Patient, caregiver, and health care practitioner knowledge of, beliefs about, and attitudes toward epilepsy

Challenges and needs of epilepsy management in primary care (from the perspective of family physicians/general practitioners): A cross-sectional study

OBJECTIVE

Family physicians are expected to have sufficient knowledge and skills in epilepsy management due to frequent encountering with epileptic patients for prescribing antiepileptics, providing preventive services such as vaccination, pre-conceptional counseling, or managing acute health problems of the patients. This study aimed to determine family physicians' challenges and needs regarding managing epilepsy in primary care.

METHODS

This cross-sectional study was carried out with the family physicians working in Family Health Centers representing the four districts of Istanbul in 2020. After enrolling sociodemographic characteristics, epilepsy knowledge, and self-efficacy questionnaire were filled out by the physicians themselves, and the difficulties and needs in the follow-up of the patients with epilepsy were evaluated with open-ended questions.

RESULTS

Two hundred and twenty-eight physicians participated in the study (48.7% F; mean age: 43.06 ± 8.82). Most of the physicians reported that they feel incompetent and hesitated while providing health reports (driving [83.3%], sport [95.5%] or work [70.2%]), and prescribing antiepileptics, especially during pregnancy (38.2%) and breastfeeding (31.2%). Despite their high awareness of psychosocial problems in epileptic patients, only 25% of physicians stated that they could make psychosocial assessments. There was no correlation between Epilepsy Knowledge and Self-efficacy scores and physicians' age, graduation period, and family medicine experience (p > .05). Most frequently encountered difficulties were reported as epilepsy-specific (follow-up of pregnant or pediatric patients, lack of information about epilepsy and antiepileptics). Most physicians (82.6%) wanted training in epilepsy management.

SIGNIFICANCE

The findings of our study suggest that family physicians need knowledge and training in epilepsy management. The main limitation of the present study is its cross-sectional design, which does not allow for causal or directional inferences.

One-day psychosocial education program for people with epilepsy: A continuation study of the "Epi-school"

Psychosocial education programs for people with epilepsy (PWE) can improve epilepsy knowledge and quality of life (QOL), whereas the availability of these programs is limited in Japan compared to other developed countries. This study evaluated the feasibility and effectiveness of a one-day group psychosocial education program named the "one-day Epi-school" for PWE and their relatives. The previous program (Epi-school) required consistent participation in three sessions, resulting in problems with program continuation rates, with 45.5% of PWE completing the program. Therefore, the "one-day Epi-school" was designed to provide information about epilepsy and address psychosocial issues related to coexisting epilepsy symptoms, such as self-stigma and self-esteem, while allowing participants to accomplish these programs within a single day. The study recruited a sample of 32 PWE and their relatives from a psychiatric clinic. They completed assessments of knowledge, self-stigma, self-esteem, and quality of life before and after the program. The results exhibited a significant increase in epilepsy knowledge after the intervention for PWE and their relatives. However, we could not identify other significant changes. The participation completion rate was 100%. The post-participation questionnaire proved beneficial to interact with other PWE. The study suggests that a single intervention, e.g., the one-day Epi-school, may be insufficient for enhancing other factors, yet it can be an adequate opportunity for learning and interacting. It is also necessary to implement future studies with larger sample sizes, a control group, and prolonged follow-up periods for the program's value and validity.

Self-management education for children with epilepsy and their caregivers. A scoping review

Self-management education programs have been highly successful in preparing people to manage medical conditions with recurring events. A detailed curriculum for epilepsy patients, and their caretakers, is lacking. Here we assess what is available for patients who have disorders with recurring events and offer an approach to developing a potential self-care curriculum for patients with seizures and their caregivers. Among the anticipated components are a baseline efficacy assessment and training tailored to increasing self-efficacy, medication compliance, and stress management. Those at risk of status epilepticus will also need guidance in preparing a personalized seizure action plan and training in how to decide when rescue medication is appropriate and how to administer the therapy. Peers, as well as professionals, could teach and provide support. To our knowledge, no such programs are currently available in English. We encourage their creation, dissemination, and widespread use.

Families' Knowledge Change in Paediatric Drug Resistant Epilepsy: A Novel Clinic Model

BACKGROUND

Epilepsy is a chronic condition that affects approximately 95,000 Ontarians, of whom approximately 15,000 are children under the age of 18. Drug resistant epilepsy (DRE) will affect around 30% of these children who will require more advanced care due to their medical complexities. The purpose of this study is to determine if receiving care in a paediatric Comprehensive Epilepsy Clinic (CEC) is associated with positive outcomes for children living with DRE and their families by looking at three health outcomes: 1) families' knowledge of their child's diagnosis and treatment plan, 2) navigational access to both the hospital and community epilepsy services, and 3) health behaviours.

METHODS

This was a prospective cohort study in which families of children diagnosed with DRE would be exposed to a CEC care model for the first time and followed for 6-months after enrollment. This was analyzed by utilizing surveys from new families at baseline and 6 months post receiving care within a CEC.

RESULTS

Results revealed a statistical significance in change of knowledge in families' knowing the type of epilepsy their child has and what epilepsy co-morbidities are. Families' also had a significant change in utilizing hospital epilepsy resources and knowing who to contact in the community and hospital for their epilepsy related questions.

CONCLUSION

A CEC model improves families' knowledge about epilepsy diagnosis and treatment plan, navigational access to both the hospital and community epilepsy services, and health behaviours.

Statins as an antiepileptogenic or disease-modifying treatment? A survey of what UK patients and significant others think about repurposing and trialing them for epilepsy

OBJECTIVE

To identify the views of people with epilepsy (PWE), and their significant others, on the repurposing and trialing of statins as a potential antiepileptogenic or disease-modifying treatment for those who have had the first seizure.

METHODS

Online questionnaire. Participants needed to be aged ≥ 16 years, UK residents, and able to independently complete a questionnaire in English. User groups distributed study adverts. Embedded infographics explained repurposing, why anti-seizure treatment is not typically started after a first seizure and the nature of randomized placebo-controlled trials (RCTs). The questionnaire asked participants to reflect and rate their expected willingness to have started an unspecified treatment after their first seizure/s (or that of the person with epilepsy they knew). They also rated willingness if the treatment were a statin, views of statins, the importance of an RCT of statins to their community, the outcomes it should assess, and their willingness to have taken part in it. The estimated number needed for the survey was 324.

