TABLE 1.

Injury Risks that Warrant Discussion and Counseling

Activity	Risk	Potential Amelioration
Driving any vehicle, including bicycle or tractor	Injury to person with epilepsy as well as to others	Avoid driving until seizure free; use helmet with bicycling and no passengers*
Carrying infant on back	May result in infant injury or even death if mother has generalized tonic–clonic seizure	Provide counseling on safer methods of transporting child; older sibling may be able to assist. Key is to assure mother that this activity can be relinquished without loss of her role and that the activity may be resumed when seizures come under better control.
Cooking/exposure to open flames	Burns	Another family member may need to take on the cooking responsibilities. It is important to try to identify roles the person with epilepsy can accept in return, if at all possible, to avoid loss of role fulfillment.
Swimming, bathing, boating, fishing, collecting water from rivers/streams	Drowning, crocodile attacks	No exposure to bodies of water when alone; accompanying person must be willing to assist, if needed.†
Travel into bush/wilderness/waterside	Animal attacks, generally getting lost	Avoid these activities when alone; accompanying person must be willing to assist, if needed.†,‡
Pedestrian injury on roadway	Road traffic accidents	Avoid walking on busy roadsides, especially if alone.
Roof thatching or otherwise working from high areas (e.g., agricultural and construction employment)	Falls	Counsel to seeking alternative activities.§

^*It is important that health care providers for people with epilepsy familiarize themselves with the local legislation regarding driving laws.

^†Note that contagion fears are substantial enough that an accompanying person willing to assist if the person has a seizure may need to be explicitly sought. Contagion fears are substantive enough in some environments to result in drowning, severe burns, and/or death while fearful relatives and friends only watch, being too afraid to assist.

^‡For people with epilepsy who have spells of “wandering,” special measures (e.g., placement in an enclosed dwelling) may be warranted. Family should be explicitly asked if they use other restraint measures (e.g., ropes, chains, etc.), as restraint of patients who are in a supine position could prove fatal, and the use of restraints undoubtedly contributes to the demoralization of people with epilepsy.

^§In some cultures, duties such as annual thatching represent an important aspect of manhood.