Marriage in people with epilepsy: A compelling theme for psycho-behavioral research

Epilepsy in rural South Africa: Patient experiences and healthcare challenges

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.

Why do patients transition between orthodontic appliances? A qualitative analysis of patient decision-making

OBJECTIVES

To gain an in-depth understanding of patients' decision-making processes when choosing to transition to a different orthodontic appliance (OA).

METHODS

This was a retrospective qualitative study using one-on-one in-depth semi-structured interviews. Patients were recruited through purposive convenience sampling. Participants who had elected to transition from and to one of these OAs: metal brackets, tooth-coloured brackets, or clear aligners before the end of treatment were recruited. Recruitment ceased when data saturation was achieved. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

RESULTS

Twenty-three adult participants (12 males, 11 females) with their ages ranging from 18 to 52 years were interviewed. The analysis of the data revealed that participants perceived two reasons for the transition: (1) insufficient initial information and (2) evolving life circumstances and personal style. Data analysis of participants who expressed a notable discrepancy between their expectations and the reality of the OA they chose revolved around three themes: (a) health benefits and threats, (b) personal control, and (c) financial considerations. Data analysis of participants who described transitioning between OAs due to changes in personal circumstances and style, revealed two themes: (a) change in personal values and motivations and (b) change in social and psychological influence.

CONCLUSIONS

This qualitative study highlighted the complex multifactorial nature of patient decision-making when choosing and transitioning OAs. Orthodontists can benefit from understanding these factors to engage in thorough patient-centered counselling, provide tailored treatment recommendations, and optimize the choice of appliances.

Epilepsy knowledge and attitudes: A large observational study among the Palestinian general public

Background

Epileptic seizures are often misunderstood as supernatural power or satanic possession in different cultures around the world. Therefore, people with epilepsy (PWE) suffer discrimination, prejudice, and stigma. The epilepsy knowledge and attitude (EKA) of the Palestinian general public were not assessed before. Therefore, this study assessed the EKA of the Palestinian general public. In addition, the study identified the characteristics that were associated with EKA.

Methods

This was a large cross-sectional study that was conducted using a self-administered instrument. The study participants were invited and recruited from the Palestinian general public. The EKA were assessed using 16 knowledge items and 13 attitude items.

Results

In this study, responses were collected from 746 participants. Knowledge scores were significantly associated with having a university degree, satisfaction with household income, adequate knowledge about epilepsy, having acquaintances with epilepsy, and having witnessed someone experiencing epileptic seizures. Attitude scores were significantly associated with living in urban areas, being married, having a university degree, satisfaction with household income, adequate knowledge about epilepsy, having acquaintances with epilepsy, and having witnessed someone experiencing epileptic seizures.

Conclusion

Large knowledge gaps and negative attitudes toward PWE were identified among the Palestinian general public. These findings might be considered a call to increase knowledge and correct negative attitudes toward PWE. Decision-makers need to design and implement effective measures to increase knowledge and correct negative attitudes toward PWE. Further studies are still needed to assess the effectiveness of these measures in increasing knowledge and positive attitudes toward PWE.

Low quality of life, increased number of anti-seizure drugs, and the lack of caregiver support are associated with internalized stigma in adult Mexican patients with epilepsy

BACKGROUND

People with epilepsy (PWE) have been subject to stigma throughout history, a factor that could compromise their performance in daily life. In Mexico, little is known about the factors that may be affecting internalized stigma.

OBJECTIVE

To evaluate the internalized stigma in adult PWE, its relationship with the quality of life, cognitive and depressive symptomatology, and clinical-demographic characteristics.

MATERIAL AND METHODS

We conducted a cross-sectional study with a consecutive sampling approach in patients with epilepsy treated at the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez (NINNMVS). Sociodemographic and clinical data, depressive symptomatology (Beck's depression inventory, DBI), cognition (MoCA test), quality of life (QOLIE-31 scale), and internalized stigma (King's internalized stigma scale, ISS) were evaluated. Correlations were made between the continuous variables and the ISS to select those with statistical significance and include them in a multiple linear regression model, along with the dummy variables, to explain internalized stigma.

