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Makhado L, Maphula A, Ngomba RT, Musekwa OP, Makhado TG, Nemathaga M, Rammela M, Munyadziwa M, Striano P. Epilepsy in rural South Africa: Patient experiences and healthcare challenges. Epilepsia Open 2024; 9:1565-1574. [PMID: 38884148 PMCID: PMC11296125 DOI: 10.1002/epi4.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/29/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024] Open
Abstract
OBJECTIVE This study investigates the prevalent issues of healthcare access and the impact of antiseizure treatments among people with epilepsy (PWE) in rural Limpopo and Mpumalanga, South Africa, where healthcare facilities and affordable treatments are often inadequate. METHODS Using a cross-sectional survey, 162 PWE were selected using multistage sampling across the provinces. Data were collected via a structured questionnaire and analyzed descriptively using SPSS v27. RESULTS Most of the participants experienced seizures intermittently, with 70.6% in Limpopo and 53.3% in Mpumalanga reporting occasional episodes, whereas a significant minority in both regions-20.6% and 40%, respectively-suffered from frequent seizures. A notable portion of PWE also reported recurring side effects from antiseizure drugs, which led to consequential life disruptions, including educational dropout and unemployment. SIGNIFICANCE The findings underscore an urgent need for enhanced educational programs and increased awareness to improve the understanding and management of epilepsy in these underserved areas. Optimizing care for PWE requires a multifaceted approach, including evaluating healthcare accessibility, affordability, and societal beliefs influencing treatment adherence. The study advocates for government and policy interventions to mitigate the quality of life deterioration caused by epilepsy and its treatment in rural communities. PLAIN LANGUAGE SUMMARY In Limpopo and Mpumalanga, many individuals with epilepsy experience seizures occasionally, while a significant minority have them frequently. Numerous people also suffer recurring side effects from antiseizure medications, impacting their lives severely by causing school dropouts and job losses. This underscores the urgent need for improved education and awareness programs to manage epilepsy in these provinces effectively. The study urges government action and policy reforms to enhance care and support for people with epilepsy in rural areas, aiming to improve their quality of life.
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Affiliation(s)
- Lufuno Makhado
- Department of Public Health, Faculty of Health SciencesUniversity of VendaThohoyandouLimpopo ProvinceSouth Africa
| | - Angelina Maphula
- Department of Psychology, Faculty of Health SciencesUniversity of VendaThohoyandouLimpopo ProvinceSouth Africa
| | - Richard Teke Ngomba
- School of PharmacyUniversity of Lincoln, Joseph Banks LaboratoriesLincolnshireUK
| | - Ofhani Prudance Musekwa
- Department of Psychology, Faculty of HumanitiesUniversity of JohannesburgJohannesburgSouth Africa
| | - Thendo Gertie Makhado
- Department of Advanced Nursing Sciences, Faculty of Health SciencesUniversity of VendaThohoyandouLimpopo ProvinceSouth Africa
| | - Muofheni Nemathaga
- Department of Advanced Nursing Sciences, Faculty of Health SciencesUniversity of VendaThohoyandouLimpopo ProvinceSouth Africa
| | - Mukovhe Rammela
- Department of Public Health, Faculty of Health SciencesUniversity of VendaThohoyandouLimpopo ProvinceSouth Africa
| | - Muimeleli Munyadziwa
- Department of Public Health, Faculty of Health SciencesUniversity of VendaThohoyandouLimpopo ProvinceSouth Africa
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto Giannina GasliniGenoaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenovaGenoaItaly
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Kaddu Mukasa M, Akpalu A, Ejilemele A, Ogunrin OA. Editorial: Epilepsy research in the developing countries: the neuro-ethical issues, cross-cultural differences, and relevance to comprehensive management. Front Neurol 2024; 15:1429745. [PMID: 38846041 PMCID: PMC11153827 DOI: 10.3389/fneur.2024.1429745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024] Open
Affiliation(s)
- Mark Kaddu Mukasa
- Neurology Unit, Department of Medicine, Makerere University, Kampala, Uganda
| | - Albert Akpalu
- Neurology Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Adetoun Ejilemele
- Department of Pathology and Immunology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, United States
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Tokuç FEU, Genç F, Göksu EÖ, Erdal A, Gömceli YB. Marriage and childbearing in patients with epilepsy in Turkey. Front Neurol 2024; 15:1304076. [PMID: 38585357 PMCID: PMC10996395 DOI: 10.3389/fneur.2024.1304076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/23/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction For epilepsy, a common neurological disorder, brings psychosocial challenges like stigma, employment difficulties, and barriers to marriage and childbearing. Stigma often stems from misconceptions and societal beliefs, particularly in less developed regions like Turkey. However, research on the marital and childbearing experiences of epilepsy patients in such settings is limited. We aimed to research the marriage and childbearing behaviors of men and women with epilepsy. Methods We conducted a cross-sectional study involving 215 adult epilepsy patients at Antalya Training and Research Hospital between 2019 and 2022. Patients were asked questions about marriage and having children on prepared questionnaires. Result The gender distribution of the 215 patients included in the study was revealed to be 62.3% (134) females and 37.7% (81) males. 71.6% of patients were married, and 12.7% had no children. 33.3% of these patients stated that they did not desire children because of the disease. A statistically significant correlation was observed between the duration of the disease and being unmarried. A significant correlation was observed between age at disease onset and number of children. Conclusion Our study revealed the effects of individuals with epilepsy on marriage and childbearing, and as we know, it is the first study conducted in Turkey on childbearing attitudes in individuals with epilepsy. Despite medical and social developments, epilepsy is still one of the most stigmatized diseases, and the disease has considerable negative effects on marriage and fertility. Our study supported the findings of a small number of previous similar studies on this subject and additionally showed that the likelihood of having children decreased in patients using multiple ASM, and on the other hand, it showed that marriage positively affected patients in terms of social support.
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Affiliation(s)
| | - Fatma Genç
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Eylem Özaydın Göksu
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Abidin Erdal
- Department of Neurology, Health Ministry of Türkiye Republic, Ankara Bilkent City Hospital, Ankara, Türkiye
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Roussos S, Gerogianni G, Vasilopoulos G, Koutelekos I, Pavlatou N, Kalogianni A, Toulia G, Zartaloudi A, Polikandrioti M. Factors Associated With Anxiety and Depression in Persons With Epilepsy (PWE). Cureus 2024; 16:e56401. [PMID: 38633953 PMCID: PMC11023706 DOI: 10.7759/cureus.56401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Epilepsy is a common neurological disease that is associated with increased morbidity and mortality globally. Persons with epilepsy (PWE) experience a heavy emotional burden mainly due to social stigmatization and limited opportunities in life. The purpose of this study was to explore factors associated with anxiety and depression in PWE. MATERIAL AND METHODS In the present cross-sectional study, we enrolled 100 PWE who visited outpatient settings in a public hospital for scheduled follow-up. Data collection was carried out by the completion of the Hospital Anxiety and Depression Scale (HADS), which included participants' characteristics. The statistical significance level was p < 0.05. RESULTS Of the 100 participants, the majority were women (65%), below 50 years old (62%), and single (40%). In terms of mental comorbidity, 58% and 48% experienced anxiety and depression, respectively. A statistically significant association was observed between anxiety and age (p = 0.002). Furthermore, a statistically significant association was observed between depression and gender (p = 0.044), age (p = 0.001), marital status (p = 0.036), educational level (p = 0.003), job (p = 0.025), residency (p = 0.041), and whether they went out at night (p = 0.009). CONCLUSION Identifying factors associated with anxiety and depression is essential for PWE to receive appropriate support.
