Epilepsy and behavior: a brief history

Perceived causes and management of epilepsy among rural community dwellers in Ghana: a qualitative synthesis

Background

In Ghana, over 270,000 people live with epilepsy, of which 70% do not receive treatment. Despite the high number of people with the condition, misconceptions exist about its causes and management in African regions. The study assessed the perceived causes and management of epilepsy among rural community dwellers in Ghana.

Methods

A qualitative approach and phenomenological design were employed for the study. The population comprised community dwellers in Berekum, a rural town in the Bono Region of Ghana. A convenience sampling technique was used to sample the participants. An in-depth face-to-face interview with a semi-structured interview guide was used to collect participant data. Data were analyzed using inductive thematic analysis.

Result

A total of 15 participants were interviewed in the study, after which saturation was reached. Seven of the participants were men, and eight were women. Two categories emerged as the causes of epilepsy: socio-cultural and superstitious causes and biomedical causes. The socio-cultural and superstitious causes include "a manifestation or an influence of an evil spirit," "family curse or disease," "punishment from ancestors or gods of the land," "having several convulsions," "exposure to foam from an epileptic," and "bites from an epileptic during seizures", while the biomedical causes are "brain damage," "blood group," and "genetic makeup". Consulting with the spiritual realm, pouring water on the person or washing the person's face, and putting a spoon in the mouth were identified by the participants as ways to manage epilepsy.

Conclusion

The causes of epilepsy are primarily linked to the supernatural, with the results indicating that rural community residents largely attribute epilepsy to "evil spirits". This implies that the rural communities' knowledge about the causes of epilepsy is based on the social causation theory of disease and disability, which relates diseases to the supernatural. Management of the condition was mainly seen as spiritual.

Exploring behavioral systems of the reinforcement sensitivity theory in people with epilepsy: A cross-sectional study

OBJECTIVES

Although epilepsy has previously been associated with behavioral changes, no previous study has utilized the behavioral models of the reinforcement sensitivity theory (RST) to investigate the impact of epilepsy on behavior. Therefore, the objective of this cross-sectional study is to examine the potential relationship between epilepsy and the neurobehavioral systems of the RST.

METHODS

Using the Reinforcement Sensitivity Theory-Personality Questionnaire (RST-PQ), this cross-sectional study assessed the behavioral systems of the RST in a sample of 27 epilepsy patients and 27 age- and gender-matched healthy individuals. The RST-PQ was designed to assess the different behavioral systems of the RST. The behavioral approach system (BAS) is responsible of the approach behavior, in high values related to risk seeking and addictive behavior and in low values well related to depression. The behavioral inhibition system (BIS) is well related to anxiety in high levels, and the fight flight freeze system (FFFS) is responsible for the avoidance behavior.

RESULTS

After adjusting for age, no significant differences were found in demographic information (gender and marital status) between the general population and epilepsy patients. Gender distribution was similar, with 55.6% females in both groups. Marital status also showed no significant difference, with 74% single in the control group and 63% in the epilepsy group. Significant differences were observed in the behavioral systems of the RST. The epilepsy group had higher scores compared with the control group in several areas. BAS reward activity had a median score of 23 in the epilepsy group and 21 in the control group (p = 0.001). BAS goal drive persistence (p = 0.04), BAS impulsivity (p = 0.014), FFFS (p = 0.002), and BIS (median score of 77 in the epilepsy group and 66 in the control group) also showed significant differences, with p = 0.001. These significant differences remained consistent before and after matching the control group, indicating their robustness. The only exception was BAS reward activity, which did not show a significant difference after matching, with p = 0.106 and p = 0.051 before and after matching, respectively.

CONCLUSIONS

The study suggests a potential positive association between epilepsy and the BIS, potentially mediated by the hippocampus. The relationship between epilepsy and the BAS, as well as the FFFS, may also be influenced by the BIS. These findings have clinical implications, but further research is needed to confirm these relationships.

