Social life

Sports and exercise

Having epilepsy does not mean you cannot be physically active. On the contrary, exercise is good for you! It improves overall health and well-being. Regular exercise has been shown to have a positive effect on improving seizure control. Breathing is deeper during physical activity, increasing oxygen flow to the body and brain. In terms of mental health, physical activity is generally stimulating, relieves symptoms of depression and puts people in a better mood.

However, some activities are not recommended for epileptics, such as climbing, scuba diving and skydiving. You should not swim alone irrespective of whether or not you have epilepsy and you should wear a life jacket when you do water sports and activities.

On the whole, sports and physical exercise are fun, enjoyable activities. We encourage you do them so that you stay physically fit. To ensure your safety, there are some restrictions you must follow.

Alcohol

General information

We recommend following the Éduc’alcool guidelines. However, it is important that drinking alcohol does not interfere with taking antiepileptic medication or any other regular medication. Some medications can slow the elimination of alcohol from the blood, prolonging its effects, such as fatigue, decreased concentration and gastrointestinal side effects.

Alcohol can reduce the absorption of medication or accelerate its elimination. This reduces the therapeutic effects of the medication, increasing the risk of seizure recurrence.

Lastly, alcohol can reduce the body’s ability to eliminate the medication, which can lead to an overdose of the medication in the blood and side effects from toxicity.

Éduc’alcool

The 2-3-4-0 formula

A national committee of experts, which included Éduc’alcool’s advisor, has developed specific low-risk drinking guidelines. They have been reviewed by leading scientists from three continents and endorsed by an impressive number of public and private organizations.

 
Most days

 
Special occasions

The following recommendations were developed based on these consultations:

To drink in moderation and prevent long-term problems, women should limit themselves to 2 drinks a day and 10 a week. For men, the limits are 3 drinks a day and 15 a week. That’s the 2-3 part of the formula.

Of course, there is no harm in drinking a little more than that every now and then. On a special occasion, for example, women may have 3 drinks and men, 4, provided, of course, that such “special occasions” don’t occur too frequently. That’s the 3-4 part.

Lastly, to prevent physical and psychological addiction, the recommendation is that everyone should abstain from drinking at least one day a week. That’s the 0.

Alcohol at a young age can interfere with physical and mental development, so it’s better to wait as long as possible before drinking. Teens who do begin to drink should do so only under parental supervision and have no more than 2 drinks at a time – and never more than twice a week.

Recommendations to reduce the long-term health risks:

Do not increase your drinking to the upper limit, since the benefits for preventing certain diseases are greatest at less than 1 drink a day.

Plan non-drinking days every week to minimize the risk of tolerance and addiction.

People with reduced tolerance, whether due to low body weight, their age (under 25 or over 65) or not being accustomed to drinking alcohol should set limits that are below the limits proposed for the general population.

Recommendations to reduce the short-term health risks:

The risk of injury increases with each additional drink in many situations

Drink at the upper limit only occasionally and always stay within the weekly limits

Have no more than 2 standard drinks in any 3-hour period

Drink with meals and not on an empty stomach. The presence of food will slow down the absorption of alcohol but absorption will not be any less complete

Alternate alcoholic drinks with caffeine-free, non-alcoholic beverages

Avoid risky situations and activities when drinking

Alcohol and pregnancy/breastfeeding

For women who are pregnant, planning to become pregnant or about to breastfeed, it is safest not to drink at all. Alcohol in the mother’s blood can harm the developing fetus. While the risk associated with light drinking during pregnancy appears to be very low, there is no level of alcohol use during pregnancy that has been definitively proven to be safe. Women who are breastfeeding should not drink alcohol just before nursing. Some of the alcohol passes into breast milk and may affect their baby. Women who plan to drink alcohol can pump their breast milk or nurse before drinking.

When zero’s the limit

There are situations when it’s better not to drink, such as:

When you are making important decisions;

When you are doing any kind of dangerous physical activity;

When you are operating a motor vehicle or using machinery and mechanical or electrical equipment;

When you are responsible for the safety of others;

When you are taking medications that interact with alcohol;

When you have mental or physical health problems;

When you have problems with alcohol dependence.

Safer drinking tips

Set limits for yourself and stick to them!

Drink slowly.

For every drink of alcohol, have one non-alcoholic drink.

Eat before and while you are drinking.

Plan to drink in a safe environment.

Légis Québec

Éduc'alcool

Drugs

There many reasons why people use drugs. However, people have misconceptions about addiction and the risks of drug use.

Justification or excuse
My life is stressful. Drugs help me cope!

Drugs are not the way to deal with stress. They change the way the brain works. This can lead to depression, anxiety and other mental illnesses. If someone already has a mental health illness, drugs can make their condition worse.

The best way to solve a stress-related problem is to deal with it without using drugs. Try to identify what is causing your stress and find a healthier way to cope with it. Doing physical activity is a good way to get rid of unhealthy thoughts. Keeping busy or developing new interests are other ways you can overcome negative thoughts. It is also a good idea to talk about what is bothering you with someone who can help such as a family member or friends. There is always someone, somewhere who is willing to listen.