RESULTS

Responses from 213 persons were analyzed; 111 (52.1%) were PWE and 102 (47.9%) significant others. The median years diagnosed was 10 and PWE suffered from relatively severe epilepsy. One hundred and seventeen (54.9%) said they would have started an unspecified treatment after their first seizure/s (or supported the person with epilepsy they knew to have). A similar proportion (55.4%) said they would have started the treatment if it were a statin. Participants' main concern about statins, expressed by 79%, was their possible side effects. Repurposing was a concern for only 25%. Most (85.8%) rated an RCT of statins as of extreme or high importance; 54.4% said they would have participated.

CONCLUSION

The PWE and significant others (SOs) responding to our survey expressed views towards repurposing statins that were generally positive and indicate a trial in those who have had a first seizure might be feasible. Concerns regarding side effects are common. Our findings could help optimize a future trial's design and the case for funding. Limitations include that we did not survey persons who had experienced a first seizure and did not go on to develop epilepsy. Also, persons with uncontrolled epilepsy were overrepresented.

Identification and referral of patients with refractory epilepsy from the primary to the tertiary care interface in New South Wales, Australia

OBJECTIVES

This mixed-method feasibility study conducted in New South Wales (NSW), Australia, aimed to explore clinical practices around the identification of patients with refractory epilepsy and referral from primary care to Tertiary Epilepsy Centers. The perceptions of general practitioners, neurologists, and adults living with refractory epilepsy were considered.

METHODS

Fifty-two data collection events were achieved through 22 semi-structured interviews with six neurologists and 12 adults who currently have, or have had refractory epilepsy, and four family members, 10 clinical observations of patient consultations and 20 surveys with general practitioners. A thematic analysis was conducted on the qualitative data alongside assessment of observational fieldnotes and survey data.

FINDINGS

Two main themes emerged: 1) Patient healthcare pathways and care experiences highlighted the complex and deeply contextualized experiences of both patients and healthcare professionals, from first identification of people's seizures, in primary and community care settings, to referral to Tertiary Epilepsy Centers, shedding light on a fragmented, nonstandardized referral process, influenced by both individual and shared-care practices. 2) Factors impacting referrals and patient pathways indicated that onward referral to a Tertiary Epilepsy Center is affected by the knowledge, or the lack thereof, of healthcare professionals regarding treatment options. Barriers include limited person-centered care, shared decision-making, and refractory epilepsy education for healthcare professionals, which can delay patients' disease identification and can hinder speedy referral pathways and processes, in Australia for up to 17 years. In addition, person-centered communication around care pathways is affected by relationships between clinicians, patients, and family members.

CONCLUSION

This study has identified a noticeable lack of standardized care across epilepsy-related healthcare sectors, which recognizes a need for developing and implementing clearer epilepsy-related guidelines and Continuing Professional Development in the primary and community care settings. This, however, requires greater collaboration and commitment in the primary, community, and tertiary care sectors to address the ongoing misconceptions around professional roles and responsibilities to optimize shared-care practices. Ultimately, prioritizing person-centered care on both patients' and professionals' agendas, in order to improve satisfaction with care experiences of people living with complex epilepsy.

Implementing standardized provider documentation in a tertiary epilepsy clinic

OBJECTIVE

To incorporate standardized documentation into an epilepsy clinic and to use these standardized data to compare patients' perception of epilepsy diagnosis to provider documentation.

METHODS

Using quality improvement methodology, we implemented interventions to increase documentation of epilepsy diagnosis, seizure frequency, and type from 49.8% to 70% of adult nonemployee patients seen by 6 providers over 5 months of routine clinical care. The main intervention consisted of an interactive SmartPhrase that mirrored a documentation template developed by the Epilepsy Learning Healthcare System. We assessed the weekly proportion of complete SmartPhrases among eligible patient encounters with a statistical process control chart. We used a subset of patients with established epilepsy care linked to existing patient-reported survey data to examine the proportion of patient-to-provider agreement on epilepsy diagnosis (yes vs no/unsure). We also examined sociodemographic and clinical characteristics of patients who disagreed vs agreed with provider's documentation of epilepsy diagnosis.

RESULTS

The median SmartPhrase weekly completion rate was 78%. Established patients disagreed with providers with respect to epilepsy diagnosis in 18.5% of encounters (κ = 0.13), indicating that they did not have or were unsure if they had epilepsy despite having a provider-documented epilepsy diagnosis. Patients who disagreed with providers were similar to those who agreed with respect to age, sex, ethnicity, marital status, seizure frequency, type, and other quality-of-life measures.

CONCLUSION

This project supports the feasibility of implementing standardized documentation of data relevant to epilepsy care in a tertiary epilepsy clinic and highlights an opportunity for improvement in patient-provider communication.

Management and attitudes toward patients with epilepsy in general practice: How far have we come in three decades?

BACKGROUND

Previous surveys of Australian primary care physicians' attitudes regarding epilepsy and persons with epilepsy (PWE), conducted 20-30 years ago, identified the need for further education in epilepsy care for frontline clinicians. This follow-up study of general practitioners (GPs) in Sydney was conducted to determine the degree of changes in knowledge, attitudes, and management of PWE, with the purpose of evaluating if there had been significant improvement during this period.

METHODS

A questionnaire, evaluating various aspects of epilepsy care, including investigations, preferred healthcare provider (HCP), and attitudes toward epilepsy was developed, largely based on the previous work, piloted, and completed by a representative sample of Sydney GPs.

RESULTS

A total of 52 completed responses were received. Thirty-six out of 47 GPs (77%) chose neurologists as the most important HCP followed by the GP (9/47; 18.7%). Almost half of the GPs (25/51; 49%) mentioned that they never initiated antiepileptic medication (AEM) therapy by themselves yet half of these GPs would alter the neurologist's regimen, without necessitating referral back to that neurologist. Another 27% (14/51 GPs) rarely commenced AEM therapy. Six out of 50 GPs did not mention an electroencephalogram (EEG) as a routine investigation, and 21/50 did not mention magnetic resonance imaging (MRI) as routine for PWE. The five most commonly used AEMs, identified by at least 10% of respondents, were sodium valproate (42), carbamazepine (37), levetiracetam (31), lamotrigine (16), and phenytoin (15). Emotional, behavioral, and psychosocial issues were perceived to be more common among PWE; however, they could contribute equally well to society as people without epilepsy.

CONCLUSION

The results of the study indicate a perceptual shift regarding GP's attitudes to epilepsy; however, there remain deficiencies in knowledge, particularly with regard to investigations and management. The study highlights the need for more formal training of GPs in caring for PWE.

Knowledge, attitudes, and practices of health sciences students regarding epilepsy at the end of their curriculum in Benin

OBJECTIVE

The main objective of this study was to evaluate the knowledge, attitudes, and practices (KAP) of health sciences students regarding epilepsy at the end of their curriculum in Benin.