RESULTS

Of 128 patients, 74 (58%) were women; 38% of the patients had more than 20 years of epilepsy evolution. In addition, 39% presented depressive symptoms, and around 60% manifested a possible cognitive impairment. The variables that showed statistical significance concerning the ISS were selected along with dummy variables for multiple linear regression analysis. The resultant model considers the QOLIE-31 total score (β = -0.489), the number of anti-seizure drugs (ASD, β = 0.253), and those patients without caregiver support (β = -0.166) with an adjusted R² value of 0.316.

CONCLUSIONS

A diminishing quality of life, an increased number of ASD, and patients without caregiver support influence a slight to moderate variation of internalized stigma in Mexican PWE. Therefore, it is necessary to continue studying other possible factors that influence internalized stigma to generate effective strategies to reduce its negative effects on PWE.

Dual burdens of felt stigma and depressive symptoms in patients with epilepsy: Their association with social anxiety, marriage, and employment

PURPOSE

The present study evaluated whether patients with epilepsy with dual conditions of felt stigma and depressive symptoms are more strongly associated with social anxiety, being unmarried, and being unemployed than those with depressive symptoms or felt stigma alone.

METHODS

This multicenter, cross-sectional study evaluated subjects using the Stigma Scale-Revised, the Patient Health Questionnaire-9, and the six-item versions of the Social Interaction Anxiety Scale, and the companion Social Phobia Scale. Subjects were grouped by depressive symptoms and felt stigma into four groups. Multivariate logistic regression analyses were performed.

RESULTS

The 298 subjects included 173 men and 125 women. Of these subjects, 35 (11.7%) had depressive symptoms alone, 33 (11.1%) had stigma alone, and 27 (9.1%) had both depressive symptoms and felt stigma. Multivariate logistic regression analyses showed that, compared with the control group having neither depressive symptoms nor felt stigma, the odds ratios (ORs) for social interaction anxiety and social phobia were highest in the group of dual conditions (OR 18.7 and 13.5, respectively), followed by the depression-alone (OR 7.7 and 4.6, respectively) and stigma-alone (OR 5.0 and 2.8, respectively) groups. Similarly, the ORs for being unmarried (OR 29.2) and unemployed (OR 3.1) were significant only in the group of dual conditions. In addition, male sex and younger age were independently associated with being unmarried whereas seizures recurring ≥1 per month were independently associated with being unemployed.

CONCLUSIONS

Dual conditions of felt stigma and depressive symptoms may be more strongly associated with social anxiety, being unmarried, and being unemployed than depressive symptoms or felt stigma alone in patients with epilepsy.

Knowledge of and Attitude towards Epilepsy among the Jordanian Community

Background: Epilepsy is a disorder characterized by recurring seizures that do not have an immediate identifiable cause. It is a disorder with complex symptoms and a wide range of risk factors, with age, genetics, and origin being the most prevalent variations. This study aimed to evaluate the knowledge of and attitude towards epilepsy among the Jordanian community. Method: An online cross-sectional study using a self-administered questionnaire was conducted between 29 March and 15 May 2022 in Jordan. In this study, three previously validated questionnaire items were adapted and employed. Binary logistic regression was applied to identify predictors of good knowledge and a positive attitude. Results: A total of 689 participants were involved in this study. A weak level of knowledge about epilepsy was observed among the study participants (35.3%). The participants showed a moderately positive attitude towards epilepsy (63.3%). Being female, holding a bachelor’s degree, knowing anyone who had epilepsy and seeing anyone having an epileptic seizure were factors that positively affected participants’ knowledge about epilepsy. Being aged between 24 and 29 years or being divorced were factors that affected the participants’ attitudes negatively towards epilepsy. Conclusion: The study’s participants had limited knowledge of epilepsy and a favorable attitude toward it. The community’s understanding of epilepsy and attitude toward epilepsy patients should be improved by an informed educational effort on the part of various media platforms. All facets of the community, including parents, should be the focus of these initiatives.