Curiosity
I was curious!

It is natural to be curious. But drugs are not worth the risk. Drugs can affect your judgment and decision-making skills, which could lead you to join in dangerous activities.

You know, a person isn’t going to jump off a 20-story building just to see if it will kill him or not … !

Influence
Everybody else is doing it. I want to fit in!

People may consider doing drugs because they think it will help them fit in. Drugs can be a waste of time and money, leaving little of either to spend with friends, do activities and be able to afford what you need for everyday life. Drugs tend to make people shut off from other people.

You don’t have to do what other people do just to stay friends with them. You have to have your own personality. That’s much more attractive to other people.

People may think that avoiding drugs might make you unpopular. However, it is much healthier to show your real personality through the activities you do and your friends.

Advertising/trivialization
I saw it on television or in a movie! It’s not dangerous!

What people think is popular can be strongly influenced by television shows and movies. Their images of drug use are unrealistic.

These media images rarely show the true consequences of drug use. In real life, using drugs often leads to poor performance at school or work, personality changes, conflicts with family and friends, health problems, possible injury or death, etc.

Addiction
I am not addicted. I can stop any time! ... yeah, right!

Even the people who are now addicted to drugs once believed they could stop using any time. Once addicted, it can be very difficult to stop. Stopping can trigger withdrawal symptoms, which may be very unpleasant and dangerous. People often begin to use drugs again in order to avoid these symptoms.

If a person becomes addicted, recognizing it is the first step to recovery. Consult the right resources, such as a health care provider or specialized therapist, or turn to support lines to start the recovery process. Where there’s a will, there’s a way!

Prescription drug addiction:

One in every four young people says they have taken a prescription drug at least once in their life to get high. This is a growing trend among young people in recent years. It is seen more in teenagers and young adults.

Looking for thrills and with little money to spend, young people turn to what they can get easily to satisfy their desires. They take combinations of drugs they find in the family medicine cabinet with alcohol and think that there won’t be any serious consequences. They think that a drug that has been approved on the market is safer than an illegal drug. However, when prescription drugs are not taken properly, they are not any safer than illegal drugs. Both are dangerous and using drugs for non-medicinal purposes carries serious risks such as poisoning, dependence, overdose and death.

Some drugs are more likely to be abused than others. It is our responsibility to be careful with any drugs we have, especially painkillers, antidepressants, stimulants and cough syrups that contain dextromethorphane. These are the drugs young people look for.

Government of Canada

Health Canada

Driving

In Quebec, driving a road vehicle is a privilege, not a right. The Société de l’assurance automobile du Québec (SAAQ) controls access to driver’s licences. The SAAQ establishes rules to obtain and maintain this privilege. The rules were established after consulting professional organizations that designated competent professionals to provide information that could influence the assessment with respect to medical standards for drivers.

The basics

Driver’s licence classes:
Licence classes are numbered 1 to 6, and 8. Each class corresponds to a specific category of vehicle. Classes 5 and 6 authorize the holder to drive a passenger vehicle or recreational vehicle. Classes 1 to 4 and Class 8 are commercial classes such as heavy trucks or patrol cars.

See Driver’s licence classes.

See the Société de l’assurance automobile du Québec’s guide to driver fitness assessment (French only)

Eligibility for a driver’s licence:
Before you can hold a licence to drive a car, you must obtain a learner's licence, successfully complete a driving course given by a driving school recognized by the Association québécoise des transports (AQTr) and then pass the SAAQ's knowledge and road tests. To obtain a Class 5 licence, you must be at least 16 years of age and have the consent of your father, mother or legal guardian if you are under 18 years of age. Other conditions apply. For more information, go to the SAAQ website.

Conditions that can be added to a driver's licence:
The SAAQ can add certain conditions to a driver’s licence. The purpose of these conditions is to make driving safer by:

  • facilitating the licence holder’s ability to drive a road vehicle;
  • restricting driving to a certain period or duration;
  • improving the licence holder’s functional capacity;
  • prescribing periodic medical examinations and health assessments;
  • restricting the classes of road vehicle that the licence holder may drive.

