Quality of life and wellness in PNES

1. Quality of life and wellness in PNES Lorna Myers, Ph.D. Northeast Regional Epilepsy Group

2. Quality of life: QOL and HRQOL • What is QOL? The perceived quality of an individual’s emotional, physical, and social life. It is made up of many factors: social economic conditions, safety, living conditions, health, etc. • Health problems can obviously affect the patient’s sense of wellbeing (HRQOL). It is the patient’s assessment of risks, limitations, functional status (cognitive, emotional, and physical), support, social economic conditions, etc.

3. QOL can change For the better or worse

4. QOL and PNES • QOL in persons with PNES tends to be poor. • QOL in PNES < medically intractable epilepsy • WHY do you think this is the case?

5. Why is QOL so poor in PNES? • Seizure-factors: • Seizure disorder: unexpectedly intrudes on life, potentially dangerous, may affect work/education/social life. Real limitations and isolation may follow. • Psychological factors: • depression, anxiety, trauma history and PTSD associated with PNES.

6. Why is QOL so poor in PNES • Ignorance and negative attitudes of health professionals: • Faking, uncaring and rejecting: drug seeking, attention seeking. • Discharge is speedy: “I need this hospital bed for a patient who is really sick.” • Often no referrals are given. • Mental health pros are unfamiliar, often refuse treatment, doubt diagnosis of PNES bouncing patients back to neurology.

7. Why is qol so poor in PNES? • Ignorance and negative attitudes of family and friends, bosses, general public: • This is not a REAL condition, we thought you had epilepsy. “Get over it, you are not getting better because you aren’t making the effort, you lack will-power.” • Overreaction: Unnecessary EMTs and ER visits with subsequent high medical bills. • PNES information is not readily available. Absence of awareness and recognition as a valid and serious health condition.

8. Why is qol so poor in pnes • Real changes: • Loss of independence • Mobility (i.e. driving) • Sick status • Inactivity • Job? • School?

9. But Quality of life is a choice too

10. QOL and safety • Depends on the characteristics of the episodes. (paralysis vs. intense motor output vs. drops) • Educate important people in your life about what your episodes look like so they can recognize them and know what to do.

11. QOL and safety • Preventing injuries: • Pad sharp corners of furniture, bathroom vanities, etc. • Thick rugs • Avoid open flames-use microwave, care when removing hot objects from oven. • Avoid steep staircases • Make sure someone is home when showering, don’t lock bathroom door, door should open outwards. • Keep away from side of road or subway/train tracks

12. Safety measures

13. QOL and safety • First Aid: Depends on your episode characteristics • Zone out: need someone to stay with you until you recover. • Physically intense: someone needs to make sure you don’t injure yourself. • Calling an ambulance is not usually necessary unless you have injured yourself during episode. • Carry a laminated card • Wear medical alerting jewelry: Conversion disorder, seizures • Cell Phone contact: ICE

14. Safety measures

15. QOL and pnes: Driving • If there is a possibility that an episode while driving can hurt you or another person, you must not drive • Driving prohibition laws vary from state to state • How to get around? Public transportation, reliance on others, taxi wholesale rates, walking.

16. Qol and PNES: Work • If possible, keep working: • Accommodations (work from home, time for doctor visits, avoid being sent out of town, breaks, perhaps even a leave of absence). • If you lose your job, avoid isolation. Volunteer work, social activities through your community centers or doctor’s office. • Disability application

17. How to improve qol? • Avoid social isolation: • Use community resources • Hospital and doctor office wellness programs • Support groups • Become part of the PNES community(raise awareness, funds, walks, meetings) • Take care of yourself: • Therapy • Exercise • Sleep • Diet

18. PNES and wellness • Taking care of yourself • Exercise • Sleep • Diet

19. PNES and exercise • Get medical clearance from doctor before starting a new exercise regimen • Choose exercise that is safe given the characteristics of your episodes • Choose exercise at your fitness level • Implement safety guidelines (automatic stop cord, buddy system)

20. Safe exercise

21. Potentially Dangerous

22. Pnes and exercise • WHY exercise? • Improves physical health, stamina, balance, lowers body fat, etc. • Reduces anxiety, depression, tension, fatigue • Burns stress hormones and encourages production of endorphins - “well being hormones” • Sense of accomplishment

23. Types of exercise to consider • Brisk walking • Moderate jogging • Cycling on stationary bike • Core muscle building • Tai chi • Yoga • Zumba • Gardening • Martial arts

24. PNES and sleep • Poor sleep   depression and anxiety • Poor sleep: • Poor concentration • Irritability • Increased risk of accidents • Weak immune system • Weight gain • Premature aging • Cardiac problems • Dependence on caffeine and sleep aids

25. PNES and sleep • Do’s • Figure out how many hours you need • Try to go to bed and wake at the same time • Keep room dark and cool (65-72 F degrees) • Make sure mattress and pillows are comfortable • Use bed only for sex and sleep

26. Pnes and sleep • Don’t • Eat heavy meals or drink a lot of fluids right before sleep • Use alcohol to induce sleep • Drink caffeine in the evening • Take naps if possible • If you can’t sleep, don’t stay in bed more than 30 minutes

27. Goal: Peaceful sleep

28. PNES and Diet • High quality fuel helps your mind and body run better. • Check with your doctor and/or nutritionist. • Do: • Eat a balanced diet: fresh vegetables, fruits, lean protein • 5-6 meals a day-breakfast is important • Eat as soon as you feel hungry or have signs of low blood sugar • Keep yourself hydrated (water is best)

29. PNES and diet • Avoid: • Foods high in sugar or refined carbohydrates (cakes, cookies, white bread) • Fasting, skipping meals, or following extreme restrictive diets • Caffeine as much as possible • Alcohol as much as possible • Rushing while eating

30. Healthy diet

31. Take home message • QOL in PNES is definitely affected but you can improve your QOL in a number of ways • 1) Participating in psychological treatment regularly and actively • 2) Taking care of yourself • Exercise • Sleep • Diet

32. Take home message • 3) Avoiding social isolation: • Use community resources • Use hospital and doctor’s office wellness programs • Support groups • Become part of the PNES community (raising awareness, funds, walks, meetings) • Use social media and the internet • Facebook: Psychological non epileptic seizures

33. Take home message 4) Owningthe condition of PNES. • It is very important that you educate yourself and others about PNES. Knowledge is Power. • Psychogenic Non-epileptic Seizures: A Guide available on Amazon Chapters 8 and 9 • 5) Continue working toward a positive future: • www.epilepsyfree.comfor continuing education scholarships and funds for educational programs

34. our community activities: DC walk

35. our community activities: DC walk

36. our community activities: knitting workshop

37. Our community: annual PNES conference

38. Thank you! • Let’s stay in touch • lmyers@epilepsygroup.com