Neural imaginaries at work: Exploring Australian addiction treatment providers' selective representations of the brain in clinical practice

Children's understanding of epilepsy: A qualitative study

PURPOSE

To use a qualitative research approach to determine children's understandings of epilepsy and their epilepsy treatment.

METHODS

Children aged 7-16 years with physician-confirmed active epilepsy (i.e., having had an epileptic seizure in the past year and or currently taking antiepileptic drugs (AEDs), and not known to have an intellectual disability, were invited to participate. Children had semi-structured interviews separately on two occasions. Between the first and second interviews, an observation of a routine epilepsy clinic appointment of individual children was conducted, and was then discussed during the second interview. Participatory research tools were used in both child interviews to facilitate discussions. Interviews were audio recorded and transcribed, pseudonymized and entered into NVivo (version 12, QSR International). Data were analyzed using a thematic approach.

RESULTS

Twenty-three children of mean age 10.1 years (range 8-14), mean duration of epilepsy of 4.6 years (range 2-10) were enrolled. Twelve were 12 female; 7 had focal, 14 had generalized, and 2 had combined epilepsy; 20 were on monotherapy; and 16 had tried previous AEDs. All had an initial (first) interview; 20 were observed during a clinic appointment and had a second interview. Five broad themes emerged: understanding of epilepsy; understanding of seizures; understanding of medication; understanding of children's role in clinical appointments; influences on children's understanding. Children spoke about what epilepsy meant by describing the physical sensations of having a seizure or through the act of taking medication. Children described the role they had, or felt they should have, but reported challenges in being meaningfully involved in clinical appointments. While healthcare professionals were initial information nodes, epilepsy information from parents appeared to be more significant for children.

CONCLUSIONS

The perspectives of children with epilepsy are valuable for clinicians to understand; assumptions should not be made that children's views can be accessed via parents. Clinicians need to be constantly aware of children's views and ways of understanding and communicating about their epilepsy. To support this, the research - drawing on children's words, meanings, and stories - was used to inform an easily accessible, gender-neutral, animation about epilepsy that provides information about the condition, seizures, and medication (https://youtu.be/MO7xXL2ZXP8).

A consideration of the social dimensions and implications of neuroimaging research in global health, as related to the theory-ladened and theory-generating aspects of technology

Drawing on insights from sociology, anthropology, and the history of science and medicine, this paper considers some of the social dimensions and implications for neuroimaging research undertaken within low- and middle-income countries (LMICs). It highlights three key inter-connected issues: (1) technologies for enhancing understandings of ill-health are theory-laden; (2) such technologies are theory-generating; and (3) studies of mental ill-health can also introduce new idioms for understanding subjective distress. The paper unpacks and explores these issues. It argues that the use of neuroimaging technologies in population research has the potential to contribute to solidifying - or even introducing - a biological (and specifically brain-based) understanding of mental ill-health within the communities under study. Examples from studies of neuroscience and society in various high-income countries (HICs) where neuroimaging is popular within public discourse illustrates how this can happen, and with what effects. The social dimensions and implications of neuroimaging are issues that all researchers using these technologies need to not only anticipate, but also explicitly plan for (and potentially seek to mitigate). Without adequate consideration, neuroimaging research carries with it particular risks in relation to extending the epistemological coloniality associated with HIC-sponsored studies conducted within LMIC settings.