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Affiliation(s)
- Spyridon Roussos
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
| | | | - Georgios Vasilopoulos
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
| | | | - Niki Pavlatou
- Department of Nursing, University of West Attica, Athens, GRC
| | | | - Georgia Toulia
- Department of Nursing, University of West Attica, Athens, GRC
| | | | - Maria Polikandrioti
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
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Ouchida S, Nikpour A, Zhang X, Faulkner H, Senturias M, Reid N, Stephens E, Fairbrother G. The long-term outcomes of patients with negative prolonged ambulatory electroencephalography tests: A cross-sectional follow-up study. HEALTH OPEN RESEARCH 2023; 5:26. [PMID: 38708033 PMCID: PMC11065127 DOI: 10.12688/healthopenres.13351.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 05/07/2024]
Abstract
Background Ambulatory electroencephalography (AEEG) recording is an essential aid for detecting interictal discharges and providing a clinical diagnosis. This study aimed to describe long-term outcomes among a cohort of patients who yielded negative results on AEEG at the time of assessment and identify factors associated with contemporary quality of life (QOL) and ultimate epilepsy diagnosis. Methods This cross-sectional telephone follow-up study was conducted in June-November 2021 at the Neurology Department in a metropolitan hospital in Sydney, Australia. Results In total, 47 of 105 eligible (45%) participants were enrolled. Overall, 21 (45%) participants had been diagnosed with epilepsy at a 12-year follow-up. Taking anti-seizure medication, having experienced a seizure event, and having marriage and education-related characteristics were associated with an epilepsy diagnosis. QOL was found to be associated with age, employment status and history of experience of a seizure event. QOL and an epilepsy diagnosis were not shown to be statistically related. Conclusions Nearly half of the participants had received an epilepsy diagnosis at long-term follow-up, despite having tested negative on AEEG at the time of assessment. Prolonged AEEG testing is an important tool to aid the diagnostic process. However, clinical examination, including accurate history taking, is vital in establishing an epilepsy diagnosis.
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Affiliation(s)
- Sumika Ouchida
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050, Australia
| | - Armin Nikpour
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2050, Australia
| | - Xin Zhang
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050, Australia
| | - Howard Faulkner
- Department of Neurology, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Maricar Senturias
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050, Australia
| | - Nicole Reid
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050, Australia
| | - Eleanor Stephens
- Department of Neurology, Westmead Hospital, Westmead, New South Wales, 2145, Australia
| | - Greg Fairbrother
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 2050, Australia
- Sydney Reseach, Sydney Local Health District, Camperdown, New South Wales, 2050, Australia
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Gillespie DC, Flewitt BI, Sacripante R, Burns V, Young L, Chin RF, Duncan SE. Questionnaire-based screening for mental distress in epilepsy: Outline and feasibility of an outpatient screening and intervention pathway. Epilepsy Behav 2023; 142:109085. [PMID: 36801165 DOI: 10.1016/j.yebeh.2023.109085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/19/2022] [Accepted: 01/01/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Mental distress is present in a significant proportion of people with epilepsy (PWE), with a negative impact across life domains. It is underdiagnosed and under-treated despite guidelines recommending screening for its presence (e.g., SIGN, 2015). We describe a tertiary-care epilepsy mental distress screening and treatment pathway, with a preliminary investigation of its feasibility. METHODS We selected psychometric screening instruments for depression, anxiety, quality of life (QOL), and suicidality, establishing treatment options matched to instrument scores on the Patient Health Questionnaire 9 (PHQ-9), along 'traffic light' lines. We determined feasibility outcomes including recruitment and retention rates, resources required to run the pathway, and level of psychological need. We undertook a preliminary investigation of change in distress scores over a 9-month interval and determined PWE engagement and the perceived usefulness of pathway treatment options. RESULTS Two-thirds of eligible PWE were included in the pathway with an 88% retention rate. At the initial screen, 45.8% of PWE required either an 'Amber-2' intervention (for moderate distress) or a 'Red' one (for severe distress). The equivalent figure at the 9-month re-screen was 36.8%, reflective of an improvement in depression and QOL scores. Online charity-delivered well-being sessions and neuropsychology were rated highly for engagement and perceived usefulness, but computerized cognitive behavioral therapy was not. The resources required to run the pathway were modest. CONCLUSION Outpatient mental distress screening and intervention are feasible in PWE. The challenge is to optimize methods for screening in busy clinics and to determine the best (and most acceptable) interventions for screening positive PWE.