Conditions that can be added to a driver’s licence

A

The holder must wear eyeglasses or contact lenses while driving

B

The holder must drive between sunrise and sunset

C

The holder must wear a hearing aid when driving (Class 2, 4A, 4B or 4C)

D*

The holder must undergo a medical examination every 5 years

E*

The holder must undergo a medical examination every 6 months

F*

The holder must undergo a medical examination every year

G*

The holder must undergo a medical examination every 2 years

H

The holder must drive a vehicle with a net weight of less than 2,500 kg

I***

The holder must drive a vehicle fitted with an alcohol ignition interlock device (breathalyzer) following a medical diagnosis

J

The holder must drive a vehicle with an automatic transmission

K

The holder must drive a vehicle with power steering

L

The holder must drive a vehicle with power brakes

M

The holder must wear a hearing aid when driving a vehicle transporting dangerous substances

N

The holder must wear a safety harness while driving

O

The holder is prohibited from driving a vehicle transporting dangerous substances

P

The holder must drive a vehicle with hand-operated controls

Q

The holder must drive a vehicle with a manual control to adjust the brightness of the headlights

R

The holder must drive a vehicle with an accelerator on the left side

S***

The holder is subject to other medical restrictions

V

The holder must drive a vehicle with controls adapted to the holder's handicap

W

The holder is prohibited from driving a heavy vehicle (Class 1, 2, 3 or 4B) in the United States, since the driver does not meet American standards with regard to the health of drivers

X**

The holder must drive a vehicle fitted with an alcohol ignition interlock device (breathalyzer) following a criminal conviction for alcohol-impaired driving

Y**

The holder must comply with the zero-alcohol rule

* Conditions D, E, F and G do not appear on the licence, but are indicated in the holder's driving record. A description or additional information about these conditions can be consulted by authorized SAAQ employees.

** Conditions I, X and Y cannot be assigned to a learner's licence.

*** Condition S is defined as follows on the back of the licence: “Autre condition” (meaning “other condition”). A description of the condition is provided in the holder's driving record.

Screening for health problems in drivers

  • Applying for a driver’s licence for the first time:
    • When he registers for the driving course, the applicant must complete a health questionnaire.
    • If he has a condition that could affect his ability to drive, he may have to undergo a medical assessment before he can learn how to drive.

     
  • Renewing a driver’s licence:
    • Under section 95 of the Highway Safety Code, a licence holder must inform the SAAQ of any change concerning the documents and information that must be provided on obtaining or renewing a licence within 30 days after the change.

     
  • Mandatory assessments based on age and licence class:
    • All private drivers (Classes 5 and 6) must undergo a medical assessment and a vision test by an ophthalmologist or an optometrist at age 75. From age 80 on, they must repeat these examinations every two years.
    • For commercial drivers (Classes 1 to 4), the frequency of the assessments is different. Those who wish to drive their commercial vehicle in the United States must undergo a medical assessment every five years until age 45, every three years from 45 to 65 years of age and then every year.
    • Commercial drivers who do not wish to drive in the United States are required to undergo a medical assessment at age 45. After this, they are required to undergo medical assessments at 55, 60 and 65 years of age and then every two years.

     
  • Assessments required based on the evaluation of medical conditions already reported to the SAAQ
    • A driver who is recognized as having a medical condition that may affect his driving ability may be required to undergo medical assessments at intervals that are established by the SAAQ depending on the nature and course of the condition (as described in the SAAQ’s regulations).

     
  • Reporting
    • Reporting is based on responsible citizenship.

     
  • Reporting of unfit drivers (under section 603 of the Highway Safety Code)
    • A report that a person is unfit to drive made by a health professional designated by the HSC that contains all the elements needed to make a decision with respect to the licence holder’s fitness to drive may lead to the licence being suspended within a very short time.

      Section 603: “A health professional (physician, optometrist, psychologist, occupational therapist, nurse) may, according to his field of practice, report to the Société the name, address and state of health of a person 14 years of age or older whom he considers unfit to drive a road vehicle having regard, in particular, to the illnesses, deficiencies and situations incompatible with the driving of a road vehicle established by regulation.
      For the purposes of this section, health professionals are authorized to disclose to the Société any information revealed to them in the practice of their profession.”

      Section 605: “No action in damages may be brought against a health care professional for having availed himself of section 603.”
       
  • Police request to verify a driver’s health
    • If a police officer believes that a driver’s driving is impaired, he may submit a request for a driver fitness assessment to the SAAQ. This may lead to the driver being required to undergo a medical assessment within a short period of time.

Information that must be provided in a driver’s medical assessment:

The SAAQ’s decision must be based on accurate, recent information. It only accepts information that dates from the past year. In his report, the health professional must provide sufficient information about the following points from his area of expertise:

  • the nature of the symptoms and objective signs as well as the underlying pathologies (the primary and secondary diagnoses);
  • the extent of the functional limitations;
  • the frequency of episodes of disability, the manifestations and, where applicable, the date of the most recent episode;
  • the possibility of an episode of physical or cognitive disability occurring with or without treatment (recurrence);
  • the patient’s attitude to his illness and treatment. Noncompliance with the treatment prescribed by a doctor for an illness that is known to affect road safety may, in a number of situations, impair driving ability.

Note also that the result of a road test may take precedence over a health professional’s opinion that is based on an office assessment only.

Legal aspects of the driver’s medical assessment:

  • The driver’s obligations
    The HSC stipulates that a driver’s licence holder is required to inform the SAAQ of any change in his status that could affect his ability to drive.
  • The health professional’s responsibilities
    The health professional’s ultimate responsibility with respect to determining his patient’s fitness to drive is to provide the SAAQ with the most relevant and most complete information possible from his area of expertise.

