**2. Challenges faced by PLWE**

To improve the everyday living of PLWE and enhance their quality of life, it is important to ask the questions: "what is the impact of epilepsy?" and "How is it like LWE?". By answering these questions, we can begin to understand the challenges PLWE has and ultimately achieve the goal. This section will highlight the challenges experienced by PLWE, the physical, psychosocial, economic, and existential challenges.

#### **2.1 Physical challenges**

In the occurrences of seizures, more often than not, patients experience uncontrolled physical challenges, e.g. urinal excretion. Some patients sustain physical injuries in the least end; they are nonfatal; however, in the end, death may result. A study done evaluating injuries among PLWE found that 85.5% have sustained an injury during a seizure [19]. On the other hand, Bifftu et al. [20] reported 27.8% of physical injuries. Some of these injuries include as follows:


Some physical challenges result from seizure aftermath and may only apply to PLWE who experience generalized or focal motor seizures. Regardless of the type of epilepsy, physical challenges (living with injuries and those that are a direct result of seizure occurrence) can negatively impact the quality of life. An epileptic experiencing mood and behavioral side effects are just as challenged as a person with a visible injury, e.g. a person with a burn or dental injury may encounter frequent stares that leave them feeling embarrassed. In essence, many physical challenges experienced are much connected with psychosocial challenges.

#### **2.2 Psychosocial challenges**

Generally, psychosocial challenges vary across ages [27–29]. PLWE are often stigmatized, prejudiced, and segregated because they are LWE. PLWE are also often excluded from educational opportunities [30]. These challenges often result in comorbidities such as depressive disorders, anxiety disorders, and stress disorders. In addition to these issues, PLWE have suicidal thoughts, they fear being alone, fear being in social spaces, suffer continuous embarrassment, and lose relationships due to this disease, and this often leads to isolation [28–32]. In most cases, epilepsy's psychosocial consequences are not directly caused by the disorder; instead, they result from external factors such as behaviors and attitudes about epilepsy and PLWE.

#### **2.3 Economic challenges**

Epilepsy poses financial challenges for PLWE as well as their caregivers/families. The WHO [30] shows that "out-of-pocket costs" become burdensome. These costs are used to purchase treatment, travel to health care facilities, and pay for therapies. In some instances, young people drop out of school (and essentially become unemployed) due to the disease burden. In one study, experiences of epileptic seizures at a workplace resulted in resignation from their work [33]. Consequently, on a personal and household level, PLWE experience or contribute to a financial burden.

#### **2.4 Treatment challenges**

This challenge contributes to physical, lifestyle/social, and economic challenges. Patients on anti-epileptic drugs (AEDs) may experience tiredness, dizziness, headaches, memory loss, and issues with attention [25, 32]. Social side effects of treatment may include altering eating schedules and what they eat and monetary challenges because of treatment costs. In their findings, Fazekas et al. [34] report that epilepsy treatment side effects are often unbearable to PLWE. In addition to the hostile experience of treatment, about 7–20% of children and 30–40% of adults living with epilepsy are said to be drug-resistant [35]. In addition, convenience, drug side effects,

*Perspective Chapter: Practical Approaches to Enhance Successful Lives among People Living… DOI: http://dx.doi.org/10.5772/intechopen.106649*

and unavailability of treatment result in the growing dependence on traditional treatment from traditional healers of epilepsy [36].

Treatment challenges are often experienced in low-middle-income countries where we find low-quality health facilities, access to health care services, short medicine supply, and cost of purchased medication. According to WHO [30], about three-quarters of PLWE may not receive proper medication, and there is a treatment gap within the low-middle-income countries. It is reported that less than 50% of PLWE have access to anti-epileptic medication.

Epilepsy is a disease that may be cured. However, in most instances, it can only be managed. In this regard, it is possible that PLWE may experience lifelong challenges if there is no intentional intervention to mitigate the effects of the factors deemed to be challenging and meet their needs.