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Affiliation(s)
- David C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Bethany Iona Flewitt
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, UK
| | - Riccardo Sacripante
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, UK; Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | | | | | - Richard F Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Royal Hospital for Children and Young People, Edinburgh, UK
| | - Susan E Duncan
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Budikayanti A, Primardi A, Indrawati LA, Hamid D, Indriyani J, Rahmi I, Andre, Supriyatna A, Hamdani IA, Listyaningrum D, Fakhrunnisa F, Wiratman W, Octaviana F. The stigma paradox: Perception of quality-of-life in people with epilepsy among themselves, the family, and the general population in Indonesian urban areas. Epilepsy Res 2022; 183:106938. [DOI: 10.1016/j.eplepsyres.2022.106938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022]
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Puteikis K, Mameniškienė R. Psychometric properties of the Lithuanian version of the patient-weighted inventory on quality of life in epilepsy. Epilepsy Behav 2022; 130:108648. [PMID: 35364472 DOI: 10.1016/j.yebeh.2022.108648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/29/2022] [Accepted: 02/24/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND We aimed (1) to confirm that the Lithuanian version of the patient-weighted 31-item Quality of Life in Epilepsy Inventory (QOLIE-31-P) is a valid and reliable tool to be used among patients with epilepsy (PWE) in Lithuania and (2) to determine how the quality of life (QoL) is associated with demographic and clinical variables, adverse effects of antiseizure medication as well symptoms of depression and anxiety in this population. METHODS We used a translated and adapted Lithuanian version of the patient-weighted 31-item Quality of Life in Epilepsy Inventory (QOLIE-31-P) and conducted a cross-sectional anonymous survey among 303 adult PWE at a tertiary epilepsy center at Vilnius University Hospital Santaros Klinikos. The questionnaire also included the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Generalized anxiety disorder scale-7 (GAD-7), and the Liverpool Adverse Events Profile scale (LAEP). Missing values were replaced after performing multiple imputation (MI). RESULTS QOLIE-31-P had high internal consistency (Cronbach's α = 0.933 for all items and α = 0.676 to 0.906 for individual subscales). Its factor structure (71.2% of variance explained) consisted of seven factors, some of which overlapped ("Emotional Well-Being" and "Overall QoL") or were split ("Social Function") in comparison to the pre-defined content of the subscales. Multitrait-scaling revealed that each item is better correlated with the subscale it is included in than other subscales, suggesting good convergent and discriminant validity. On average, PWE scored 69.9 ± 16.8 (n = 164, mean = 64.9 after MI) on the QOLIE-31-P. Results were higher among male PWE, those employed or studying and having a higher level of education. In a pooled multiple regression model (adjusted R¯2 = 0.700, p < 0.001), the NDDIE (βst = -0.230, p < 0.001), the GAD-7 (βst = -0.226, p < 0.001), the LAEP (βst = -0.406, p < 0.001), and seizure frequency (βst = -0.156, p < 0.001) were statistically significantly associated with total QOLIE-31-P scores. CONCLUSION The Lithuanian version of the QOLIE-31-P demonstrates optimal reliability and construct validity to be applied in this population. It is strongly associated with seizure frequency as well as short instruments used to measure anxiety, depression, and adverse medication effects.
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Soraya H, Amin MM, Husada MS, Effendy E. Factors Associated with Anxiety Scores in People with Epilepsy in Neurological Installations of Haji Adam Medan Center General Hospital. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND: Anxiety disorder is the most prevalent comorbidity that may persist chronically in individuals with epilepsy. Unfortunately, anxiety is commonly ignored and rarely reported by epileptic patient. Therefore, early intervention and proper treatment should be addressed in these people. Acknowledging risk factors related to anxiety among epileptic patients may be useful in tailoring more appropriate psychiatric support.
AIM: The aim of our study is to investigate risk factors related to anxiety among epileptic patients.
METHODS: This cross-sectional predictive analytical multivariate study was conducted through March to May 2021 in Haji Adam Malik General Hospital Medan involving 84 epileptic patients visiting Neurology outpatient clinic who fulfilled inclusion and exclusion criteria COVID-19 health protocols. Anxiety score was assessed using HADS-A self-reported questionnaire.
RESULTS: We found that most of our patients are female who have experienced epilepsy for around 3 years. Exacerbations occurs approximately 4 times a year with duration of 10–20 min. Finally, we found that age, seizure duration, epileptic frequency, and gender are independent risk factors for anxiety severity among epileptic patients.
CONCLUSION: Age, seizure duration, epileptic frequency, and gender are independent risk factors for anxiety severity among epileptic patients.
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Marital status among patients with epilepsy in Saudi Arabia. Epilepsy Behav 2022; 126:108452. [PMID: 34864382 DOI: 10.1016/j.yebeh.2021.108452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 02/01/2023]
Abstract
There are no adequate studies on Saudi Arabia regarding the effect of the social environment on marriage among people with epilepsy (PWE). To fill this gap in the literature, we investigated the marital status of PWE to determine the factors affecting their marital prospects. The subjects of the study included PWE aged 18 years or above, recruited between 1998 and 2019 from the Epilepsy Registry of King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We collected a wide range of socio-demographic data on age, gender, location, education level, employment status, and marital status. In total, 1857 PWE, comprising 1086 men (58.48%) and 771 women (41.52%), were enrolled in the study. The data analysis showed that those 'married' and those who 'had been married' comprised 46.96% of the sample, while those 'never married' comprised 53.04%; 65.37% of the sample held a 'high school diploma or less' or had 'no education', 26.85% reported ongoing university education or had already obtained a bachelor's or higher degree; 50.08% of the respondents were employed, while 47.98% were not. Of the sample, 40.28% resided in Riyadh, whereas 13.14% were from the Asir region. We found that socio-demographic factors, especially employment status, had a major influence on the marital prospects of PWE.
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Nigussie K, Lemma A, Sertsu A, Asfaw H, Kerebih H, Abdeta T. Depression, anxiety and associated factors among people with epilepsy and attending outpatient treatment at primary public hospitals in northwest Ethiopia: A multicenter cross-sectional study. PLoS One 2021; 16:e0256236. [PMID: 34388228 PMCID: PMC8363019 DOI: 10.1371/journal.pone.0256236] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the magnitude and factors associated with depression and anxiety among people with epilepsy and attending out-patient treatment at central Gondar zone primary public hospitals, northwest, Ethiopia. Method An institutional based cross-sectional study was conducted from May—June, 2020 at central Gondar zone primary public hospitals. A total of 589 participants were chosen by systematic sampling technique. Data was collected by utilizing Amharic version interviewer-administered structured and semi-structured questioners. Depression and anxiety were assessed by using hospital anxiety and depression scale. Bivariate and multivariate logistic regression analysis was done to recognize variables related to both depression and anxiety. Association was described by using “adjusted odds ratio” (AOR) along with 95% full Confidence interval (CI). Finally, P-values < 0.05 in adjusted analysis were taken as a cut off for significant association. Result Out of 556 participants included in the study, 30.9%, 33.1% had depression and anxiety respectively. Being divorced/widowed (AOR = 2.43, 95% CI, 1.18–4.99), using two and above number of antiepileptic medications (AOR = 1.77,95% CI,1.02–3.09), very frequent seizure frequency (AOR = 2.68, 95% CI,1.30–5.51), current substance use (AOR = 1.82, 95% CI, 1.03–3.22), perceived stigma (AOR = 5.67,95% CI,3.14–8.18), and hazardous alcohol use (AOR = 2.84, 95% CI,1.32–6.09) were statistically associated with depression. While, being a single (AOR = 1.65, 95% CI, 1.04–2.63), using two and above number of antiepileptic medications (AOR = 2.27, 95% CI, 1.42–3.62), duration of illness ≥16 years (AOR = 2.82, 95% CI, 1.26–6.31), and perceived stigma (AOR = 2.49, 95% CI, 1.63–3.82) were statistically associated with anxiety at a p-value < 0.05. Conclusion This study showed that the magnitude of depression and anxiety were relatively high among people with epilepsy. Using two and above number of antiepileptic medications and perceived stigma were statistically associated with both depression and anxiety. Screening, early identification and providing appropriate intervention of depression and anxiety among people with epilepsy should be great concern for the health care providers.