Regulation respecting the health of drivers:

Epilepsy / seizure / loss of consciousness:

Section 32

Epilepsy, if less than 5 years have elapsed since the last seizure, is essentially inconsistent with driving a road vehicle of Class 1 to Class 4, unless the affected person:

  • has had partial simple seizures, somatosensory seizures or motor seizures involving one anatomical area having no impact on driving; the seizures are always of the same type and do not perturb the person’s state of consciousness, and a period of not less than 3 years has elapsed without any other type of seizure;
  • has had one or more seizures resulting from an interruption or change in the treatment for epilepsy prescribed by a physician while epilepsy was well controlled, and the person had no seizure during the 5 preceding years if a period of not less than 6 months has elapsed since the last seizure resulting from the interruption or change in the treatment and treatment has resumed;
  • has had one or more seizures in a brief period of time due to exceptional circumstances or an intercurrent disease whose cause has been clearly established, which are unlikely to recur in a person who is usually well controlled and closely follows the treatment, provided that the person had no seizure during the 5 preceding years and a period of not less than 6 months has elapsed since the last seizure;
  • has had seizures occurring while sleeping or shortly after waking up and a period of not less than 5 years has elapsed without any other type of seizure.

Section 33

Epilepsy, if less than 6 months have elapsed since the last seizure, is essentially inconsistent with driving a road vehicle of Class 5, Class 6 or Class 8, unless the affected person:

  • has had focal seizures, excluding partial complex and partial simple seizures with adverse symptoms, limited to one anatomical area, without perturbing the person’s state of consciousness and where a period of not less than 12 months has elapsed without any other type of seizure;
  • has had one or more seizures resulting from an interruption or change in the treatment for epilepsy prescribed by a physician while epilepsy was well controlled, where a period of not less than 3 months has elapsed since the last seizure and treatment has resumed;
  • has had one or more seizures in a brief period of time, due to exceptional circumstances or an intercurrent disease whose cause has been clearly established, which are unlikely to recur in a person who is usually well controlled and closely follows the treatment, and where a period of not less than 3 months has elapsed since the last seizure;
  • has had seizures occurring while sleeping or shortly after waking up and a period of not less than 12 months has elapsed without any other type of seizure.

Section 34

Convulsive seizures or loss of consciousness provoked by toxic substances or alcohol are essentially inconsistent with driving a road vehicle of Class 1 to Class 4 if a period of less than 12 months has elapsed since the last seizure or loss of consciousness, during which period the person abstained from the substance that caused the seizures or the loss of consciousness.

Section 35

Convulsive seizures or loss of consciousness provoked by toxic substances or alcohol are essentially inconsistent with driving a road vehicle of Class 5, Class 6 or Class 8 if a period of less than 6 months has elapsed since the last seizure or loss of consciousness, during which period the person abstained from the substance that caused the seizures or the loss of consciousness.

Section 36

A single convulsive seizure without evident cause after a neurological and cardiac investigation, including an electroencephalogram showing no epileptic activity, is essentially inconsistent with driving a road vehicle of Class 1 to Class 4 if a period of less than 12 months has elapsed without any seizure or loss of consciousness.

Section 37

A single convulsive seizure without evident cause after a neurological and cardiac investigation, including an electroencephalogram showing no epileptic activity, is essentially inconsistent with driving a road vehicle of Class 5, Class 6 or Class 8 if a period of less than 3 months has elapsed without any seizure or loss of consciousness.

Section 38

One or more episodes of non-convulsive loss of consciousness or one or more episodes of syncope the cause of which remains unknown after medical investigation or for which there is no efficient treatment are essentially inconsistent with driving a road vehicle of Class 1 to Class 4 if a period of less than 12 months has elapsed without any loss of consciousness or syncope.

Section 39

Episodes of non-convulsive loss of consciousness or syncope the cause of which remains unknown after medical investigation or for which there is no efficient treatment are essentially inconsistent with driving a road vehicle of Class 5, Class 6 or Class 8 if a period of less than 3 months has elapsed without any loss of consciousness or syncope.

Regulation respecting the health of drivers

In short… for a Class 5,6 or 8 licence (epilepsy / seizure / loss of consciousness)

Focal non-dyscognitive epileptic seizures

  • without adverse symptoms,
  • limited to one anatomical area
  • without any other type of seizure for at least 12 months

OK to drive 6 months after the first seizure

OK to drive if this type of seizure has persisted without any other type of seizure for 12 months

An interruption or change in the treatment prescribed by a physician / well controlled epilepsy

No driving for 3 months after the last seizure and treatment has resumed

Epileptic seizure in exceptional circumstances

No driving for 3 months after the last seizure

Epileptic seizure at night without any other type of seizure for at least 12 months

OK to drive 6 months after the first seizure

OK to drive if this type of seizure has persisted without any other type of seizure for 12 months

