• Talk to her epilepsy care team. Counselling to improve coping skills in dealing with worries about seizures and the stigma surrounding epilepsy may help reduce your child’s anxiety.
• Create an environment that allows your child to discuss her worries and concerns.
• Some adolescents have reported that supportive discussion with peers or older youth with epilepsy about how they cope and manage life with seizures can be very helpful.

In rare cases, there may be situations in which a child or adolescent’s anxiety is overwhelming and limits her ability to function normally, that is, to attend school or even leave the house. In those situations, assessment by a social worker, psychologist, or psychiatrist might be required, as well as treatment with an anti-anxiety medication.

It should also be noted that severe anxiety in children can be an expression of depression. The following section describes this more fully.

Depression

Depression is more than just "the blues." It is a serious illness, or mood disorder, that is caused by a combination of biological and social factors. People who are depressed cannot just "snap out of it."

Depression can impair a child’s social and emotional development: children with depression tend to be more isolated, with poorer social relationships and low self-esteem. Children and teenagers with depression are also more likely to attempt suicide. In the long term, depression often recurs and may continue into adulthood.

Studies have found that between 10% and 26% of children and adolescents with epilepsy report that they are depressed, compared to 2% to 6% of children in the general population. However, depression in children with epilepsy is often overlooked.

Factors that increase the risk of depression include:

• frequent seizures
• long duration of epilepsy
• family history of depression
• negative attitude toward having epilepsy
• stressful family relationships
• feelings of loss of control over seizures

In adults with epilepsy, certain anti-epileptic drugs (phenobarbital, topiramate, vigabatrin, and tiagabine) have also been found to increase the risk of depression. Studies have found that complex partial seizures affecting certain locations of the brain are associated with depression in adults.

Possible signs of depression in children include:

• persistent anxiety that reduces a child or adolescent’s ability to participate in normal activities of daily living
• emotional symptoms such as frequent sadness, tearfulness, and crying; increased irritability, anger, and hostility; or extreme sensitivity to rejection and failure
• behavioural symptoms such as a loss of interest in activities or the inability to engage in previously enjoyed favourite activities; talk of or attempts to run away from home; social isolation, poor communication, and difficulty with relationships; frequent absences from school or poor school performance; alcohol or drug use or abuse; or expressions of suicide or self-destructive behaviour
• cognitive symptoms such as low self-esteem, feelings of worthlessness, hopelessness, and guilt, feeling unloved, poor concentration, decline in school performance, and frequent thoughts of death or suicide
• physical symptoms such as low energy; frequent complaints of physical illnesses such as headaches and stomach aches; or a major change in eating habits or sleeping patterns

Between 40% and 70% of depressed children and teenagers have other psychiatric disorders as well, such as anxiety or substance abuse.

If you suspect your child may be depressed, talk to her epilepsy care team, family doctor, and/or paediatrician. They will need to evaluate your child’s situation fully, including her school and family environment. The earlier your child can be assessed and treated, the better.

Treatment for depression in children may include:

• individual and/or family therapy
• antidepressant medication

If your child has had more than one episode of depression, or if she is considering or has attempted suicide, the team may suggest referring her to a specialist in mental health for children or teenagers.