Marital status among patients with epilepsy in Saudi Arabia

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.

Seizure and social outcomes in patients with non-surgically treated temporal lobe epilepsy

OBJECTIVES

To investigate the seizure outcome with medical treatment in patients with temporal lobe epilepsy (TLE) and its associated factors. We also investigated the social outcome of the patients.

METHODS

This was a retrospective study of a prospectively built electronic database of patients with epilepsy. All patients with a diagnosis of TLE were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2019. In a phone call to the patients, at least 24 months after their diagnosis at our center, we investigated their current seizure control and social status.

RESULTS

Two hundred and twenty-two patients were studied; 101 patients (45.5%) were seizure free. A lower number of the prescribed drugs was the only factor with a significant association with the seizure-free outcome (Odds Ratio: 1.460; p = 0.001). At the time of the phone call, 76 patients (37.6%) reported having a college education, 103 patients (51%) were employed, 146 patients (72.3%) were married, and 81 patients (40%) reported driving a motor vehicle. The employment status, college education, and driving a motor vehicle were significantly associated with a seizure-free outcome status. The social achievements of the patients, who were partially responsive to medical therapy, were significantly worse than those who were seizure free.

CONCLUSION

Many patients with TLE may suffer from drug-resistant seizures. Ongoing seizures in these patients may affect their social lives substantially. Seizure reduction (not freedom) is not good enough to help the patients with TLE enjoy a healthy life with satisfactory social achievements.

Marital status in young adult patients with seizures: Epilepsy vs. functional seizures

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.

Depression, anxiety levels and sleep quality indexes among the spouses of people with epilepsy

BACKGROUND

Psychiatric problems and sleep disturbances are comorbidities that are frequently encountered among people with epilepsy. However, their presence among the spouses of peoples with epilepsy remains to be elucidated.

OBJECTIVE

The objective of this study was to evaluate the spouses of people with epilepsy (PWE), with and without a history of seizures during sleep, in terms of depression, anxiety and sleep quality.

METHODS

This prospective, cross-sectional study was conducted in three groups of 18 to 65-year-olds. Group 1 consisted of healthy spouses of 127 healthy volunteers without any known neurological disease; group 2 comprised spouses of 63 PWE who had no history of seizure during sleep; and group 3 consisted of spouses of 63 PWE who had a history of at least one seizure during sleep in the course of the previous year. Questionnaires seeking demographic data and the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory and Beck Anxiety Inventory were applied to all participants.

RESULTS

The depression scores of the group of spouses of PWE were higher than those of the control group and were higher in group 3 than in group 2 (p = 0.017). The anxiety scores of the group of spouses of PWE were significantly higher than those of the control group, but no difference in anxiety scores was found between group 2 and group 3 (p = 0.170). The mean PSQI score of group 3 was higher than that of group 2 (p = 0.029). However, regression analyses did not show any difference between these groups.

CONCLUSION

We found that the PSQI scores, which reflected sleep quality, were higher among the spouses of PWE who had seizures during sleep and who had more severe epilepsy.

Attitudes Toward Epilepsy Among Parents of Children With Epilepsy in Southern China

Purpose: To evaluate the attitudes toward epilepsy among parents of children with epilepsy (CWE) in China and identify some related factors for future interventions for parents to offer more social support for CWE.

Method: The Chinese Public Attitudes Toward Epilepsy (CPATE) scale was administered to 234 parents of CWE and 203 parents of normal children in Xiangya hospital during 2019–2020.

Results: The cumulative score of the parents of CWE (26.427 ± 6.688) was significantly lower than that of the normal children group (32.330 ± 7.234, p < 0.001). Subanalysis showed more positive attitudes among parents of CWE than the control group (p < 0.001) toward education (4.765 ± 1.985 vs. 6.621 ± 2.419), social life (6.556 ± 2.456 vs. 8.010 ± 2.683), marriage (9.586 ± 2.675 vs. 11.025 ± 2.900), and employment (3.876 ± 1.364 vs. 4.5123 ± 1.283). The attitudes toward epilepsy among parents of CWE with seizures in public (27.16 ± 6.66) or during sleep (27.10 ± 6.38) were more negative than those without (25.35 ± 6.62 and 25.08 ± 7.10, respectively) (p < 0.05). In addition, female and low income were negatively related to parents' attitudes toward epilepsy.