Convulsive seizures or loss of consciousness provoked by toxic substances or alcohol

No driving for 6 months after the last seizure or loss of consciousness and the person must not consume the substance that caused the seizures or loss of consciousness

A single convulsive seizure without evident cause

  • after a neurological and cardiac investigation,
  • an electroencephalogram showing no epileptic activity

No driving until a period of at least 3 months has passed without any seizures or loss of consciousness

One or more episodes of non-convulsive loss of consciousness or syncope the cause of which remains unknown after medical investigation or for which there is no efficient treatment

No driving until a period of at least 3 months has passed without any loss of consciousness or syncope

Driving and prescription drugs

The patient is responsible for not driving when he is experiencing side effects from his prescription drug that affect his condition and his ability to drive.

Driving and drinking

Every one commits an offence who operates a motor vehicle […] or has the care or control of a motor vehicle […], whether it is in motion or not:

  • while the person's ability to operate the vehicle […] is impaired by alcohol or a drug; or
  • having consumed alcohol in such a quantity that the concentration in the person's blood exceeds eighty milligrams of alcohol in one hundred millilitres of blood;

The zero alcohol rule applies to:

  • Drivers under 22 years of age
  • Learner drivers
  • Probationary licence holders

Consequences:

  • Immediate licence suspension for 90 days
  • 4 demerit points
  • A fine

Reminder: Drinking too much alcohol can be causal factor in seizure recurrence

Driving and marijuana

The SAAQ does not make a distinction between recreational and medical marijuana.

The onset and duration of the effects of marijuana (according to Health Canada data).

 

Inhalation / vaporization

Oral ingestion /oil

onset of effects

a few minutes

30 to 60 minutes

duration of effects

2 to 4 hours

8 to 12 hours

Duration of effects on driving ability (unsafe driving)

Cannabis

Duration of effects on driving

Inhalation

4–6 hours

Vaporization

4–6 hours

Oral ingestion

6–8 hours

Driving under the influence of a substance, whether prescribed or not, is illegal under Canada’s Criminal Code.

Women’s health and epilepsy

Epilepsy and hormonal fluctuations

In some women with epilepsy, hormonal fluctuations can have an impact on seizure frequency. In these patients, puberty, fluctuations associated with hormonal cycles, oral contraceptives, pregnancy and the perimenopausal period are all clinical situations that can affect epilepsy control.

Catamenial epilepsy refers to seizures that occur during the perimenstrual period, generally when progesterone levels are low and estrogen levels are high, typically from day -3 to day +3, where day 0 is the first day of the menstrual period.

Contraception

Some medications reduce the effectiveness of the pill and a second method of contraception is needed to ensure protection. They include: carbamazepine CR or regular (Tegretol), phenytoin (Dilantin), phenobarbital, primidone (Mysoline), and topiramate (Topamax) at doses higher than 200 mg/day.

Oral contraceptives reduce serum levels of lamotrigine (Lamictal), potentially reducing its efficacy. This means that the dose of lamotrigine may need to be increased.

Barrier methods (condoms), IUDs (Mirena or copper IUD) and surgical methods (tubal ligation) are equally effective in women with epilepsy as in the general population. For women with epilepsy, some particularities regarding combined oral contraceptives (the pill) must be considered.

Pregnancy

Women with epilepsy can become pregnant and most pregnancies go smoothly. It is important to talk to your neurologist about pregnancy, ideally before you get pregnant but if not, then as soon as you know that you are pregnant. You should not make changes to your medication without discussing it with your neurologist first.

Most importantly, major seizures (generalized tonic-clonic seizures or grand mal seizures) must be prevented during pregnancy because they can reduce blood and oxygen flow to the fetus. To do so, continue taking your medication as prescribed. Being seizure free in the 9 months prior to pregnancy is also known to be a predictive factor for being seizure free during pregnancy. Other recommendations given to people with epilepsy also apply to women with epilepsy who are pregnant, for example, avoid alcohol and make sure you get enough sleep.

In some cases, your neurologist may decide to increase the doses of some anti-epileptic drugs because some medications are eliminated by the body faster during pregnancy.

Antiepileptic drugs can increase the risk of fetal malformations. It should be noted that:

  • Malformation rates in babies of non-epileptic women are 0.5–1%.
  • Most major malformations occur in the 1st trimester when the organs are formed.
  • The risk of malformations is different for different antiepileptic drugs (ranging from 2 to 10% with monotherapy).
  • The risk of malformations usually depends on the dose and number of antiepileptic drugs.
  • The risk of malformations is unknown for some more recent drugs, for pregnant women are excluded from scientific studies.
  • Taking preconception vitamins lowers the risk of some malformations and ideally should be started around 3 months before conception. For some anti-epileptic drugs, your neurologist may recommend a higher dose of folic acid than the amount in regular pregnancy vitamins.
  • The complications associated with generalized seizures are more severe than the complications caused by antiepileptic drugs.