METHODS

We conducted a cross-sectional survey among medical, pharmacy, nursing, and midwife students in their last year of health sciences training in the University of Abomey-Calavi in Benin. Students completed a self-administered questionnaire, containing items addressing demographics, epilepsy treatment, diagnosis, clinical practice, and social tolerance regarding a person with epilepsy (PWE).

RESULTS

The response rate to our survey was 87.7% (n = 164). The sample consisted of 64 medical students, 22 pharmacy students, 43 nursing students, and 35 midwife students. They were divided into 95 female subjects and 69 males; sex ratio was 0.7. The mean age of participants was 23.6 ± 1.8 years. The mean scores for epilepsy knowledge, practices, and attitudes were respectively 7.6 ± 1.7 out of a maximum score of 11, 3.9 ± 1.8 out of 8, and 9.6 ± 0.8 out of 10. The KAP overall score was 21.1 ± 3.4 out of a maximum score of 29.0. The variables associated with the overall KAP score were training school, gender, having heard about epilepsy before health sciences studies (p = 0.017), and having a relative with epilepsy (p = 0.001). Male students and medical school students had significantly better overall KAP score than female students or the other training schools respectively (p < 0.001).

SIGNIFICANCE

These findings support the need to improve the health sciences students' knowledge of epilepsy, in particular, during their training.

Assessing Treatment Fidelity within an Epilepsy Randomized Controlled Trial: Seizure First Aid Training for People with Epilepsy Who Visit Emergency Departments

Purpose

To measure fidelity with which a group seizure first aid training intervention was delivered within a pilot randomized controlled trial underway in the UK for adults with epilepsy who visit emergency departments (ED) and informal carers. Estimates of its effects, including on ED use, will be produced by the trial. Whilst hardly ever reported for trials of epilepsy interventions—only one publication on this topic exists—this study provides the information on treatment fidelity necessary to allow the trial's estimates to be accurately interpreted. This rare worked example of how fidelity can be assessed could also provide guidance sought by neurology trialists on how to assess fidelity.

Methods

53 patients who had visited ED on ≥2 occasions in prior year were recruited for the trial; 26 were randomized to the intervention. 7 intervention courses were delivered for them by one facilitator. Using audio recordings, treatment “adherence” and “competence” were assessed. Adherence was assessed by a checklist of the items comprising the intervention. Using computer software, competence was measured by calculating facilitator speech during the intervention (didacticism). Interrater reliability was evaluated by two independent raters assessing each course using the measures and their ratings being compared.

Results

The fidelity measures were found to be reliable. For the adherence instrument, raters agreed 96% of the time, PABAK-OS kappa 0.91. For didacticism, raters' scores had an intraclass coefficient of 0.96. In terms of treatment fidelity, not only were courses found to have been delivered with excellent adherence (88% of its items were fully delivered) but also as intended they were highly interactive, with the facilitator speaking for, on average, 55% of course time.

Conclusions

The fidelity measures used were reliable and showed that the intervention was delivered as attended. Therefore, any estimates of intervention effect will not be influenced by poor implementation fidelity.

Sociocultural aspects and different types of stigmatization in epilepsy

This literature review deals with knowledge and beliefs about epilepsy and with the attitude of patients, relatives, and society as a whole towards epilepsy. It discusses the stigma that is associated with the  disease and has a strong impact on patients with epilepsy and their  families. The problems of stigma or related concepts in different countries are analyzed.

Knowledge, attitudes, and first-aid measures about epilepsy among primary school teachers in northern Iran

OBJECTIVE

To assess knowledge, attitudes, and first-aid measures about epilepsy among primary school teachers.

METHOD

This cross-sectional study was conducted with participation of 342 primary school teachers during September 2016 to January 2017 in cities of Babol and Qaem-Shahr in Mazandaran Province in northern Iran. Primary schools were selected using simple random sampling. Data were collected through interviews using a structured questionnaire. The knowledge section included general knowledge, causes, symptoms, seizure triggers, first-aid measures, and recommended treatments. The Likert scale was used for the attitudes section. Answers about first-aid measures were categorized as helpful or harmful.

RESULTS

The level of total knowledge score of 25 (7.7%) teachers was very high, 140 (43.3%) high, 141 (43.8%) moderate, and 17 (5.2%) low. The mean score about general knowledge was as follows: 6.1 (1.9), range = 0-9; causes 6.3 (1.9), range = 0-10; symptoms of seizures 8.5 (2.5), range = 0-12; and first-aid measures 6.8 (2.0), range = 0-11. Some 83% knew not taking anticonvulsants regularly could trigger seizures, and all teachers said a person with epilepsy should go see a physician. Attitudes were generally positive except for marriage and having children. The level of first-aid measures score of 8 (7.2) teachers was very high, 79 (70.5) high, 25 (22.3) low. Teachers with teaching experience at special schools took more helpful measures CONCLUSIONS: The knowledge of teachers about epilepsy was insufficient, attitudes toward people with epilepsy were generally positive, and first-aid measures at the last witnessed seizure were fairly helpful. Having teaching experience in special schools had a positive influence over knowledge and taking appropriate first-aid measure at time of the last witnessed seizure.

First-aid management of tonic-clonic seizures among healthcare personnel: A survey by the Apulian section of the Italian League Against Epilepsy

INTRODUCTION

To evaluate the knowledge of healthcare workers about first-aid measures to be performed during and after a tonic-clonic seizure.

METHODS

One hundred and fifty-four healthcare workers (86 physicians) working at 8 tertiary hospitals in the Apulia region, Italy, responded to a questionnaire comprising of 28 questions based on available Italian and international recommendations about what to do during a tonic-clonic seizure.

RESULTS

One hundred and fifty-four healthcare workers completed and returned surveys with a response rate of 96.25%. There were 55 nurses (35.7%), 86 physicians (55.8%), and 13 healthcare workers with different roles (Electroencephalograph technicians, psychologists, social workers). Among physicians, there were 7 cardiologists, 3 surgeons, 12 infectious-disease specialists, 11 internal medicine specialists, 2 psychiatrists, 2 gynecologists, 27 specialists working in the emergency department, and 22 physicians with different specializations. Nearly 90% of the respondents identified head protection as important first aid, while 100% responded to not keep the legs elevated. To avoid tongue bite, both physicians and other healthcare workers would put something in the mouth (54.0%), like a Guedel cannula (71.0%) fingers (29.5%). Grabbing arms and legs, trying to stop the seizure, would be potentially performed by 11.6% of our sample. Physicians would administer a benzodiazepine during the seizure (65.7%) and during the postictal phase (29.2%), even if the patient is known to have epilepsy (23.7%), and in this case, 11.3% of respondents would administer the usual antiepileptic medications. More than half of respondents would call the emergency telephone number, because of necessary hospitalization in case of tonic-clonic seizure, even if it is experienced by a patient known to have epilepsy.