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Affiliation(s)
- Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- * E-mail:
| | - Alemu Lemma
- Department of Psychiatry, School of Medicine, College of Medial and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Addisu Sertsu
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Henock Asfaw
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Habtamu Kerebih
- Department of Psychiatry, School of Medicine, College of Medial and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tilahun Abdeta
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Asadi-Pooya AA, Barzegar Z. Marital status in young adult patients with seizures: Epilepsy vs. functional seizures. Epilepsy Behav 2021; 121:108066. [PMID: 34052634 DOI: 10.1016/j.yebeh.2021.108066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We investigated the marital status (married vs. none) among patients with seizures [i.e., epilepsy or functional seizures (FS)]. METHODS This was a retrospective study of an electronic database of patients with seizures. All young adult patients, 18 to 45 years of age, with a diagnosis of either epilepsy or FS were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020. The two groups were matched for their age at diagnosis. Age at onset, sex, the marital status, and the final diagnosis were registered routinely. RESULTS During the study period, 194 patients with FS and 455 patients with epilepsy fulfilled the inclusion criteria. The rates of the married status were not significantly different between the two groups; 101 patients with FS (52%) and 204 PWE (45%) were married (p = 0.103). In the general population in Iran, 42,399,792 out of 66,421,989 (64%) of all people older than 16 years of age were married. This rate is significantly higher than the rate of the married status among patients with FS (p = 0.0006) and also those with epilepsy (p = 0.00001). CONCLUSION While the rates of the married status were not significantly different between PWE and those with FS, these rates were significantly lower than that in the general population in Iran. There are intriguing cross-cultural similarities and differences between our observations and those from other nations. These should be investigated in large multicenter international studies in the future.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Zohreh Barzegar
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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'To reveal or to conceal'- Disclosure strategies in parents of children with epilepsy in India. Seizure 2021; 91:507-512. [PMID: 34371247 DOI: 10.1016/j.seizure.2021.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Disclosure of epilepsy is a relevant but under-researched topic in epilepsy research. This study was done to assess the disclosure strategies in parents of CWE in a developing country with conservative culture. The study also assessed the influence of demographic factors and seizure characteristics on the choice of disclosure. Enablers and barriers behind disclosure and the consequences after disclosure were evaluated. METHODS A cross-sectional analytical, self-report survey was done in 284 parents of CWE with the help of a semi-structured questionnaire over a 7-month period in the paediatric epilepsy clinic. Disclosure was considered present if epilepsy was revealed to two or more of the five target groups (extended family, school, friends, neighbours, and peers of children). Separate set of questions was given for reasons behind their choice and consequences after disclosure. For continuous variables, unpaired T test or Mann - Whitney U test between group and for categorized variables, Pearson's Chi square test or Fisher's exact test was used. RESULTS 92.96 % of 284 subjects disclosed their child's epilepsy while 7.04% concealed. Demographic factors and seizure characteristics did not influence the disclosure choice. Most parents revealed to the extended family followed by teachers. Type of seizure was the commonest information revealed. The main reason behind disclosure was better acceptance of the child followed by safety while main barrier was considering epilepsy as private grief. 92.8% felt their children were better accepted after disclosure. CONCLUSION Disclosure practices have improved in parents of CWE in India and well-being and safety of the child has overridden the fear of stigma and discrimination. This could be the first major step to bring epilepsy out of the shadows at national and global levels.
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The Impact of Social Cognition on the Real-Life of People with Epilepsy. Brain Sci 2021; 11:brainsci11070877. [PMID: 34209039 PMCID: PMC8301878 DOI: 10.3390/brainsci11070877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/12/2021] [Accepted: 06/26/2021] [Indexed: 11/22/2022] Open
Abstract
Background. Previous research has demonstrated the impairment of social cognition (SC) in people with epilepsy. It is associated with worse social functioning and quality of life; however, the influence on real-life outcomes is unknown. The purpose of this study was to investigate how SC is associated with epilepsy variables and real-life outcomes (education, employment and relationships) among patients with epilepsy (PWE). Methods. Eighty-one PWE completed tasks of theory of mind (ToM) (faux pas recognition (FPRT) and Happé Strange Stories test (HST)) and emotion recognition (ER) (Reading of the Mind in the Eyes (RMET)). Variables reflecting their education, employment and relationship status were treated as endpoints in search of association with SC. Data from a matched group (n = 30) of healthy controls (HCs) were used for comparison of ToM abilities. Results. ToM scores were lower among PWE as compared to HCs (U = 1816.0, p < 0.0001 (HST), U = 1564.5, p = 0.020 (FPRT)). All SC tests were associated with the level of education (OR = 1.22, 95% confidence interval (CI) = 1.09 to 1.36 (RMET), OR = 1.20, 95% CI = 1.02 to 1.40 (HST), OR = 0.93, 95% CI = 0.87 to 1.00 (FPRT)). The results of ToM and ER testing were not associated with employment (χ2 = 33.423, p < 0.0001) if adjusted for the level of education (B = 0.804, OR = 2.23 (95% CI = 1.33 to 3.76), p = 0.002). SC abilities did not differ between PWE who were single and those in a relationship (U = 858.5, p = 0.541 (HST)), t= −1.236, p = 0.220 (RMET), U = 909.5, p = 0.271 (FPRT)). Conclusion. Better social cognition skills are linked to a higher level of education among PWE. SC probably has less influence on professional achievements and interpersonal relationships.
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Abdel Ghaffar NF, Asiri RN, Al-Eitan LN, Alamri RS, Alshyarba RM, Alrefeidi FA, Asiri A, Alghamdi MA. Improving public stigma, sociocultural beliefs, and social identity for people with epilepsy in the Aseer region of Saudi Arabia. Epilepsy Behav Rep 2021; 16:100442. [PMID: 33997759 PMCID: PMC8094896 DOI: 10.1016/j.ebr.2021.100442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022] Open
Abstract
An update of the data reported previously in 2016 in Aseer region. The level of education and awareness regarding epilepsy in Aseer region has improved recently. The belief in spiritual and traditional therapies has decreased, considering them as additional options.
Differences in the sociocultural practice and biases against people with epilepsy (PWE) largely contribute to the development of stigmatization. In this study, we evaluated factors that impact stigma for PWE involved in evolution and maintenance to report changes in the public awareness and cultural practices. We performed a cross-sectional study in which data were collected from a self-administered electronic survey composed of 33 items targeting the population in the Aseer region. Feedback response was obtained from 937 respondents. Of these, 921 participants (98.3%) had heard or read about the disorder previously. Approximately 84.8% believed that epilepsy was one of the brain disorders. 95.8% disagreed that epilepsy was due to a contagious disease. However, 40.1% of the responders were convinced that it was the result of a spiritual reason. Still, more than 9% believed treating PWE should be approached spiritually. About 75% felt that epilepsy could be the results of a test delievered by God. In addition to the clinical impact from seizures in PWE, it carries a social label and public stigma that influences one's social prognosis. Raising awareness through campaigns would improve the knowledge and practices of the population and hence provide a healthier environment for PWE, alleviating feelings of stigma, and improving their quality of life.