The Neuropsychiatric Approach to the Assessment of Patients in Neurology

Neuropsychiatry is a clinical neuroscience specialty focused on the evaluation and treatment of patients who present with symptoms at the intersection of neurology and psychiatry. Neuropsychiatrists assess and manage the cognitive, affective, behavioral, and perceptual manifestations of disorders of the central nervous system. Although fellowship training in behavioral neurology-neuropsychiatry exists in the United States and several other countries internationally, the need for neuropsychiatric expertise greatly outweighs the number of specialists in practice or training. This article serves as a primer for both neurologists and psychiatrists seeking to improve or refresh their knowledge of the neuropsychiatric assessment, including detailing aspects of the history-taking, physical exam, psychometric testing, and associated diagnostic work-up. In doing so, we urge the next generation of neurologists and psychiatrists to take on both the opportunity and challenge to work at the intersection of both clinical neuroscience specialties using an integrated neuropsychiatric perspective.

Epilepsy - from mysticism to science

The understanding of epilepsy has been in progressive evolution since Antiquity, with scientific advances culminating in the last few decades. Throughout history, epilepsy was plagued by mystical misconceptions involving either demonic possessions, witchcraft, or divine interventions. This has frequently altered or even halted any real progress in its scientific understanding or its social perception. This metaphysical context is also at the core of the stigma revolving around this condition, some of which still lingering today. This review explores the origins of these mystical beliefs, and describes the chronological evolution of epilepsy from mysticism to science across different civilizations and eras.

Behavioral implications of temporal lobe epilepsy on social contingency

OBJECTIVE

Temporal lobe epilepsy (TLE) is a chronic condition classically characterized by recurrent unprovoked episodes of involuntary violent motion and behavior whose degree and nature often overshadow the more subtle interictal neuropsychiatric symptoms. The purpose of this research was to investigate further the nature of cognitive impairment seen in social interaction within the population with TLE.

METHODS

We recorded the dynamics of real-time sensorimotor interaction in 10 pairs of control participants and ten pairs of participants with drug-resistantTLE using a minimalistic human-computer interface paradigm known as "perceptual crossing." We investigated whether TLE is associated with impaired detection of social contingency, i.e.,reduced sensitivity to their teammate's responsiveness to their behavior.

RESULTS

Our analysis reveals that using a simplified, computer-mediated, embodied form of social interaction, people with TLE demonstrated a statistically significant decrease in identification accuracy ratio (p-value is 0.00084,p < 0.05), a decrease in turn-taking (p-value is 0.03216,p < 0.05), decrease in player-object discrimination specificity (p-value is 0.00695,p < 0.05), and a decrease time spend in contact both in absolute terms (p-value is 0.00181, p < 0.05) and as a percentage of time after first contact (p-value is 0.0268, p < 0.05) when compared with age-gender-matched controls.

DISCUSSION

We found that coregulated interactions differed significantly between subjects with drug-resistantTLE and age-gender-matched controls consistent with prior meta-analysis observations regarding social cognition impairment in TLE. This is the first study to demonstrate social contingency impairment through dyadic interaction in the population with TLE.

The intersections of stress, anxiety and epilepsy

Stress is ubiquitous in chronic medical conditions; however, the connections to psychiatric and neurologic conditions are not always clearly established. Epilepsy is a unique illness that is intimately intertwined with stress and anxiety not only as a result of the disease process but also as a cause of disease exacerbation. Anxiety and depression also involve stress management and often overlap with epilepsy. Anxiety symptoms themselves may be present as intrinsic aspects of seizure phenomena, either during the events or closely related to them. The pathways of stress and anxiety involve the hypothalamic pituitary adrenal (HPA) axis and explain at least in part how stress may lead to worsening seizure control. Ultimately, the study of stress, anxiety, and epilepsy offers insight into mind and body connections, and furthers understanding of neuropsychiatric illness.

Psychiatric Comorbidity in Children with Epilepsy: A Cross-sectional 5 Years Rural Prevalence Study

Background:

Epilepsy is one of the most common chronic neurological disorders. In children, it has long debilitating course and is associated with comorbidities including psychiatric comorbidity. To tackle this burden of comorbidities, we must know the extent of problem. Hence, there is a need for estimation of prevalence of psychiatry disorder in children with epilepsy.

Aim:

The present study was aimed at measuring the prevalence of various psychiatry disorders among children suffering from epilepsy.

Settings and Design:

Cross-sectional chart review.

Methodology:

We reviewed case record files of all patients with a diagnosis of epilepsy in the age group of 9–17 years. Chart review was done for 5 years, May 1, 2007, to April 30, 2012. A total of 718 patients record were included in the study after satisfying inclusion criteria and excluding nonepilepsy diagnosis.

