Q: I’ve been experiencing anxiety attacks since my first seizure a couple of months ago. Is that normal?
A: Anxiety is a core emotion that many people experience at certain points in life. Anxiety is quite normal when we sense something bad is going to happen, but it can become problematic if it gets out of hand, causing a constant feeling of nervousness, distress and unease for no apparent reason. With any medical condition, people may become anxious after diagnosis, but anxiety is also related to epilepsy in more specific ways, not only as a reaction to the diagnosis, but also as a symptom of the epilepsy. In some cases, it’s a side-effect of seizure medicines. For many, knowing a seizure can occur at any time without much or any warning is a major point of anxiety. Relaxation, meditation and yoga will help if done on a regular basis. There are a number of online sites and apps that can help with anxiety such as Headspace, Smiling Mind, CALM and MindSpot a free virtual clinic offering initial assessment and psychological well-being treatment courses. If your anxiety is severe please seek the assistance and guidance of your doctor for potential referral.
Q: Apart from a few dollars in price, what’s the difference between branded and non-branded medications from chemists?
A: Generic medications are generally less expensive copies of the original, branded medication. Neurologists can spend years titrating their patient’s antiepileptic drugs for optimal seizure control while minimising adverse effects. Due to the narrow therapeutic range of antiepileptic drugs, switching from innovator (original drug) to generic (copy drug), generic to innovator or generic to another generic drug isn’t recommended. Innovator and generic drugs almost contain identical active ingredients and must meet the same standards in quantity, purity and quality.
However, some variation in bioequivalence is permitted, and the inactive ingredients (such as fillers and colours) may differ. The difference in the inactive ingredients may change the bioavailability of the active ingredient. This is especially important for drugs with a narrow therapeutic range, as it can lead to subtherapeutic or toxic doses.
If your pharmacist offers a different brand of the same medication, don’t accept it. It is important to stick with the same brand. Speak with the prescribing doctor before switching between generics and innovator drugs.
Q: My 11-year-old has gained weight on Epilim despite healthy eating. Which medications don’t have this effect?
A: Side-effects of any medication are a concern for parents, especially when they impact a child’s health, self-esteem and social interactions. Ask the prescribing doctor to consider the impact of these side-effects versus the benefits gained, namely seizure control, before considering other therapies. Many drugs can cause weight gain including Valproate (or Epilim). Others have no impact on weight or suppress the appetite and cause weight loss. Clinical trials indicate a dose dependant weight gain in 4-9% of people who are only taking Valproate. This gain does not appear to plateau as it does with other drugs. The mechanism of Valproate induced weight gain remains unclear, but recent evidence suggests a relationship between the drug and levels of gherlin and leptin – hormones that play a major role in appetite control and long-term weight regulation. Speak to your doctor about this side effect and medications that may be a better choice for your child.
Q: Is it a legal requirement to disclose epilepsy when applying for work?
A: The nature of the work involved and period of seizure freedom will influence your decision to inform any potential employer when applying for work. Some occupations require mandatory periods of seizure freedom such as professional truck, bus or emergency vehicle drivers whilst other occupations may be hazardous if a seizure occurs such as working around water, fire and at heights. In those instances, you will need to inform a potential employer. It is important for you to consider the consequences of experiencing a seizure in the potential workplace and if it poses any risk to yourself or others around you such as working near the frying vats in a commercial kitchen. People with epilepsy can work in commercial kitchens however reasonable adjustments will need to be made to ensure a safe workplace.
The general rule of thumb is, if you have been deemed fit to drive a motor vehicle, your seizures are considered well controlled and there is no real need to inform a potential employer of your epilepsy. If you choose to inform a potential employer it is best to time it after you have received a job offer in writing and before you accept the position. It is at this point any work place accommodations can be negotiated. Under the Work Health & Safety Act, employers need to know about a condition, or they can’t be held responsible for failing to adopt safety measures. If you choose not to inform your employer of your epilepsy, you may choose to let a co-worker know so if you do experience a seizure in the workplace they will have some idea what is happening and how to assist you. When completing an application form you can leave sections blank however it is important not to say you do not have a health condition when you do as this can lead to instant dismissal.
Q: My seven-year-old son was diagnosed with epilepsy four years ago. Recently the GP mentioned that he had cortical dysplasia. What is cortical dysplasia?
A: Cortical dysplasia refers to a disorganisation of the neurones (nerve cells) in the grey matter of the brain (cerebral cortex) and is classified within the group of ‘Malformations of Cortical Development.’ The cerebral cortex is a 2-4 mm thick outer layer of the brain made up of nerve cells often referred to as grey matter. As the brain develops in utero, nerve cells migrate to different parts of the surface of the brain. If this migration is altered or disrupted, the structure of the cerebral cortex can become disorganised and hyper-excitable nerve cells can develop. These nerve cells may misfire giving rise to abnormal signals. Focal (localised) cortical dysplasia is the most common cause of intractable epilepsy in children and is a frequent cause of epilepsy in adults. It would be important to have contact with an epilepsy specialist for assessment and ongoing management.