Conclusions: More active policy guidance and adequate social support should be given to parents of children with seizures in public or during sleep to instruct their children to form a positive perception about epilepsy, which is expected to have a positive impact on their social abilities in the future.

Reproductive health in patients with epilepsy

The aim of the present study was to review existing knowledge on the impact of epilepsy in reproductive health of both sexes. Extensive searches of relevant documentation published until February 2020 were retrieved from PubMed and Google Scholar literature in English or in other languages with an English abstract. In females, epilepsy may lead to estrogen and androgen level abnormalities. Women with epilepsy may develop Polycystic Ovaries Syndrome (PCOS), anovulatory cycles, and menstrual disorders. In men, epilepsy may cause sex hormone dysregulation and influence spermatogenesis. Males with epilepsy may also suffer from sexual dysfunction. Antiepileptic drugs (AEDs) have adverse effects on peripheral endocrine glands, influence hormones' biosynthesis and protein binding, diminish the bioactivity of serum sex hormones, and lead to secondary endocrine disorders related to changes concerning body weight and insulin sensitivity. Valproic acid (VPA) was the first recognized AED to cause disturbances potentially due to metabolic changes and increasing weight. Women taking VPA may develop PCOS, while men may have sperm abnormalities and/or sexual dysfunction. Liver enzyme inducing AEDs may also cause menstrual and sexual disorders in women and sexual dysfunction in men. Newer AEDs are much safer but studies still suggest reduced sexuality and erectile dysfunction.

Marital status in patients with functional (psychogenic nonepileptic) seizures: An international study

PURPOSE

The study aimed to investigate the marital status in a cohort of patients with functional seizures from seven countries in four continents. Factors associated with marital status were also explored.

METHODS

Adult patients with functional seizures who were admitted to the epilepsy monitoring units at centers in Iran, Qatar, USA, France, Georgia, Egypt, and United Arab Emirates (UAE) were retrospectively identified. Marital status was assessed in the whole cohort.

RESULTS

Four hundred thirty-two patients were included (241 from Iran, 52 from France, 48 from Qatar, 41 from the USA, 19 from UAE, 18 from Egypt, and 13 from Georgia); 302 were women and 130 were men. One hundred fifty (35%) subjects were single, 245 (57%) were married, and 37 (8%) were separated (31 divorced, 7%; 6 widowed, 1%). Auras with functional seizures were less frequently reported by single people in comparison with that by married patients (54% vs. 61%) [odds ratio (OR) = 0.58]. Separated people compared with those who were married less often had auras with their functional seizures (27% vs. 61%; OR = 0.26) and more often reported a history of sexual abuse (49% vs. 12%; OR = 6.14).

CONCLUSION

The marital status has significant associations with the semiology of functional seizures. A history of sexual abuse is significantly associated with being separated and should be inquired and tackled appropriately during the management process of patients with functional seizures.

Socioeconomic consequences of drug-resistant epilepsy in an adult cohort from southern India

OBJECTIVE

The objective of this study was to describe the socioeconomic consequences of drug-resistant epilepsy (DRE).

METHODS

This study comprised 132 (equal males and females) consecutive patients aged ≥18 years, who fulfilled the International League Against Epilepsy (ILAE) definition for DRE, prospectively seen in a tertiary care center in South India. We used a structured questionnaire to gather relevant information.

RESULTS

The mean age was 31 (range 18-70) years. Mean age of onset of epilepsy was 17 years and mean duration of epilepsy 14 years. The most common epilepsy type and etiology were focal epilepsy and gliotic lesions secondary to perinatal insults, respectively. The average out of the pocket expenditure on antiseizure drugs annually amounted to 19% of the gross national product (GNP)/capita, which was borne by family members in more than two-thirds of the subjects. Almost 60% reported epilepsy having affected their education, 40% their employment, and 90% their marital prospects. Female patients were less often employed outside their homes and had more marital problems compared with males.