Statistical Analysis:

Statistics was done using Statistical Package for Social Sciences (SPSS 18.0). Descriptive statistics were used to calculate the result, Chi-square and Mann–Whitney U-test used wherever applicable.

Results:

The prevalence of childhood psychiatric disorder among children with epilepsy found to be 31.2%. We also found that having a partial component (73.21%, n = 164) in seizure has more chances of psychopathology in comparison to generalized seizure (8.1%, n = 18). Among them, those having a partial component with generalization (66.96%, n = 150) had a greater prevalence of psychopathology. Mental retardation was most common psychiatric disorder among psychopathology followed by manic/depressive illness (unipolar) followed by unspecified nonorganic psychosis.

Conclusion:

From our study, we demonstrate the significant mental health needs of children with epilepsy. The evident high prevalence of psychiatry disorder emphasizes the need for psychopathology assessment and treatment as a part of any comprehensive epilepsy clinic.

Knowledge about epilepsy in university health students: A multicenter study

Even with economic development and improvements in health care around the world, it is estimated that nowadays, 50 million people have epilepsy. It is one of the most prevalent neurological diseases, yet it is still surrounded by prejudice, stigma, lack of awareness, and wrong attitudes of the population towards the disease. The aim of this study was to evaluate and compare the knowledge about epilepsy in health students from different countries: Brazil, Argentina, Portugal, United States, and South Africa. Students were asked to complete a survey regarding knowledge about epilepsy (the Epilepsy Knowledge Questionnaire). One hundred and two students participated, 62.2% of them were female. Portuguese students had significantly higher values than the American ones (p=0.025). Regarding the medical aspects, on average, students hit 63.8% of the questions, and the students from Portugal had significantly higher average than the ones from the United States (p=0.0007). Statements with lower percent of correct answers were about pathophysiology, medication, and treatment of the disease. There were no differences between the scores obtained by the students of each country in the social aspects of the disease. Statements with higher percent of mistakes were about sports practice, labor, proceedings in case of convulsion, and ability to drive vehicles. General knowledge of senior health students about epilepsy was considered low, however, regarding the medical aspects of the disease, students from Brazil and Portugal exhibited a slightly superior knowledge. Changing the way of seeing and treating people with epilepsy brings, as a consequence, increased opportunities for these people in different sectors of society.

Aliocha Dostoevski’s death during an epileptic seizure

ABSTRACT Mortality due to epilepsy is of great concern worldwide. Individuals with epilepsy have a two- or three-fold risk of death when compared to the general population. Based on biographical data and Anna Grigoriévna Dostoevskaia’s memories, the authors concluded that a prolonged episode of status epilepticus was the culprit in the death of young Aliocha, youngest son of Fyodor Mikhailovich and Anna Dostoevski. At the time of Aliocha’s death, very limited knowledge about epilepsy or therapeutic resources was available. Despite all the progress, epilepsies remain potentially fatal conditions. The suffering generated by Aliocha’s death and other similar cases remains as a challenge for epileptologists who assemble efforts to fight against such conditions.

Development of the Adult Epilepsy Self-Management Measurement Instrument (AESMMI)

Epilepsy self-management is the total sum of steps that people perform to maximize seizure control, to minimize the impact of having a seizure disorder, and to maximize quality of life. As part of a phased approach to instrument development, we conducted descriptive analyses of data from epilepsy self-management items covering 10 domains of self-management gathered from 422 adults with epilepsy from multiple study sites. Participants most frequently reported performing sets of behaviors related to managing treatment and stigma, information seeking, managing symptoms, and communicating with providers. Behaviors reported with lower frequency were related to seeking social support and engaging in wellness behaviors. Significant differences for the domains were found for income, gender, and education levels but not for other different demographic variables. A subsequent analytic phase, reported in a companion article, will use factor analysis to identify and validate the subscale structure of the domains.

