34 - Neurorehabilitation in epilepsy

Summary

Introduction: is rehabilitation necessary in epilepsy?

We usually do not associate rehabilitation with patients with epilepsy (PWE). Epileptic seizures consist of recurrent episodes during which there is a transient loss of awareness of their surroundings, a display of purposeless behavior or a generalized convulsion; unless the seizure activity evolves into status epilepticus, patients usually recover after a few minutes, though occasionally it may take several hours before their motor, sensory and cognitive functions return to baseline. Yet epilepsy includes cognitive and psychiatric disturbances in addition to epileptic seizures. Furthermore, frequent psychosocial obstacles in the form of stigma, discrimination, and plain misinformation about this disease add to the difficulties PWE have to face and in some patients the cognitive and psychiatric disturbances may constitute the principal cause of impairment. For example, a child with an acquired epileptic aphasia of childhood (or Landau–Kleffner syndrome) may have rare clinical seizures that usually respond well to antiepileptic drugs (AED). However, the principal expression of this seizure disorder is a global aphasia and severe behavioral disturbances consisting of motor hyperactivity, impulsive and aggressive behavior (Morrell et al., 1995).

In this article, we review the causes that limit PWE from reaching their full potential academically, professionally and socially, and the potential role of rehabilitation in overcoming these obstacles. Finally, we offer suggestions on how the field of rehabilitation should be incorporated into the evaluation and management of every PWE.