This is why a planned pregnancy is always best. Your medication can be adjusted with your neurologist to minimize the risk of fetal malformations.

Postpartum period

The postpartum period can be challenging for all women and women with epilepsy are no exception.

Postpartum depression and anxiety
Postpartum depression and anxiety are complications that can affect anyone during the postpartum period. It is vital for your and your baby’s health that you talk to a health professional if you think you have these symptoms.

Sleep
Sleep is a major issue during the postpartum period and for women with epilepsy, sleep deprivation can have harmful effects on seizure control. It is important to find solutions that are right for you so that you get the rest you need, for example, accept help from your family/friends/partner, take naps during the day, etc.

Breastfeeding
There are no contraindications to breastfeeding. There are multiple benefits for the mother’s and the baby’s health (lower risk of postpartum depression). Some medication passes into breast milk but less than the amount the baby was receiving in the mother’s womb. The decision to breastfeed is a personal choice. Being able to share night feeds with someone else so that the mother can sleep may be factor to consider.

Infant safety
Here are a few recommendations for patients with uncontrolled epilepsy to prevent accidents in the event of a seizure:

  • Change the baby’s diaper on the floor rather than on a changing table.
  • Use a stroller to transport the baby rather than a sling.
  • Have someone help you when you give the baby a bath.

Psychiatric comorbidities

The prevalence of psychiatric disorders is higher in people with a neurological disorder than in the general population. Epilepsy can be accompanied by cognitive disorders, behavioural disorders, learning disabilities or other conditions associated with psychiatric or psychological disorders.

Epilepsy clinics increasingly screen their patients so that symptoms of disabling depression and anxiety can be managed from the outset. These are excellent initiatives that can prevent psychiatric complications in patients with epilepsy.

Many epilepsies have also been found to be associated with physical comorbidities such as diabetes and high blood pressure. Epilepsy clinics work with other specialties and family doctors. Together, we will identify these disorders at an early stage, make a diagnosis and ensure appropriate management. It is important to be informed and to be alert to symptoms without, however, thinking about them constantly so that they become a source of worry.

Learning

Various aspects of epilepsy can affect school performance. The main ones are seizures, antiepileptic drugs, the emotional and psychological effects of epilepsy and the number of missed days. They have an impact on memory and concentration, two abilities essential to academic success.

Seizures:
Of course, seizures have a major impact on learning and therefore on school performance. They affect the ability to retain information, the ability to concentrate and can even have significant physical effects. These are certainly not optimal conditions for learning.

Memory

For some people, seizures will have an impact on memory. Depending on the type of seizures and seizure frequency, memory may be affected to a greater or lesser degree. Since different areas of the brain perform different functions, seizures in the left temporal lobe will not have the same impact as those in the frontal lobe.

  • Seizures in the left temporal lobe can affect verbal memory, which might mean that you find it harder to remember words.
  • The right temporal lobe is important for visual memory. Seizures in this lobe might mean that you find it hard to find your way around a new place.
  • The frontal lobe is responsible for prospective memory, that is, about things to do in the future. A seizure in this lobe might mean that you find it hard to remember to do things in the future.

Lastly, after a seizure, it is often difficult to remember what happened before the seizure and it may take a while to recover. So, when epilepsy affects memory, learning becomes a real challenge. However, a number of techniques can help offset these memory problems. For example, you can:

  • Have someone take notes for you in class
  • Use a laptop or tablet
  • Make memory aids
  • Use a calendar
  • Make a list of things to do
  • Use alarms and cell phones
  • Use pictures

Concentration

Seizures can affect your concentration both during a seizure and afterwards. Of course, it is impossible to concentrate during the seizure. After a seizure, you might feel tired, which will affect your ability to concentrate.

If you have problems with concentration because of your epilepsy, it would be better to ask a colleague to take notes for you during classes. Also, try to figure out when you are able to concentrate well and do tasks that require a lot of concentration at these times.

Physical effects

Some seizures may have physical effects because they can cause injuries (atonic) or because they are physically draining (tonic-clonic). They are also often associated with headaches. In these conditions, seizures will affect learning because they can take time to recover from and this means young people will have to either miss days of classes or put their work off until later.

Fatigue

After a seizure, it is normal to feel tired. This makes it hard to go about your activities immediately afterwards. It is better to rest and take time to recover. Tiredness can affect learning and school performance because you have to stop the activity you were doing and take it up later. Lastly, seizures sometimes occur during the night which can mean that you don’t get a good night’s sleep. This can make it harder for you to go about your day-to-day activities.

Medication

Antiepileptic drugs have various adverse effects that can affect school performance. For example, the side effects often reported are fatigue, drowsiness or a slowing down effect. Difficulties with concentration and memory are also recognized side effects of antiepileptic drugs. These effects have an impact on learning because they cause periods of inattention, which makes learning challenging. Learning may take longer for a person with epilepsy because of fatigue and concentration problems associated with medication.