The effects of diagnostic group and gender on challenging behaviors in infants and toddlers with cerebral palsy, Down syndrome or seizures

Challenging behaviors are frequently studied in individuals with various developmental disabilities, although specific conditions are rarely compared to one another. Such data would be informative to clinicians who assess and develop treatment plans for children with these disabilities. For that reason, the current study's aim was to analyze problem behavior deficits in infants and toddlers diagnosed with cerebral palsy (CP), Down syndrome (DS), and a history of seizures/seizure disorder. Seventy six children participated in this study and were administered the Baby and Infant Screen for Children with aUtIsm Traits-Part 2 (BISCUIT-Part 2). Inspection of the Tantrum/Conduct Behavior subscale of this measure revealed that children with a history of seizures/seizure disorder exhibited significantly higher scores, indicating greater impairment, than those with CP or DS. Children with DS and those diagnosed with CP did not significantly differ from one another. Additionally, there was no significant main effect by gender. The CP and DS groups also had fewer endorsements on all 18 items of the subscale as compared to the seizures group. Implications of these results are discussed.

Epilepsy and law

Epilepsy can define who one is rather than the diagnosis one has. It may be considered under the rubric of disability with legislative protection against discrimination. Those seeking remedy should investigate alternative dispute resolution in preference to litigation. Many areas of the life of a person with epilepsy deserve examination when considering epilepsy and law. Just some of these include: duty of care; informed consent; driving; research; social interactions; insurance; recreational pursuits; employment; and privacy. This article examines the legal implications and ramifications of these selected topics, acknowledging that the limited scope of the article has only exposed the tip of the iceberg to encourage further exploration.

História da epilepsia: um ponto de vista epistemológico

INTRODUÇÃO: A história da epilepsia estuda a evolução do conhecimento médico com as suas contradições e incrementos aqui abordados eurocentristicamente. A literatura relacionada é rica e extensa. METODOLOGIA: Revisão narrativa baseada em fatos históricos sobre epilepsia em perspectiva epistemológica. OBJETIVOS: Apresentar uma breve resenha da evolução do conhecimento e de fatos no decorrer de quase 2300 anos desde Hipócrates até meados do século XIX, na virada para a epileptologia moderna que tem como símbolo, John Hughlings Jackson (1834-1911). Mencionar, da era pré-moderna, as hipóteses sobre a origem das crises epilépticas (CE) no organismo humano e suas causas e os conseqüentes procedimentos terapêuticos. Arrolar, dos anos subseqüentes ao mestre inglês, aspectos fundamentais da epileptologia moderna através dos seus Centros precursores, personalidades e fatos mais marcantes: terapia medicamentosa e cirúrgica, diagnóstico neurofisiológico e o retorno à abordagem integrada biopsicossocial patrocinada pela Campanha Global Contra Epilepsia, Saindo das sombras. Considerar: personalidades com/ou apenas hipoteticamente com epilepsia; literatura feita por escritores com epilepsia ou expectadores das CE de pessoas com epilepsia ou conhecedores de relatos secundários delas; livros médicos e periódicos precursores sobre epilepsia. CONCLUSÃO: A história da epilepsia consegue fazer uma resenha da evolução do conhecimento médico o que pode ser feito for fatos científicos e suas interfaces socioculturais. Ela demonstra, por exemplo, a importância histórica do método dedutivo-hipotético na elucidação da fisiopatogenia da epilepsia, magistralmente feita por John Hughlings Jackson, ao lado do mais usualmente usado nas Ciências, o indutivo.

Behaviour problems in children and adolescents with seizure disorder: associations and risk factors

PROBLEM

Fifty million people worldwide have epilepsy of whom 33 million are children. Children and adolescents with epilepsy are known to have high rates of behaviour problems and psychiatric co-morbidity. No studies on this topic have been conducted in developing countries, although 90% of such children live in the developing world.

METHODS

The current study, set in Vellore in India, assessed the prevalence of psychopathology and its associations in children and adolescents with seizure disorder. One hundred and thirty two children were rated for psychopathology on the Child Behaviours Check List, and those who qualified as psychiatric cases were compared with those who did not.

RESULTS

Seizure disorder was associated with significant psychopathology in 53.8% children. Belonging to a higher income group and living in an urban area (OR: 7.61, 95% CI: 2.78-20.8, p=0.0001), having longer than 3 years of illness (OR: 2.39, 95% CI: 2.18-5.67, p=0.03) and being treated by more than one anti-epileptic drug (OR: 3.08, 95% CI: 1.09-8.72, p=0.03) independently predicted psychopathology.

CONCLUSIONS

Psychopathology reflected a complex interaction of seizures, socio-demographic factors and treatment related variables, in accord with studies in industrialised countries. Clinicians should be sensitive to identifying psychopathology since this may lead to effective interventions for this group of children.