CONCLUSION

Our survey suggests the need for epilepsy educational programs on first-aid management of seizures among healthcare workers.

Epilepsy or a Seizure Disorder? Parental Knowledge and Misconceptions About Terminology

OBJECTIVE

To assess primary caregiver understanding of the term epilepsy.

STUDY DESIGN

A cross-sectional telephone survey evaluated understanding of the term epilepsy among primary caregivers of children diagnosed with epilepsy at an urban referral center during a 24-month period. Three measures of primary caregiver understanding were used: (1) identifying if their child had a seizure disorder, epilepsy, or both; (2) providing an open-ended definition of epilepsy; and (3) selecting from a multiple-choice definition of epilepsy. Caregivers with 3 correct answers were assigned the greatest knowledge score. Associations with possible predictor variables were analyzed.

RESULTS

Caregivers for 75 of 116 eligible patients were contacted successfully. Of those, 55 of 75 met eligibility criteria; 45 of the eligible caregivers completed the survey. Twenty-six of 45 caregivers (58%) identified that their child had both a seizure disorder and epilepsy, 5 of 45 (11%) provided a correct open-ended definition of epilepsy, and 16 of 45 (36%) selected the correct multiple-choice definition. Fifteen caregivers (33%) had no correct answers. Seventeen (38%) answered 1, 9 (20%) answered 2, and 4 (9%) answered all 3 measures correctly. Caregivers with greater self-rated understanding had greater epilepsy knowledge scores (P = .008). Having a child neurologist as the first person to discuss the diagnosis with the caregiver also predicted a greater epilepsy knowledge score (P = .04).

CONCLUSIONS

Most primary caregivers of children with epilepsy have a poor understanding of the term epilepsy. Changes are needed in how we educate caregivers about the meaning of this term.

Exploring the role of knowledge of condition and psycho-social profiles of young people with epilepsy during transition

Transitioning from paediatric to adult care can be a particularly challenging time for young people with epilepsy and research has shown that there are a range of factors which may influence a young person's ability to successfully cope with this difficult time. The following study aimed to explore the psychosocial characteristics of this transitioning population, as well as investigate how knowledgeable the young person and their parent/carer are of their own condition throughout transition. Young people with epilepsy were recruited from two specialist epilepsy clinics in the North West and allocated to one of three groups; Group 1 pre-transition, Group 2 transitioning, and Group 3 post-transition. Results found that the young person's knowledge increased significantly throughout transition, whilst parent/carer's knowledge decreased. In addition, anxiety was found to be significantly lower in Group 2 (transitioning group) compared to Group 1 (pre-transition) and Group 3 (post-transition) and a number of significant gender differences were also identified across the groups. The study highlights the importance of considering all relevant psychosocial factors, such as anxiety, gender and the degree of knowledge the individual holds of their own condition during the transition process in order to develop psycho-educational programmes and transition pathways.

Knowledge, attitudes, and practices among mothers of children with epilepsy: A study in a teaching hospital

OBJECTIVE

Knowledge about epilepsy and attitudes towards patients with epilepsy can affect measures taken to manage epilepsy and seizures. Support and understanding of mothers is invaluable in enabling children with epilepsy to develop normal life skills in living with epilepsy. In order to identify the educational needs of mothers of children with epilepsy, their knowledge, attitudes, and practices should be assessed. Therefore, we interviewed a group of mothers of children with epilepsy who were referred to a pediatric neurology clinic in a teaching hospital. The objective of this study was to assess knowledge, attitudes, and practices among mothers of children with epilepsy in order to identify their educational needs.

METHODS

In the period of August 2014 to January 2015, mothers whose children were diagnosed with epilepsy for at least six months participated in this cross sectional study, while returning to the neurology clinic of a pediatric hospital for usual follow-up. Data were collected through face-to-face interviews, held by trained female general practitioners. The interviewer used questions from a questionnaire. The knowledge section of the questionnaire included questions regarding prevalence and general knowledge about epilepsy, its etiology, symptoms, and seizure provoking factors. The attitudes section included statements regarding the mother's attitudes towards epilepsy and patients with the disease. The practice section included questions about first-aid measures taken by mothers who had witnessed generalized seizures by the time of interview.

RESULTS

Responses of 206 participants were analyzed. At least 83% of mothers knew that epilepsy is a noncontagious neurological disorder which can be treated by regular drug therapy. In spite of demonstrating good knowledge scores, the majority of mothers felt the need for further training in epilepsy. More than 98% of mothers were against the idea that patients with epilepsy should hide their disease. Though having been referred to physicians, 84% of mothers had provided their children with at least one ineffective treatment, mostly based on superstitions.

CONCLUSION

Mothers' level of knowledge of epilepsy was good, and their attitudes towards epilepsy were mainly positive. Regarding the right first-aid measures at time of the last seizure, mothers' practices were acceptable. However, there is still room for improvement regarding avoiding the wrong measures. It is suggested that both practice-related issues and other aspects of epilepsy be taken into account in epilepsy-related education programs.

Epilepsy-associated levels of perceived stigma, their associations with treatment, and related factors: A cross-sectional study in urban and rural areas in Ecuador

BACKGROUND

Epilepsy is felt to be a stigmatizing condition. Stigma has been considered one of the major factors contributing to the burden of epilepsy and to the treatment gap. Stigma has a negative effect on the management of people with epilepsy (PWE). Furthermore, lack of information and inappropriate beliefs are still the factors that most contribute to stigma and discrimination. In this study, we assessed the level of perceived stigma in urban and rural areas and we report their association with in antiepileptic drug (AED) use, effects on seeking medical care, and stigma-associated factors.

METHODS

A cross-sectional study in urban and rural areas in Ecuador from January 2015 until May 2016. People with a confirmed diagnosis of epilepsy were included using three sources of information. The survey was implemented through a questionnaire to determine perceived stigma and evaluate the factors associated. The perceived stigma was measured using the revised Jacoby's stigma scale to detect differences in levels of stigmatization. Access to treatment was evaluated through self-report of AED use, and attainment of medical care and stigma-associated factors were assessed. Furthermore, a multivariate analysis adjusted for possible confounders was performed using stigma as the outcome variable.

RESULTS

A total of 243 PWE were interviewed, 65.8% reported feeling stigmatized and 39.1% reported a high stigmatized level. We found a significant difference in high stigma perception in the urban area compared to the rural area. However, the lack of use of AEDs was significantly higher in the rural areas. No significant correlation was found between use of AEDs and the levels of perceived stigma. PWE who did not talk about their condition and those who did not feel well informed about their epilepsy had significantly higher perceived stigma levels. Additionally, the multivariate analysis demonstrated that area, educational level, type of seizure, talk about epilepsy, and information were associated with perceived stigma.