Emotional and psychological effects

Epilepsy can cause anxiety because of the unpredictable nature of seizures. Even if you try to avoid seizure triggers, they cannot be prevented 100%. A seizure can happen without warning or without a trigger. This can make people with epilepsy feel stressed or anxious. This has repercussions on concentration and memory which are essential to learning. So the emotional effects of epilepsy also have an impact on learning.

Missed days

Like any chronic illness, epilepsy means more medical appointments. This means that young people with epilepsy will miss more days of school. As a result, they may fall behind in their school work. They may be able to make it up without affecting their school performance. However, it is better to manage the situation before academic problems arise. To do so, the person’s needs must be evaluated. Sometimes, simply having a friend bring you your homework can be enough. In other cases, it might be better to inform the teacher so that adjustments can be made if necessary. Discussing the situation with your teacher can be very helpful.

Academic accommodations

All universities provide services for students with disabilities. Epilepsy is seldom referred to outright in these various programs. However, if you read carefully, you will see that it is included. To find out more about the services, accommodations or scholarships offered at your university, go to their respective web pages and make an appointment with an advisor. He/she will be able to provide guidance and develop an accommodations plan to make going to university as straightforward as possible.

Guide to academic accommodations at university

Université de Montréal: Soutien aux étudiants en situation d’handicap (SESH)

To find out if you are eligible and to learn more about the services offered, make an appointment with an advisor at 514 343-7928.

For more information

UQÀM: Service d’accueil et de soutien aux étudiants en situation d’handicap.

To find out if you are eligible and to learn more about the services offered, make an appointment with an advisor at 514 987-3148 or go to reception at J-M870.

For more information

McGill University: Office for Students with Disabilities

To find out if you are eligible and to learn more about the services offered, make an appointment with an advisor by telephone at 514 398-6009 or by email

For more information

Université Concordia: Access center for students with disabilities

To find out if you are eligible and to learn more about the services offered, make an appointment with an advisor by telephone at 514 848-2424, extension 5525 or by email

For more information

Université de Sherbrooke: Programme d’intégration des étudiantes et étudiants et situation de handicap

To find out if you are eligible and to learn more about the services offered, make an appointment with an advisor by telephone at 819 821-7997 or toll free at 1 800 267-8337, extension 67997 or by email

For more information

Université Laval: Centre d’aide à l’accessibilité des étudiants en situation de handicap

To find out if you are eligible and to learn more about the services offered, make an appointment with an advisor by telephone at 418 656-2880 or by email.

For more information

Employment and epilepsy

Finding a job is a challenge for people with epilepsy. Moreover, various statistics reflect this difficulty: the unemployment rate is 2 to 4 times higher in this population than in the general population and one third of those who do find employment are employed in jobs below their qualifications. Based on these two statistics alone, it is clear that job hunting is a major issue for a person with epilepsy. The challenge is not only to get a job but to get one that fully uses their skills.

Choosing a job

The first step to avoid difficulties is to choose the right job. First, you should know that most jobs are open to people with epilepsy. However, to choose the right job, you have to know your skills, interests and limitations. This will make it easier to find an appropriate job. If you are having trouble deciding on a career, a consultation with a career counsellor may be helpful.

Getting a job

It is sometimes harder for a person with epilepsy to get a job. Studies show that 25 to 75% of people say they had difficulty finding work because of their epilepsy. This statistic is supported by the higher employment rate in this population. The main problem, according to these studies, is stigmatization.

Contributing factors

  • Seizure control: It is easier for people who have their seizures under control to find a job.
  • Medication: Polytherapy is said to have a negative impact on job hunting. This situation may be related to seizure control, since polytherapy is also often associated with less reliable seizure control.
  • Age at seizure onset (easier if after age 6): If epilepsy begins after age 6, finding a job is said to be easier. This factor may be due to the fact that when epilepsy starts at an earlier stage in the brain’s development, it is more likely to be associated with other neurodevelopmental disorders.

Issues

Various issues can make it harder for people with epilepsy to find a job. The main issues associated with employment are:

Ignorance and discrimination
The general population knows very little about epilepsy and employers are therefore afraid to hire people from this population. Moreover, many employers, owing to their ignorance, think that an employee with epilepsy will be less productive and will take more days off. However, recent studies show the opposite. Employees with epilepsy think they have to prove themselves and so they work harder and absenteeism rates are lower.

Ignorance about epilepsy can also lead to discrimination towards this population. Since employers know little or nothing about this neurological condition, they prefer to hire someone who does not have epilepsy. This is discriminatory. This also applies when it comes to getting a promotion. People with epilepsy do not get as many promotions. Yet they are just as qualified. If you think you have experienced discrimination, you can take legal action. An employer cannot disqualify you because of a health problem unless it means that you are not able to do the job properly.

To find out how to defend your rights

Accommodations and safety
The work environment does not always have to be adapted for an employee with epilepsy. And even if accommodations are required, they are often minimal and require little investment from employers. However, they ensure the employee’s safety and an optimal work environment.