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Affiliation(s)
- Nawal F Abdel Ghaffar
- Neurology Department, Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Giza 12613, Egypt.,Neurology Department, Aseer Central Hospital, Abha 62523, Saudi Arabia
| | - Reem N Asiri
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Laith N Al-Eitan
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan.,Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Reem S Alamri
- Department of Neurology, King Abdulaziz Medical City, Riyadh 14815, Saudi Arabia
| | - Reem M Alshyarba
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Faris A Alrefeidi
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Ashwag Asiri
- Department of Child Health, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Mansour A Alghamdi
- Department of Anatomy, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia.,Genomics and Personalized Medicine Unit, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
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Kluger BM, Drees C, Wodushek TR, Frey L, Strom L, Brown MG, Bainbridge JL, Fischer SN, Shrestha A, Spitz M. Would people living with epilepsy benefit from palliative care? Epilepsy Behav 2021; 114:107618. [PMID: 33246892 PMCID: PMC9326903 DOI: 10.1016/j.yebeh.2020.107618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 12/30/2022]
Abstract
Palliative care (PC) is an approach to the care of persons living with serious illness and their families that focuses on improving quality of life and reducing suffering by addressing complex medical symptoms, psychosocial needs, spiritual well-being, and advance care planning. While PC has traditionally been associated with hospice care for persons with cancer, there is now recognition that PC is relevant to many noncancer diagnoses, including neurologic illness, and at multiple points along the illness journey, not just end of life. Despite the recent growth of the field of neuropalliative care there has been scant attention paid to the relevance of PC principles in epilepsy or the potential for PC approaches to improve outcomes for persons living with epilepsy and their families. We believe this has been a significant oversight and that PC may provide a useful framework for addressing the many sources of suffering facing persons living with epilepsy, for engaging patients and families in challenging conversations, and to focus efforts to improve models of care for this population. In this manuscript we review areas of significant unmet needs where a PC approach may improve patient and family-centered outcomes, including complex symptom management, goals of care, advance care planning, psychosocial support for patient and family and spiritual well-being. When relevant we highlight areas where epilepsy patients may have unique PC needs compared to other patient populations and conclude with suggestions for future research, clinical, and educational efforts.
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Affiliation(s)
- Benzi M Kluger
- Departments of Neurology and Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - Cornelia Drees
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas R Wodushek
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren Frey
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura Strom
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mesha-Gay Brown
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacquelyn L Bainbridge
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah N Fischer
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Archana Shrestha
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark Spitz
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Zhao T, Zhong R, Chen Q, Li M, Zhao Q, Lu Y, Li N, Zhang X, Lin W. Sex differences in marital status of people with epilepsy in Northeast China: An observational study. Epilepsy Behav 2020; 113:107571. [PMID: 33242773 DOI: 10.1016/j.yebeh.2020.107571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Our aims were to determine (1) whether the marriage rate was different between the sexes and (2) whether the influencing factors of marital status varied by sexes. METHODS A cross-sectional study was performed among 475 people with epilepsy (PWE) in Northeast China. The demographic information and clinical data were gathered and recorded. Sex differences in the marriage rate of PWE and the related influencing factors were analyzed. Multivariate logistic regression analyses were used to investigate the independent factors influencing marital status in men and women, respectively. RESULTS Among 475 participants, 219 (79.6%) men with epilepsy (MWE) were married, and 140 (70%) women with epilepsy (WWE) were married. In MWE, age, educational level, age at seizure onset, and disease duration were significantly different between the married men and the single men. In WWE, age, educational level, occupation and age at seizure onset showed significant differences between the married women and the single women. In the multiple logistic regression model, age and age at first seizure onset had an independent effect on the marital status in men with epilepsy. Multiple logistic regression analysis also revealed that age and age at first seizure onset were independent factors that influenced marital status in WWE. CONCLUSION Men with epilepsy were more likely to marry than WWE. Age and the age of seizure onset independently affected the marital status of men and women.
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Affiliation(s)
- Teng Zhao
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Qingling Chen
- Department of Hepatology, Tianjin Medical University, Tianjin Second People's Hospital, Tianjin, China
| | - Mengmeng Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qian Zhao
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yingxue Lu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Nan Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
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Abstract
BACKGROUND Epilepsy and mental illness share similar problems in terms of stigma, as a result of centuries of superstition, ignorance and misbeliefs. Stigma leads not only to discrimination and civil and human rights violations but also to poor access to healthcare and non-adherence or decreased adherence to treatment, ultimately increasing morbidity and mortality. Despite continuous efforts in fighting stigma in these conditions, there is very limited knowledge on the phenomenon of double stigma, meaning the impact of having two stigmatised conditions at the same time. AIMS To discuss double stigma in mental health with special reference to epilepsy. METHOD Articles were identified through searches in PubMed up to 31 October 2019 using the search terms 'epilepsy', 'psychiatric disorders', 'stigma' and additional material was identified from the authors' own files and from chosen bibliographies. RESULTS Double stigma is gaining attention for other stigmatised medical conditions, such as HIV, however, the literature on epilepsy is almost non-existent and this is quite astonishing given that one in three people with epilepsy have a lifetime diagnosis of a psychiatric condition. Felt (perceived) stigma and psychiatric disorders, particularly depression, create a vicious circle in epilepsy maintaining both, as depression correlates with stigma and vice versa as well as epilepsy and depression serving as bidirectional risk factors. This phenomenon has no geographical and economic boundaries as similar data have been reported for low-income and high-income countries. CONCLUSIONS Governments and policymakers as well as health services, patients' organisations, families and the general public need to be aware of the phenomenon of double stigma in order to develop campaigns and interventions tailored for these patients.