CONCLUSION

The stigma perception was relevant in all PWE. We found a higher stigma level perception in the urban compared to rural area. Moreover, the lack of treatment was a serious problem mainly in rural areas. Even though we did not find that perceived stigma was associated with AED use, our study pointed out the influence of educational level and information related to stigmatization. Consequently, a coordinated effort to reduce stigma should include strategies focused on PWE education and information about their condition.

Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy

BACKGROUND AND AIM

Adherence to treatment is a critical component of epilepsy management. This study examines whether addressing antiepileptic drug (AED) side effects at every visit is associated with increased patient-reported medication adherence.

PATIENTS AND METHODS

This study identified 243 adults with epilepsy who were seen at two academic outpatient neurology settings and had at least two visits over a 3-year period. Demographic and clinical characteristics were abstracted. Evidence that AED side effects were addressed was measured through 1) phone interview (patient-reported) and 2) medical records abstraction (physician-documented). Medication adherence was assessed using the validated Morisky Medication Adherence Scale-4. Complete adherence was determined as answering "no" to all questions.

RESULTS

Sixty-two (25%) patients completed the interviews. Participants and nonparticipants were comparable with respect to demographic and clinical characteristics; however, a smaller proportion of participants had a history of drug-resistant epilepsy than nonparticipants (17.7% vs 30.9%, P=0.04). Among the participants, evidence that AED side effects were addressed was present in 48 (77%) medical records and reported by 51 (82%) patients. Twenty-eight (45%) patients reported complete medication adherence. The most common reason for incomplete adherence was missed medication due to forgetfulness (n=31, 91%). There was no association between addressing AED side effects (neither physician-documented nor patient-reported) and complete medication adherence (P=0.22 and 0.20).

DISCUSSION AND CONCLUSION

Among patients with epilepsy, addressing medication side effects at every visit does not appear to increase patient-reported medication adherence.

Knowledge and Attitude toward Epilepsy of Close Family Members of People with Epilepsy in North of Iran

Background. Knowledge and attitudes are required for relatives of people with epilepsy to allow them to better understand and cope with this condition. This study evaluated the knowledge and attitudes of family members of people with epilepsy about the disease. Methods. This cross-sectional survey was conducted using a self-administered questionnaire completed by close family members of people with epilepsy at the outpatient clinic of a medical university. The questionnaire included 25 items that determined the demographics and information on the level of knowledge and attitudes about epilepsy. Results. The 124 participants had an average age of 36.88 ± 10.68 years. The mean knowledge score was 10.32 ± 2.25 (range: 4 to 15). 87.1% of respondents answered that epilepsy is a brain disorder, 39 (31.5%) said epilepsy is inherited. As a whole, 62 (50%) had good knowledge about the disease. The mean score of attitude was 7.25 ± 1.54 (range: 2 to 10). 83.9% of respondents believed that a person with epilepsy can get married and get pregnant (76.6%). Overall, 15 (12.1%) had negative attitudes and 109 (87.9%) had positive attitudes. Conclusion. The main findings of this study indicated good knowledge and a positive attitude about epilepsy among family members of people with epilepsy.

Association of knowledge about epilepsy with mood and self-efficacy in Korean people with epilepsy

PURPOSE

We determined the level of knowledge about epilepsy in Korean people with epilepsy (PWE) and evaluated whether this is associated with self-efficacy, perceived stigma, anxiety, and depressive mood in these patients.

METHODS

This was a cross-sectional multicenter study. A total of 530 PWE participated from 31 secondary or tertiary hospitals in Korea. Knowledge about epilepsy was assessed using 34 medical items (EKP-M) of the Epilepsy Knowledge Profile-General. Additional questionnaires included the Epilepsy Self-Efficacy Scale (ESES), Stigma Scale, and Hospital Anxiety and Depression Scale (HADS). Multiple linear regression analyses were used.

RESULTS

The mean EKP-M score was 22.2 (SD: 4.1). By univariate analyses, the EKP-M was related to ESES (r=0.220, p<0.001) and HADS-D (r=-0.154, p<0.001) scores but not to the Stigma Scale or HADS-A. By linear regression analyses, after adjusting for the confounding variables, the higher EKP-M scores were independently related to both higher ESES (p<0.001) and lower HADS-D scores (p<0.05).

CONCLUSION

Korean PWE have a relatively low level of knowledge about their condition. Knowledge about epilepsy is associated with a high level of self-efficacy and less depressive symptoms in affected individuals.

Association of adherence to epilepsy quality standards with seizure control

OBJECTIVE

We assessed the relationship between adherence to epilepsy quality measures (EQM) and seizure control over 2-3 years in a retrospective cohort study.

METHODS

6150 patients were identified at two large academic medical centers with a primary or secondary diagnosis of epilepsy, were 18-85 years old and seen in outpatient general neurology or epilepsy units between June 2011 and May 2014. Patients were included if: their initial visit was between June 2011 and June 2012, treatment was with ≥1 anti-seizure drug, there was ≥1 visit per year during the timeframe, and seizure frequency was documented at initial and final visits, yielding 162 patients/1055 visits from which socio-demographic, clinical and care quality data were abstracted. Quality care was assessed as (1) percent adherence to up to 8 eligible EQM, and (2) defect-free care (DFC: adherence to all eligible EQM). Seizure control (SC) was defined as ≥50% reduction in average seizures/month between initial and final visits. Chi-square and t-test compared care quality with seizure control. Logistic regression was used to assess the relationships between SC, quality of care and subspecialist involvement.

RESULTS

Care quality, reflected by documentation of seizure frequency, addressing therapeutic interventions, and referral to a comprehensive epilepsy center, all exceeded 80% adherence. Care quality as reflected by documentation of seizure type, etiology or syndrome; assessment of side effects, counseling about epilepsy safety and women's issues, and screening for psychiatric disorders ranged from 40 to 57%. Mean EQM adherence across all applicable measures was associated with greater seizure control (p=0.0098). DFC was low (=8%) and did not covary with seizure control (p=0.55). The SC and non-SC groups only differed on epilepsy etiology (p=0.04). Exploratory analysis showed that mean quality scores are associated with seizure control (OR=4.9 [1.3-18.5], p=0.017) while controlling for the effect of subspecialty involvement as a possible confounding variable.

CONCLUSIONS

Average quality of care but not defect-free care was associated with seizure control in this retrospective cohort.