Accommodations can take different forms. The most common are:

  • Keep the worker away from heights, ladders
  • Schedule a steady day or evening shift
  • Alter lighting to eliminate flickering
  • Be flexible about making up time if seizures occur
  • Put a carpet under the desk (can sometimes prevent injuries)
  • Promote a positive environment, with a dialogue on epilepsy

Low self-esteem
Low self-esteem in people with epilepsy can affect job hunting. During interviews, you have to be able to talk about your qualities and why you are the best person for the job. If a person lacks confidence, it is harder to do this.

Disclosing epilepsy
The decision to disclose your epilepsy is a personal one that varies depending on the situation. No employer has the right to ask you for information about your health. He can ask you questions about your physical ability to do certain tasks but cannot ask you health-related questions. It is up to you to decide whether or not it is appropriate to disclose your epilepsy and when to do so.

Different characteristics of your epilepsy can influence this decision:

  • the date of the last seizure;
  • seizure frequency;
  • the type of seizure;
  • potential triggers;
  • the help needed during and after a seizure;
  • the side effects of medication or other health problems or disabilities that could affect your ability to work;
  • potential safety problems for you and for other people;
  • the accommodations needed to do your job.

For example, if you have seizures every day, it would be better to tell your employer at the outset. He will be able to make changes to your work environment or adapt your schedules to your condition. However, if you do mention it at the outset, you may not be hired. This is why, if you choose to do so, you must be ready to respond to your future employer’s concerns so that you can reassure him and show that your epilepsy will not affect your work.

If your epilepsy is well controlled, it is not always necessary to disclose it. Since it does not affect your day-to-day life, it is not always appropriate to mention it. Moreover, many people with epilepsy do not disclose it at work and go about their work without any problems. However, you must know that if you choose this option and if you have a seizure at work, people may not respond in the right way. Furthermore, your employer may feel betrayed and the relationship of trust will be affected.

Self-esteem and epilepsy

Good self-esteem is essential to be able to take on new projects. It also contributes to a good quality of life. However, some situations can affect self-esteem. This is the case for many people with epilepsy.

Various factors account for low self-esteem in people with epilepsy, such as:

  • The frequency, nature and course of seizures
    The frequency, nature and course of seizures can have an impact on self-esteem. The more frequent and sudden seizures are, the higher the risk of having problems with self-confidence. The frequency and unpredictable nature of seizures can make the person anxious. Fear of having a seizure in public can lead to isolation and consequently low self-esteem.
     
  • Perceived control over the condition
    Feeling out of control during an epileptic seizure is often a factor that contributes to low self-esteem. In a world where being independent is so important, knowing that a seizure can happen at any time can be very disabling. Furthermore, this situation is contrary to society’s “standards” of self-control and independence. A person with epilepsy may feel inferior as a result, contributing to low self-esteem.
     
  • The impact of epilepsy on daily activities and future plans
    When daily activities and future plans are affected by epilepsy, it becomes a disability for the person. In this context, there is a strong possibility that confidence will be affected. Carrying out daily activities and future plans is very important for ensuring a good quality of life. This is why when epilepsy has an impact on these plans and activities, self-esteem is affected at the same time.
     
  • The reaction of peers and family members to the illness
    • Tendency to become overprotective
      It can be very difficult for someone to learn that their child, brother/sister or partner has epilepsy. They often react by becoming overprotective. However, a person with epilepsy must learn to manage his condition himself and for him to do this, he must be allowed to be independent. Furthermore, learning that he has epilepsy is very difficult for the person himself. If, at the same time, his family make him feel that his independence is affected, acceptance will be even harder and the impact on self-esteem even greater. It is important to allow people with epilepsy to be independent.
    • Lack of understanding
      The general public knows very little about epilepsy which can lead to discrimination or stigmatization. This negative reaction to epilepsy can cause people with epilepsy to isolate themselves. By excluding or stigmatizing this population, a person with epilepsy may feel inferior and that he cannot cope. These feelings lead to lower self-esteem.

A number of interventions can help people in this situation, such as:

  • Encouragement
    Epilepsy brings its share of challenges. Simply managing this neurological condition can be complex. It is important to encourage the person with epilepsy as they deal with these new challenges and show them our support. Even if the victories are very small, highlighting them can help raise self-esteem.
     
  • Promoting independence
    By promoting independence, we are showing the person with epilepsy that they are able to take care of themselves and manage their medical condition. This will raise their confidence and self-esteem.
     
  • Maintaining a normal lifestyle (work, sports, leisure)
    Once epilepsy has been diagnosed, it is important to maintain the same lifestyle as before as far as possible. It is important to keep on doing the same activities and to return to work if possible. Resuming a “normal” routine will help maintain self-esteem. If a person with epilepsy has to stop their activities on top of having to learn to live with this new condition, the condition is more likely to take over and lead to low self-esteem. To prevent this from happening, people with epilepsy must try to resume their lives as quickly as possible.