CONCLUSIONS

In addition to high seizure burden, DRE adversely affects the pursuit of higher education, employment, and marriage. Besides the direct cost of epilepsy, these issues augment both the patient and the caregiver's liability. Socioeconomic consequences of DRE are widely prevalent in developing countries, and this study highlights the need to address them.

Traditional practices and perceptions of epilepsy among people in Roma communities in Bulgaria

PURPOSE

We attempted to identify cultural aspects of epilepsy among the Roma community in Bulgaria by elucidating cultural beliefs, traditional treatments, and potential markers of stigma.

METHODS

We established representative discussion groups among five distinct Roma subgroups (Lom, Kalderas, Thracian Tinsmiths (Tinkers), Kyustendil Xoroxane and Kopanari) from different Bulgarian regions. Data about local beliefs and treatment strategies were gathered.

RESULTS

Most people were familiar with convulsions but non-convulsive focal seizures were seen not as epileptic but mainly as a "mental problem". Beliefs about putative etiologies for epilepsy were not uniform as some considered environmental and external factors such as high environmental temperatures, electric shocks, loud music, and fever as causes of seizures while others listed bad experiences, stress, trauma, and fear as possible causes. Epilepsy was seen by some as a divine punishment or resulting from black magic. Most considered epilepsy shameful and an obstacle to children attending school. Despite local differences, there was a uniform belief that epilepsy is incurable by Western medicine and people usually resort to traditional healers. A variety of rituals performed by local healers to treat epilepsy were described.

DISCUSSION

Misconceptions about epilepsy may contribute to stigmatization in this population; this may in turn contribute to a high treatment gap in this group. As a result, the majority of Roma children with epilepsy are likely to leave school early, are greatly limited in their choice of spouse (particularly girls), and marriages often occur between people with epilepsy or those with a family history of epilepsy.

Evaluation of sleep quality in spouses of people with epilepsy

OBJECTIVE

The objective of this study was to evaluate the spouses of people with epilepsy with and without a history of seizures during sleep in terms of depression, anxiety, and sleep quality.

METHODS AND MATERIALS

This prospective, cross-sectional study was conducted in three groups of 18-55 year olds, who were at least primary school graduates. The 1st group consisted of healthy spouses of 30 healthy volunteers with age and sex matched with the other groups. The 2nd group comprised spouses of 30 people with epilepsy who had been married for at least one year and had no history of seizures during sleep. The 3rd group consisted of spouses of 30 people with epilepsy who had been married for at least one year and had a history of at least one seizure during sleep in the course of the previous year. The questionnaire including demographic data, Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) was applied to all participants.

RESULTS

The mean age of the 1st group was 35.07 ± 8.33 years, that of the 2nd group was 36.47 ± 7.63 years, and that of the 3rd group was 35.33 ± 6.05 years. There was no significant age difference between the groups (p = 0.740). The depression scores of the 2nd and the 3rd groups were significantly higher than that of the 1st group (p < 0.001, for both). The anxiety scores of the 3rd group were significantly higher than those of the 1st and the 2nd groups (p < 0.001 and p = 0.001, respectively). Thirty percent (n = 9) of the 1st group, 40% (n = 12) of the 2nd group, and 70% (n = 21) of the 3rd group had poor sleep quality. The sleep disorder rate in the 3rd group was significantly higher than in the 1st and the 2nd groups (p = 0.002 and p = 0.020, respectively). When the PSQI subscales were examined, the sleep quality, sleep latency, usual sleep efficiency, daytime dysfunction, and the total sleep total score were significantly higher in the 3rd group than the 1st and the 2nd groups. The patients in the third group had significantly higher scores of sleep duration, sleep disturbance, and sleep medication use than those in the 1st group.

CONCLUSION

We found out that the PSQI score, which reflected the sleep quality, was poor in the spouses of people with epilepsy, who had seizures during sleep. To the best of our knowledge, these findings are the first in the literature on this subject.