The social context and the need of information from patients with epilepsy: evaluating a tertiary referral service

Objective Characterize the social profile and the need of information from patients with refractory epilepsy. Method A semi-structured questionnaire was applied to 103 patients to investigate sociodemographic aspects, pharmacotherapy and any doubts about epilepsy. Results Patients were highly dependent on having a free and accessible supply of antiepileptic drugs. Sixty-eight percent of the population was unemployed, and 26% confirmed receiving social security benefits due to epilepsy. Twenty-nine percent of the population reached high school. Eighty-five percent of the patients had at least one doubt about epilepsy; treatment and epilepsy aspects in general were the main topics. Conclusion : As observed in developed countries, patients with refractory epilepsy from a developing country also have high rates of unemployment and low educational levels. The results raise a concern about the need of information about epilepsy by patients and their families, urging the necessity to invest in strategies to solve this deficiency in knowledge.

Quality care in epilepsy: Women's counseling and its association with folic acid prescription or recommendation

OBJECTIVE

This study aimed to determine if annual counseling about contraception and pregnancy in the setting of treatment for epilepsy is associated with increased recommending or prescribing of folate.

METHODS

This is a retrospective cohort study with medical record abstraction. We selected records from 77 women of childbearing age who had two or more visits for epilepsy at a neurology clinic. The assessment included a review of documentation from the first three visits for epilepsy within a 24-month follow-up window. We defined perfect adherence to annual counseling about the impact of epilepsy treatment on contraception or pregnancy as defect-free care for women (DFCW). A recommendation that the patient take over-the-counter folate or a prescription for folate was independently abstracted from the chart at each visit.

RESULTS

The group of patients who received DFCW (N=28, 36.36%) and the group who did not receive DFCW (N=49, 63.63%) were comparable with respect to age, disease duration, baseline history of drug-resistant epilepsy (DRE), presence of concurrent psychiatric disease, epileptologist involvement, number of antiepileptic drugs (AEDs) prescribed, seizure type, and etiology. Twenty (71.4%) patients in the DFCW group and 42 (85.7%) in the non-DFCW group were not recommended or prescribed folic acid (p=0.12).

CONCLUSIONS

Even with annual documentation of counseling about how epilepsy treatment may affect contraception and pregnancy, the "action" of prescribing or recommending folic acid during the ensuing 24months is frequently omitted.

Knowledge, attitudes, and behavior among key people involved in the employment of people with epilepsy in southern Benin

PURPOSE

This study aimed to investigate knowledge, attitudes, and behavior among individuals working to achieve, or promote, the employment and retention in employment of people with epilepsy (PWE) in Benin.

METHODS

We interviewed 300 subjects using a self-administered questionnaire.

RESULTS

Knowledge: 93% had heard of epilepsy; 8.8% had at least one person with epilepsy (PWE) in their family; and 67.3% had witnessed a person having epileptic seizures. Attitudes and behavior: 95.3% and 95%, respectively, expressed their views that PWE should be able to enter mainstream education and that PWE should marry; 76.4% considered PWE equal to themselves; and 28.6% reported they would not hire a PWE. We found some associations between demographic characteristics and knowledge, attitudes, and behavior among respondents. A few unhelpful aspects of knowledge, attitudes, and behavior were identified.

CONCLUSIONS

Our study showed a fairly high level of accurate knowledge of epilepsy, but some misperceptions and unhelpful attitudes and practices toward PWE in Benin were noted. This study's findings can be used to help plan appropriate strategies based on correcting misperceptions concerning inclusion and retention in employment of PWE in Benin.

Safety, Awareness, and Familiarity regarding Epilepsy in Teenage Years (SAFETY): understanding the adolescents' perspective about their disease

OBJECTIVE

The objective of this study was to evaluate the understanding of adolescent patients regarding epilepsy.

METHODS

The SAFETY (Safety, Awareness, and Familiarity regarding Epilepsy in Teenage Years) questionnaire (content validity index: 0.96, Flesch readability score: 66.6) was administered to 165 cognitively normal adolescents with epilepsy (85 females, mean age: 15.2 ± 1.6 years, range: 13-18 years). The first part of the questionnaire was devised to evaluate knowledge about epilepsy and antiepileptic medications (SAFETY-K: 7 questions). The second part queried lifestyle modifications and safety (SAFETY-S: 10 questions). Female participants answered 5 additional questions related to reproductive health (RH questionnaire).

RESULTS

The correct response rate for the composite SAFETY questionnaire was 51.5%. The average rates of correct responses for the SAFETY-K and SAFETY-S questions were 47.9% and 53.9%, respectively. On univariate logistic regression analysis, factors which were significant predictors of correct responses included age (odds ratio: 1.8, C.I. = 1.3-2.4), race (Caucasian vs. African-American; odds ratio: 3.9, C.I. = 1.4-10.4), and employment of at least one parent in a professional occupation (odds ratio: 3.3, C.I. = 1.1-10.3). The correct response rate did not correlate with the duration of epilepsy, extent of seizure control, number of antiepileptic medications, parental educational, or (un)employment status. The mean rate of correct responses for the RH questions amongst teenage girls was 17.4%.

CONCLUSIONS

There is lack of awareness about epilepsy and its associated lifestyle modifications in adolescents with epilepsy seen at our institution. This is especially true in young adolescents, African-American patients, and those whose parents are not employed in professional occupations. Teenage girls with epilepsy appear to have limited knowledge with respect to contraception and childbearing.

Effective process or dangerous precipice: qualitative comparative embedded case study with young people with epilepsy and their parents during transition from children's to adult services

Background

Transition from children’s to adult epilepsy services is known to be challenging. Some young people partially or completely disengage from contact with services, thereby risking their health and wellbeing. We conducted a mixed-method systematic review that showed current epilepsy transition models enabling information exchange and developing self-care skills were not working well. We used synthesised evidence to develop a theoretical framework to inform this qualitative study. The aim was to address a critical research gap by exploring communication, information needs, and experiences of knowledge exchange in clinical settings by young people and their parents, during transition from children’s to adult epilepsy services.

Method

Qualitative comparative embedded Case study with 2 'transition’ cases (epilepsy services) in two hospitals. Fifty-eight participants: 30 young people (13–19 years) and 28 parents were interviewed in-depth (individual or focus group). Clinical documents/guidelines were collated. 'Framework’ thematic analysis was used. The theoretical framework was tested using themes, pattern matching and replication logic. Theory-based evaluation methods were used to understand how and why different models of service delivery worked.

Results

A joint epilepsy clinic for young people 14–17 years coordinated by children’s and adult services was more likely to influence young people’s behaviour by facilitating more positive engagement with adult healthcare professionals and retention of epilepsy-related self-care information. Critical success factors were continuity of care, on-going and consistent age-appropriate and person centred communication and repeated information exchange. Three young people who experienced a single handover clinic disengaged from services. Psychosocial care was generally inadequate and healthcare professionals lacked awareness of memory impairment. Parents lacked knowledge, skills and support to enable their child to independently self-care. Translation of transition policies/guidelines into practice was weak.