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Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London, UK; and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, UK
| | - Kenneth R Kaufman
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, USA; and Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
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Gabriel D, Ventura M, Samões R, Freitas J, Lopes J, Ramalheira J, Martins da Silva A, Chaves J. Social impairment and stigma in genetic generalized epilepsies. Epilepsy Behav 2020; 104:106886. [PMID: 31931462 DOI: 10.1016/j.yebeh.2019.106886] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Patients with epilepsy have poor social outcome. Multifactorial factors are usually involved, but among them, stigma features may have an important role. Genetic generalized epilepsies (GGEs) were previously considered "benign" syndromes. The aim of our study was to assess social impairment and stigma in GGE and to evaluate differences between the following GGE subsyndromes: juvenile myoclonic epilepsy (JME), juvenile absence epilepsy (JAE), and generalized tonic-clonic seizures alone (GTCSA). Additionally, we compared these outcomes with outcomes from a cohort of patients with epilepsy with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS), a severe and difficult-to-treat syndrome. Results were compared with social data from the general population. METHODS Adult patients with epilepsy with a previously classified GGE or MTLE-HS were consecutively invited to fill in a sociodemographic and stigma questionnaire in outpatient clinic. Clinical data and psychiatric comorbidities were retrieved from clinical notes. RESULTS Questionnaires from 333 patients were obtained: 226/67% from patients with GGE (JME: 106/31.8%, GTCSA: 74/22.2%, and JAE: 46/13.8%) and 107/32.1% from patients with MTLE-HS. We found that patients with GGE have a good academic achievement but they have increased difficulties in finding a partner, higher rates of divorce, and a reduced number of children per woman and per man when compared with general population. We also observed that patients with GGE have higher rates of unemployment (22.6%) and lower monthly income than general population. Severe problems in housing were only seen in GGEs. Of these, 3 patients (1.3%) were in homeless condition. Over half (52%) of patients with MTLE-HS and over a quarter (28%) of patients with GGE experienced felt stigma. Psychiatric comorbidity was highly prevalent among GGE (34.1%), especially in patients with refractory epilepsy. Mood and anxiety disorders were the most prevalent conditions. No other significant differences were found between GGE subsyndromes. DISCUSSION We found an impairment in every social domain assessed (except in level of education) when compared with general population. Most of the social outcome parameters were unexpectedly close or similar to MTLE-HS or even worse as it was the prevalence of homelessness among GGE. Social impairment is underdiagnosed and might be considered in clinical practice even in syndromes for some time considered benign such as GGE.
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Affiliation(s)
- Denis Gabriel
- Serviço de Neurologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - Magda Ventura
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Raquel Samões
- Serviço de Neurologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Joel Freitas
- Serviço de Neurofisiologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - João Lopes
- Serviço de Neurofisiologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - João Ramalheira
- Serviço de Neurofisiologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - António Martins da Silva
- Serviço de Neurofisiologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - João Chaves
- Serviço de Neurologia, Departamento de Neurociências, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal; UMIB - Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
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Li S, Chen J, Abdulaziz ATA, Liu Y, Wang X, Lin M, Qin Y, Liu X, Zhou D. Epilepsy in China: Factors influencing marriage status and fertility. Seizure 2019; 71:179-184. [PMID: 31382137 DOI: 10.1016/j.seizure.2019.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/19/2019] [Accepted: 07/25/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To investigate the current status of marriage and fertility of patients with epilepsy (PWE) and characterize its influencing factors. METHODS A total of 1,823 adult patients (males age 22 years or older, females age 20 years or older) were included in this study. Data concerning sociodemographic and clinical characteristics were collected. Descriptive analyses, followed by univariate and multivariate logistic regression analyses were utilized to examine factors associated with marriage and fertility of PWE. Marital status of PWE was compared with Chinese population. Standardized marriage rate (SMR) for age and sex was estimated based on the 2010 sixth national population census. RESULTS 1,132 patients (62.1%) were married and 823 (45.1%) had a history of fertility. Patients had lower marriage rates than Chinese population (62.1% vs 78.4%). Patients with adult-onset epilepsy (>18 years) had a significantly higher rate of marriage and fertility (p < 0.001) compared to those with childhood-onset epilepsy (≤18 years). Employed patients had higher marriage rates than unemployed patients (64.9% vs 58.6%, p = 0.006), with only male patients being significantly affected by employment status (p < 0.001). Multiple logistic regression revealed that age, age at first seizure onset, and employment status were related to both marriage and fertility. CONCLUSION Epilepsy had negative effects on marriage and fertility status. Marriage and fertility rates were lower in patients with Childhood-onset epilepsy (≤18 years). Furthermore, employment status mainly affected the marriage rate of male patients.
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Affiliation(s)
- Sisi Li
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Jiani Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Ammar Taha Abdullah Abdulaziz
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Yadong Liu
- West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Xuran Wang
- West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Mintao Lin
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Yingjie Qin
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Xu Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China.
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Algahtani H, Shirah B, Alzahrani A, Shaheen M. Perception and Attitude of the General Population towards Epilepsy in Jeddah, Saudi Arabia. J Epilepsy Res 2019; 9:42-50. [PMID: 31482056 PMCID: PMC6706646 DOI: 10.14581/jer.19005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/29/2019] [Accepted: 06/21/2019] [Indexed: 01/16/2023] Open
Abstract
Background and Purpose There are several conflicting beliefs about epilepsy, and public awareness about this disease varies widely among different countries. The present study aimed to determine public perception and attitude regarding different aspects of epilepsy in Jeddah, Saudi Arabia. In addition, we aim to identify the cultural and religious beliefs in Saudi Arabia associated with the causes and treatment of epilepsy. Methods This is a cross-sectional study that was conducted between January 2018 and June 2018 in malls and public places in Jeddah, Saudi Arabia. This study utilized a self-administered questionnaire composed of 40 items. Results A total of 1,940 individuals participated in the study, of which 1,675 participants (86.3%) had previously heard about epilepsy. Approximately 60% of the participants believed that epilepsy was caused by a brain disease and 17.1% believed that it is a genetic disease. Over 50% of the participants believed that epilepsy is treated with medications, 31.5% believed that it can be treated by the recitation of Quran, and 16.2% believed that it can be treated by surgery, while 10.2% believe that there is no treatment. Conclusions The results of the present study suggest that awareness about epilepsy in the general public should be raised to avoid a negative impact on the patients, their families, their communities, and the healthcare system. Several misconceptions were identified, particularly in the etiology and management of the disease. Increased awareness will help in the early diagnosis, appropriate care, and management of the patients, and lead to better social acceptance. Dissemination of information about epilepsy through social media should be considered to reach a great proportion of the general public.
