Dissociation in Epilepsy: Symptoms and Management

Dissociative symptoms

Hello Doctor, I have symptoms of epilepsy.
I have experienced three episodes where I was unaware of what I was doing or where I was going.
The symptoms appear after the seizures, and I only feel disoriented after taking my anti-epileptic medication.
During the seizures, I thought the doctor was giving me medication (sedatives, anti-epileptic drugs) to help me sleep and rest, but then I realized (after an unknown number of hours) that I was actually discharged with my family.
I didn't even realize what was happening and I am afraid to go to school.
During the episodes of disorientation, I exhibit symptoms such as cursing at others, cursing at myself, unsteady walking, and not recognizing people (similar to being intoxicated).
Upon waking, I experience symptoms like dizziness, headaches, blurred vision, a spinning sensation, unsteady walking, increased appetite, and I sometimes engage in activities that I had no intention of doing.
All these descriptions come from my family and friends, who also ask me if I am mentally ill and repeatedly question who they are.
Whenever my dad is present, he tells the doctor not to administer medication because he knows that after taking the medication, I become somewhat disoriented and my memory declines.
Additionally, at school, I am introverted and afraid of strangers, but I used to chat with others.
Recently, I have not been under much stress, but I frequently experience insomnia.
Doctor, could this be due to medication overdose or stress-related issues?

ll, 10~19 year old female. Ask Date: 2016/02/23

Dr. Ding Shuyan reply Psychiatry

Hello, after a seizure, it is common to experience a state of confusion, even without medication.
When a seizure occurs and you are taken to the hospital, the physician will assess your condition and may administer necessary medications to prevent further seizures or reduce the risk of injury.
This medical decision is made after weighing the benefits and risks.
If you have any doubts, it is best to discuss them with your physician.
Our primary goal should be to adhere to the prescribed antiepileptic medications regularly to minimize the frequency of seizures, which will help reduce the various situations you mentioned.
It is also important to pay attention to psychological stress assessment and adjustment, but controlling the seizures should take precedence.
Wishing you all the best.
Sincerely, Dr.
Ding Shuo-Yan.

Reply Date: 2016/02/23

More Info

Dissociation in epilepsy can be a complex and distressing experience for those affected. It often manifests as a temporary disconnection from one's thoughts, feelings, or sense of identity, which can be particularly alarming when it occurs during or after a seizure. Based on your description, it seems that you are experiencing dissociative symptoms following your seizures, which can include confusion, memory loss, and altered awareness of your surroundings.

Understanding Dissociation in Epilepsy
Dissociation can occur in various forms, and in the context of epilepsy, it may be related to the neurological effects of seizures themselves. During a seizure, especially focal seizures that affect the temporal lobe, individuals may experience altered consciousness or awareness. This can lead to behaviors that seem out of character, such as inappropriate speech or actions, which you described as "cursing at others or yourself" and feeling disoriented.

After a seizure, many individuals report a postictal state, which is a recovery phase characterized by confusion, fatigue, and sometimes emotional disturbances. Symptoms like dizziness, headache, and a feeling of being "out of it" are common. The fact that you are unaware of your actions during these episodes and rely on family and friends to recount what happened is indicative of a dissociative experience.

Potential Causes of Your Symptoms
1. Medication Effects: The medications used to manage epilepsy, such as antiepileptic drugs (AEDs), can have side effects that include sedation, cognitive impairment, and mood changes. If you feel that your medication might be contributing to your dissociative experiences, it is crucial to discuss this with your healthcare provider. They may need to adjust your dosage or consider alternative medications.

2. Stress and Anxiety: While you mentioned that you are not currently under significant stress, the cumulative effects of living with epilepsy can lead to anxiety and fear about future seizures. This anxiety can exacerbate dissociative symptoms. Sleep disturbances, which you also noted, can further contribute to cognitive issues and emotional instability.

3. Underlying Neurological Factors: The nature of your seizures themselves may play a role in your dissociative experiences. Temporal lobe epilepsy, for instance, is known for causing complex partial seizures that can lead to significant alterations in consciousness and behavior.

Management Strategies
1. Medication Review: Consult with your neurologist or healthcare provider about your current medication regimen. They can assess whether your symptoms might be related to your medications and make necessary adjustments.

2. Psychological Support: Engaging with a mental health professional who understands epilepsy can be beneficial. They can help you develop coping strategies for managing anxiety and dissociation, as well as provide support for any emotional distress you may be experiencing.

3. Education and Awareness: Understanding your condition and the nature of your seizures can empower you. Keeping a seizure diary that records the frequency, duration, and any associated symptoms can help you and your healthcare team identify patterns and triggers.

4. Lifestyle Modifications: Prioritize good sleep hygiene, regular exercise, and stress management techniques such as mindfulness or relaxation exercises. These can help improve your overall well-being and potentially reduce the frequency of seizures.

5. Support Networks: Connecting with support groups for individuals with epilepsy can provide a sense of community and understanding. Sharing experiences with others who face similar challenges can be comforting and informative.

Conclusion
Dissociation in the context of epilepsy is a significant issue that warrants attention and management. It is essential to work closely with your healthcare team to address your symptoms, review your treatment plan, and explore psychological support options. Remember, you are not alone in this journey, and there are resources available to help you navigate the complexities of living with epilepsy and its associated challenges.

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