Conclusion

Findings make a significant contribution to understanding why young people disengage from epilepsy services, why some parents prevent independent self-care, and what constitutes good communication and transition from the perspective of young people and parents. The type of service configuration, delivery and organisation influenced the behaviours of young people at transition to adult services. The novel theoretical framework was substantially supported, underwent further post-hoc development and can be used in future practice/intervention development and research.

Epilepsy: What do health-care professionals in Riyadh know?

PURPOSE

The objective of this study was to report on the knowledge of epilepsy, as well as attitudes and practices toward individuals with epilepsy, among health-care professionals in Riyadh, the capital city of Saudi Arabia.

METHODS

A survey consisting of 23 questions pertaining to epilepsy awareness was distributed to health education workers (n=51), nutritionists (n=56), physicians (n=265), dentists (n=58), pharmacists (n=41), nurses (n=224), physiotherapists (n=65), and fifth-year medical students (n=62) in three tertiary hospitals in Riyadh.

RESULTS

Of the 822 respondents who completed the questionnaire, 100% had heard about epilepsy, and 92.6% would allow their children to interact with an individual who has epilepsy. However, 67% of respondents would not want their children to marry an individual with epilepsy, 97.9% of respondents believed that individuals with epilepsy should have the same employment opportunities as the general population, 10.5% believe that supernatural power is the cause of epilepsy, 67.2% did not know how to deal with an individual experiencing an epileptic episode, and 56% did not know that surgery was a treatment option for individuals with epilepsy in Saudi Arabia. Of the 822 respondents, 39% would not abide by a physician's advice not to operate a motor vehicle because of their illness, 91% of whom cited problems with the public transportation system as a reason for disregarding the doctor's advice. When asked if the participants had access to any information on how to deal with epilepsy during their professional training, 60.3% had access to such information during their graduate studies. Ninety-eight percent of those with access to this information were physicians and health-care educators (p<0.001). Physicians and health-care educators were significantly more aware of epilepsy than any of the other groups.

CONCLUSION

The level of epilepsy awareness among health-care professionals in Riyadh needs improvement.

Can an epilepsy nurse specialist-led self-management intervention reduce attendance at emergency departments and promote well-being for people with severe epilepsy? A non-randomised trial with a nested qualitative phase

Objectives

To (1) describe the characteristics and service use of people with established epilepsy (PWE) who attend the emergency department (ED); (2) evaluate the economic impact of PWE who attend the ED; (3) determine the effectiveness and cost-effectiveness of an epilepsy nurse specialist (ENS)-led self-management intervention plus treatment as usual (TAU) compared with TAU alone in reducing ED use and promoting well-being; (4) describe patients' views of the intervention; and (5) explore their reasons for attending the ED.

Design

Non-randomised trial with nested qualitative study.

Setting

The EDs of three inner London hospitals. The EDs each offer similar services and support a similar local population, which made a comparison of patient outcomes reasonable.

Participants

Adults diagnosed with epilepsy for ≥ 1 year were prospectively identified from the EDs by presenting symptom/discharge diagnosis. We recruited 85 of 315 patients with 44 forming the intervention group and 41 the comparison group.

Intervention

Intervention participants were offered two one-to-one outpatient sessions delivered by an ENS who aimed to optimise self-management skills and knowledge of appropriate emergency service use. The first session lasted for 45–60 minutes and the second for 30 minutes.

Main outcome measures

The primary outcome was the number of ED visits that participants reported making over the 6 months preceding the 12-month follow-up. Secondary outcomes were visits reported at the 6-month follow-up and scores on psychosocial measures.

Results

In the year preceding recruitment, the 85 participants together made 270 ED visits. The frequency of their visits was positively skewed, with 61% having attended multiple times. The mean number of visits per participant was 3.1 [standard deviation (SD) 3.6] and the median was two (interquartile range 1–4). Mean patient service cost was £2355 (SD £2455). Compared with findings in the general epilepsy population, participants experienced more seizures and had greater anxiety, lower epilepsy knowledge and greater perceived stigma. Their outpatient care was, however, consistent with National Institute for Health and Clinical Excellence recommendations. In total, 81% of participants were retained at the 6- and 12-month follow-ups, and 80% of participants offered the intervention attended. Using intention-to-treat analyses, including those adjusted for baseline differences, we found no significant effect of the intervention on ED use at the 6-month follow-up [adjusted incidence rate ratio (IRR) 1.75, 95% confidence interval (CI) 0.93 to 3.28] or the 12-month follow-up (adjusted IRR 1.92, 95% CI 0.68 to 5.41), nor on any psychosocial outcomes. Because they spent less time as inpatients, however, the average service cost of intervention participants over follow-up was less than that of TAU participants (adjusted difference £558, 95% CI –£2409 to £648). Lower confidence in managing epilepsy and more felt stigma at baseline best predicted more ED visits over follow-up. Interviews revealed that patients generally attended because they had no family, friend or colleague nearby who had the confidence to manage a seizure. Most participants receiving the intervention valued it, including being given information on epilepsy and an opportunity to talk about their feelings. Those reporting most ED use at baseline perceived the most benefit.

Conclusions

At baseline, > 60% of participants who had attended an ED in the previous year had reattended in the same year. In total, 50% of their health service costs were accounted for by ED use and admissions. Low confidence in their ability to manage their epilepsy and a greater sense of stigma predicted frequent attendance. The intervention did not lead to a reduction in ED use but did not cost more, partly because those receiving the intervention had shorter average hospital stays. The most common reason reported by PWE for attending an ED was the lack of someone nearby with sufficient experience of managing a seizure. Those who attended an ED frequently and received the intervention were more likely to report that the intervention helped them. Our findings on predictors of ED use clarify what causes ED use and suggest that future interventions might focus more on patients' perceptions of stigma and on their confidence in managing epilepsy. If addressed, ED visits might be reduced and efficiency savings generated.

Trial registration

Current Controlled Trials ISRCTN06469947.

Funding

This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 1, No. 9. See the HSDR programme website for further project information.

