Chapter 60 - Social aspects of epilepsy and rehabilitation

Abstract

Epilepsy is a multifaceted and often chronic illness. Patients frequently experience social problems. These are associated with seizure severity, psychiatric comorbidities, neuropsychological dysfunctions, and various contextual factors. Contextual factors are analyzed following the International Classification of Functioning, Disability and Health, which leads to a multidimensional approach including stigma (felt and enacted), public attitudes, discrimination, and legal provisions. The literature is scarce about interventions on how to reduce these problems. In this chapter, we combine individual factors with contextual factors and introduce a new approach assessing seizure severity in categories relevant for task performance and activities. This assessment procedure, initially created for judgment of workplace risks, has been developed in cooperation with the German State Accident Insurance Agency, and thus is recognized officially. The focus lies on seizures being described in terms relevant to their effects within the demands of a specific context. Conclusions for tailored counseling for various groups of patients with respect to employment, sports, and mobility (given as examples) are drawn together with examples of rehabilitation measures. It is outlined how physicians can influence employability and social participation of patients with epilepsy. Teaching patients to evaluate their individual risk profiles can be the first, yet rather basic, step.