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Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Bader Shirah
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Alhussain Alzahrani
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mostafa Shaheen
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Budikayanti A, Larasari A, Malik K, Syeban Z, Indrawati LA, Octaviana F. Screening of Generalized Anxiety Disorder in Patients with Epilepsy: Using a Valid and Reliable Indonesian Version of Generalized Anxiety Disorder-7 (GAD-7). Neurol Res Int 2019; 2019:5902610. [PMID: 31275648 PMCID: PMC6582805 DOI: 10.1155/2019/5902610] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/17/2019] [Accepted: 05/09/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Generalized anxiety disorder (GAD) is one of the most common types of anxiety disorder in epilepsy population, comprising 21.9%, that would further impair patients' quality of life. Generalized Anxiety Disorder-7 (GAD-7) is the only screening tool for GAD that has been validated in patients with epilepsy (PWE). It is a self-reporting instrument that can be completed in less than three minutes; hence, its usage is appropriate in primary healthcare and neurology outpatient clinic. This study aimed to obtain a valid and reliable Indonesian version of GAD-7, assess its accuracy, and finally evaluate the prevalence of GAD in Indonesian PWE along with its contributing factors. METHODS A cross-sectional study was conducted in Cipto Mangunkusumo General Hospital, Jakarta. The GAD-7 was translated and adapted using World Health Organization (WHO) steps. Validity, reliability, test-retest reliability, and diagnostic accuracy were evaluated. Then, epilepsy outpatients were screened for GAD using the Indonesian version of GAD-7. RESULTS Internal validity and reliability for Indonesian version of GAD-7 were satisfactory with validity coefficient of 0.648 to 0.800 (p<0.01) and Cronbach's alpha value of 0.867. The best cutoff value to detect GAD in Indonesian PWE was >6 with the sensitivity, specificity, negative predictive value, and positive predictive value of 100%, 84.4%, 100%, and 55.8%, respectively. ROC analysis showed the area under the curve of 0.98 (95% CI: 0.96-0.99). The total subjects screened with the validated Indonesian version of GAD-7 were 146, and 49% were screened as having GAD. Sociodemographic and clinical characteristics had no statistically significant association with the presence of GAD. CONCLUSION The Indonesian version of GAD-7 was a valuable screening tool to detect GAD in PWE. GAD was screened in a quite high proportion of PWE. Sociodemographic and clinical characteristics were not proven to play role in its development.
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Affiliation(s)
- Astri Budikayanti
- Department of Neurology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Andira Larasari
- Department of Neurology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Khamelia Malik
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Zakiah Syeban
- Department of Neurology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Luh Ari Indrawati
- Department of Neurology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Fitri Octaviana
- Department of Neurology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Singh G, K Ganguly K, Banerji M, Addlakha R, Shah U, Tripathi M, Saxena V, Vohra H, Wakankar Y, Sharma M, Radhakrishnan K. Marriage in people with epilepsy: A compelling theme for psycho-behavioral research. Seizure 2018; 62:127-130. [PMID: 30122424 DOI: 10.1016/j.seizure.2018.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022] Open
Abstract
People with epilepsy frequently experience problems in marriage including reduced marital prospects, poor marital outcomes and diminished quality of married life. Conversely, marriage might impact epilepsy self-management and quality of life in people with epilepsy. There is little in published literature on marriage and epilepsy, so there is a need for psycho-behavioral research. Here, we focus on arranged marriages which, although now rare in western cultures, are widely prevalent in South Asian communities. Arranged marriages, in which families rather than individuals choose marital partners, are particularly problematic because epilepsy is frequently hidden during marital negotiations as well as later. From the psycho-behavioral perspective, marital prospects, outcomes and satisfaction should be examined in relation to the type of marriage (arranged vs. love) and whether or not epilepsy is hidden. Additionally, culturally-relevant tools to appraise marital quality and epilepsy self-management within marriage should be developed. The main objective should be to develop a multi-sectorial action plan with interventions at several different levels involving different stakeholders to mitigate stigma associated with epilepsy in matrimony.
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, India; Department of Clinical & Experimental Epilepsy, UCL-Institute of Neurology, Queen Square, London, UK
| | - Kalyan K Ganguly
- Socio-Behavioral Research Unit, Indian Council of Medical Research, New Delhi, India
| | - Manjistha Banerji
- School of Educational Studies, Ambedkar University, New Delhi, India
| | - Renu Addlakha
- Centre for Women's Development Studies, New Delhi, India
| | - Urvashi Shah
- Department of Neurology, KEM Hospital, Mumbai, India
| | - Manjari Tripathi
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Hitant Vohra
- Department of Anatomy, Dayanand Medical College, Ludhiana, India
| | | | - Meenakshi Sharma
- Non-communicable Research Division, Indian Council of Medical Research, New Delhi, India
| | - Kurupath Radhakrishnan
- Department of Neurology, Amrita Institute of Medical Sciences, Cochin, 682041, Kerala, India.
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Abstract
PURPOSE OF REVIEW To review some aspects of the relationship between epilepsy and depression that have recently received increasing attention and may become major research topics in the near future. RECENT FINDINGS Epidemiological studies show that depression and suicide are, in some cases, premorbid symptoms preceding the onset of the epilepsy. Suicide is also three times more frequent in epilepsy than in the general population. Reliable screening instruments for depression and suicidality in patients with epilepsy are now available but data from real life clinical settings are needed to develop shared clinical pathways between neurology and psychiatry. Data in children with epilepsy are still limited although it is well known that, outside epilepsy, almost 50% of adult patients with mood and anxiety disorders have a previous history during childhood. Despite increasing attention to the problem, the additional stigma associated with mental health problems still represents one of the major barriers to prompt diagnosis and treatment. SUMMARY New studies will focus on the development of shared clinical pathways between neurology and psychiatry for mood disorders and suicide prevention. New global campaigns on the double stigma will support this process in areas where psychiatric comorbidities are still underdiagnosed and undertreated.
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Zhao T, Gao Y, Zhu X, Wang N, Chen Y, Zhang J, He G, Feng Y, Xu J, Han X, Zhang J. Awareness, attitudes toward epilepsy, and first aid knowledge of seizures of hospital staff in Henan, China. Epilepsy Behav 2017; 74:144-148. [PMID: 28738284 DOI: 10.1016/j.yebeh.2017.06.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study was to evaluate awareness of, attitudes toward, and first aid knowledge of seizures of hospital staff in Henan, China. METHOD Two hundred nineteen hospital staff, including doctors, nurses, medical technicians, logisticians, and executives working at tertiary hospitals in Henan, China, completed the survey from March to September in 2016. The data comprised the demographic data section, awareness of epilepsy section, attitude toward epilepsy section, and first aid knowledge of seizure attack section. RESULTS The participants obtained a mean score of 7.48±1.705 on the awareness of epilepsy section, and a mean score of 5.32±1.165 on the first aid knowledge of seizure attacks section. There were significant correlations between educational level (r=0.187, P=0.006), occupation (r=-0.244, P=0.000), and attitudes toward patients with epilepsy (r=0.351, P=0.000) with the awareness of epilepsy. There were significant correlations between age (r=0.170, P=0.014), educational status (r=0.139, P=0.040), and professional titles (r=0.197, P=0.004) with the first aid knowledge of seizures. CONCLUSION The study showed that hospital staff had a moderate level of knowledge regarding epilepsy, and they generally displayed a positive attitude. It was also determined that as the awareness of epilepsy increased, they displayed more positive attitudes toward patients with epilepsy. The study also suggests that specialists working on epilepsy should provide more lectures and educational sessions to improve the knowledge of and attitude toward epilepsy and first aid knowledge of seizures among hospital staff.
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Affiliation(s)
- Ting Zhao
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Yajuan Gao
- Department of Clinical Medicine, Zhengzhou University, Zhengzhou 450000, China
| | - Xuerui Zhu
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Na Wang
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Yanan Chen
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Jiahui Zhang
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Guinv He
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Yan Feng
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Jun Xu
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China.
| | - Jiewen Zhang
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
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26
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Wang FL, Gu XM, Hao BY, Wang S, Chen ZJ, Ding CY. Influence of Marital Status on the Quality of Life of Chinese Adult Patients with Epilepsy. Chin Med J (Engl) 2017; 130:83-87. [PMID: 28051028 PMCID: PMC5221117 DOI: 10.4103/0366-6999.196572] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Epilepsy is a chronic disorder characterized by recurrent seizures and has significant psychological and social consequence for everyday living. Epilepsy affects various aspects of ones’ social life. The present study aimed to investigate the influence of marital status on the quality of life of adult Chinese patients with epilepsy. Methods: This study surveyed 805 Chinese adults who have been clinically diagnosed with epilepsy for longer than 1 year in 11 hospitals in Beijing. In this survey, 532 (66.1%) participants were married. All of them completed the case report form with enquiries on demographic data, social factors, and illness. The marriage status of adult epileptic quality of life was the dependent variable, and demographic data and clinical data were independent variables, analyzed through the multiple linear regression analysis methods. The patients’ quality of life was assessed using the Quality of Life in patients with Epilepsy-31 items (QOLIE-31) questionnaire, the Patient Health Questionnaire-9 items (PHQ-9), and the Generalized Anxiety Disorder-7 items (GAD-7). Results: The PHQ-9 and GAD-7 scores in the unmarried group (PHQ-9 = 6.0 and GAD-7 = 5.0) were significantly higher than that of the married group (PHQ-9 = 4.0 and GAD-7 =3.0). The scores of married adult patients with epilepsy on QOLIE (61.8 ± 15.3) and social function (70.9 ± 22.7) were higher than the scores of the unmarried patients aged between 20 and 44 years. The scores of married adult epileptics on the QOLIE (58.4 ± 14.6) and the energy/fatigue (62.1 ± 20.4) were higher than the scores of the unmarried patients (QOLIE = 58.4 ± 14.6 and the energy/fatigue = 62.1 ± 20.4) aged between 45 and 59 years. For the adult epilepsy patients, depression, anxiety, seizures within the last year, disease course, medical expense category, and marriage* age are negatively correlated with the quality of life. Occupation, educational level, and average monthly income are closely related to the quality of life. Conclusions: Married adult epileptic patients have better quality of life than that of unmarried adult patients in young and middle-aged age groups. Unmarried adult patients with epilepsy are more anxious and depressed than married adult patients.
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Affiliation(s)
- Fu-Li Wang
- Department of Hospital Management, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China
| | - Xiang-Min Gu
- Department of Programmed Immunization, Center for Disease Control and Prevention of Tianjin Binhai New Area, Tianjin 300450, China
| | - Bao-Yun Hao
- Department of Programmed Immunization, Center for Disease Control and Prevention of Tianjin Binhai New Area, Tianjin 300450, China
| | - Shan Wang
- Department of Epilepsy, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China
| | - Ze-Jie Chen
- Department of Epilepsy, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China
| | - Cheng-Yun Ding
- Department of Epilepsy, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China
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Kinariwalla N, Sen A. The psychosocial impact of epilepsy on marriage: A narrative review. Epilepsy Behav 2016; 63:34-41. [PMID: 27552484 DOI: 10.1016/j.yebeh.2016.07.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 01/22/2023]
Abstract
There have been many studies exploring quality of life as well as the impact of epilepsy on the affected individual. However, epilepsy affects more than the patients themselves, and there seems to be a paucity of data regarding the impact of epilepsy beyond the person with epilepsy (PWE). In particular, it is uncertain what the impact of epilepsy on marriage may be. We therefore performed a narrative review to evaluate work measuring the psychosocial effect of epilepsy on marriage. We reviewed the literature on epilepsy and marriage by searching PubMed (Medline) and EMBASE and thoroughly examining relevant bibliographies. Forty-two papers were identified that addressed the issue of the psychosocial effect of epilepsy on marriage. The different approaches used to assess the impact of epilepsy on marriage can be broadly grouped into three categories: assessment of the social effect of living with epilepsy, which includes the marital prospects of PWEs and how changes in martial status associate with seizure frequency; assessment of quality of life (QOL) of PWEs; assessment of the association of social support with the disease burden of epilepsy. Within each of these approaches, different research methods have been employed including questionnaires, qualitative methods, and scales. The studies reviewed indicate that epilepsy has a severe impact on individuals and their families. While many quality-of-life surveys do comment on the marital status of the patient, there is little expansion beyond this. The impact that seizures may have on the partner of a patient with epilepsy is barely addressed. With increasing incidence of epilepsy in older populations, potential changes in the dynamic of a long-term marriage with the development of epilepsy in older age are not known. Similarly, the impact of marriage on concordance with medication or proceeding to, for example, surgical treatment for pharmacoresistant epilepsy has not been studied in detail. We suggest ways in which to address these aspects in order to better deliver holistic care to patients with epilepsy and their partners.
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Affiliation(s)
- Neha Kinariwalla
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Arjune Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
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28
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Mula M, Sander JW. Psychosocial aspects of epilepsy: a wider approach. BJPsych Open 2016; 2:270-274. [PMID: 27703786 PMCID: PMC4995176 DOI: 10.1192/bjpo.bp.115.002345] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 11/23/2022] Open
Abstract
SUMMARY Epilepsy is one of the most serious neurological conditions and has an impact not only on the affected individual but also on the family and, indirectly, on the community. A global approach to the individual must take into account cognitive problems, psychiatric comorbidities and all psychosocial complications that often accompany epilepsy. We discuss psychosocial issues in epilepsy with special focus on the relationship between stigma and psychiatric comorbidities. Social barriers to optimal care and health outcomes for people with epilepsy result in huge disparities, and the public health system needs to invest in awareness programmes to increase public knowledge and reduce stigma in order to minimise such disparities. DECLARATIONS OF INTEREST J.W.S. receives research support from the Dr Marvin Weil Epilepsy Research Fund, Eisai, GlaxoSmithKline, the World Health Organization and the EU's FP7 programme, and has been consulted by, and has received fees for lectures from, GlaxoSmithKline, Eisai, Lundbeck, Teva and UCB. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Marco Mula
- Marco Mula, MD, PhD, Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals NHS Foundation Trust, London, UK; South West London and St George’s Mental Health Trust, London, UK; Institute of Medical and Biomedical Sciences, St George’s University of London, London, UK
| | - Josemir W. Sander
- Josemir W. Sander, MD, PhD, FRCP, Department of Clinical and Experimental Epilepsy, NIHR UCL Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK; Epilepsy Society, Chalfont St Peter, UK; Stichting Epilepsie Instellingen Nederland – SEIN, Heemstede, The Netherlands
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