Association between knowledge and attitudes of school nurses towards epilepsy and the risk of accidents in Greek schools

School nurses have the ability to enhance the knowledge and tolerance of an entire community and to form more positive and sensitized attitudes to future adults. The aim of this study was to investigate the relationship between the knowledge and attitudes of nurses and the frequency of accidents caused by epilepsy in Greek schools. Our sample consisted of 306 school nurses from all over the country. It was observed that the knowledge of school nurses on epilepsy was quite high, although there were specific aspects that raise concerns on their preparedness to respond to seizure-related emergencies, while their attitudes, although positive, still need improvement. Accidents caused by epilepsy were reported by half of the nurses, and prevention was considered of major importance. Therefore, organized continuous education programs and clear guidelines by the responsible authorities would help school nurses provide better services to students with epilepsy.

Is insufficient knowledge of epilepsy the reason for low levels of healthcare in the Lao PDR?

Background

The treatment gap for epilepsy is considerable in low and middle-income countries. In the Lao PDR it is estimated at over 90%. Health workers play a significant role in bridging the gap between people with epilepsy (PWE) and access to epilepsy care. In a national survey we assessed: 1) the knowledge and practices of health workers in the Lao PDR towards the disease, and, 2) patient attendance at health facilities.

Methods

We conducted a random three-stage sampling of health workers at the provincial, district and health center levels in 2009.

Results

Overall, 284 health workers were enrolled in 50 health facilities of 11 provinces: health centers 24.7%; district hospitals 23.2%; and province hospitals 52.1%. Only a minority of these (2.5%) recalled ever having received training or seeking information on epilepsy. Our survey showed a lack of knowledge in diagnosing and prescribing drugs for epilepsy, including phenobarbital, the first-line of treatment. The majority of respondents (59.9%) was unaware of the availability of antiepileptic drugs in health facilities. Only 10 (20%) health facilities, and no health centres, received people with epilepsy. It was estimated that one PWE per month receives medical attention. Traditional beliefs about PWE were common; such as the idea that epilepsy could be transmitted through saliva (63.2%). A higher attendance of PWE was observed in province hospitals where the knowledge of epilepsy care was higher. Global acceptance of people with epilepsy was low.

Conclusions

The low level of knowledge of epilepsy on the part of health workers may be contributing to the wide treatment gap in the Lao PDR. Improving knowledge of this disease and increasing the availability of antiepileptic drugs will reduce misconceptions about epilepsy, thus encouraging more PWE to seek treatment. Community-based educational programs and extensive advocacy for people with epilepsy only began in 2009.

Epilepsy training needs for Spanish neurologists: ARPE study results

INTRODUCTION

This study was designed to create an updated training program on epilepsy to solve whatever problems that general neurologists may detect in patients during consults.

OBJECTIVES

To understand general neurologists' training needs in order to plan a specific program that may improve/standardize the clinical management of patients with epilepsy.

MATERIAL AND METHODS

122 general neurologists non-subspecialized on epilepsy were surveyed in all regions of Spain regarding the following issues: initial diagnosis, treatment, special situations by population group and/or comorbidity, prognosis and follow-up as well as whatever other topics the training program should cover.

RESULTS

Neurologists agreed that treatment was the most interesting topic for them (100%), followed by diagnosis (46.67%), special situations by population group and/or comorbidity (30%), and prognosis/follow-up (7.14%). There were insignificant differences attributable to age and sex.

CONCLUSIONS

Training ensures success, provided that it takes into account pedagogical considerations and professional targets to be trained, as well as technological and formal issues.

Explanations given by people with epilepsy for using emergency medical services: a qualitative study

Half of the people with epilepsy (PWE) in the UK experience seizures and 13-18% attend emergency medical services (EMS) annually. The majority of attendances are regarded as clinically unjustified. This study describes PWE explanations for using EMS. A nested qualitative study, part of a larger study based in three South London hospitals, was conducted. Semi-structured interviews were recorded, transcribed, and analyzed thematically. A seizure alone was not the main explanation for attending EMS; knowledge, experience, and confidence of those nearby on what to do and seizure context were important. Additionally, fears of sudden death held by the PWE and others were reported. From the patients' perspective, use of EMS is regarded as appropriate when they are away from home or someone nearby lacks knowledge of seizure management. Hospitals could provide regular group sessions on seizure management for PWE and their significant others, in which fears are discussed and evaluated.

Epilepsy across the spectrum: promoting health and understanding. A summary of the Institute of Medicine report

Approximately 1 in 26 people will develop epilepsy at some point in their lives. Although epilepsy is one of the nation's most common neurological disorders, public understanding is limited. A complex spectrum of disorders, epilepsy affects an estimated 2.2 million people in the United States. Living with epilepsy is about more than just seizures; it is often defined in practical terms, such as challenges, uncertainties, and limitations in school, social situations, employment, driving, and independent living. People with epilepsy are also faced with health and community services that are fragmented, uncoordinated, and difficult to obtain. The Institute of Medicine's report (2012) [1], Epilepsy across the spectrum: promoting health and understanding, examines the public health dimensions of epilepsy with a focus on (a) public health surveillance and data collection and integration; (b) population and public health research; (c) health policy, health care, and human services; and (d) education for providers, people with epilepsy and their families, and the public. The report's recommendations range from the expansion of collaborative epilepsy surveillance efforts to the independent accreditation of epilepsy centers, to the coordination of public awareness efforts, and to the engagement of people with epilepsy and their families in education, dissemination, and advocacy activities. Given the current gaps in epilepsy knowledge, care, and education, there is an urgent need to take action-across multiple dimensions-to improve the lives of people with epilepsy and their families. The realistic, feasible, and action-oriented recommendations in this report can help enable short- and long-term improvements for people with epilepsy.

Factors associated with knowledge and attitudes in persons with epilepsy

Treating persons with epilepsy (PWE) in developing countries may be different from elsewhere. Knowledge and attitudes of PWE are known to be associated with seizure control. This study aims to evaluate factors related with the knowledge and attitudes of PWE in northeastern Thailand. A cross-sectional survey using questionnaires and interviews was undertaken at the Khon Kaen University epilepsy clinic. The questionnaire comprised 22 questions (14 knowledge questions and 8 attitude questions). Two hundred three PWE participated in the study with a mean age of 36.5 years. Four factors were significantly associated with the knowledge about epilepsy, which included education level, age, epilepsy duration, and a history of experiencing antiepileptic medication side effects. In addition, there were four factors significantly associated with the attitudes about epilepsy, which included seizure control, education level, epilepsy duration, and marital status. There is a need to provide more education, preferably community based, to help PWE obtain more accurate information.

Multicultural challenges in epilepsy

Epilepsy is a common neurological condition throughout the world. Its care involves medical expertise, but may also bring different cultural challenges. We discuss clinical, social and psychological outcomes in different cultural settings. We point out differences and similarities in epilepsy epidemiology (etiology and risk factors, prognosis, and natural history), disparities in care and health services, and cultural influences and traditional beliefs, with special respect to practical issues and possible transcultural misunderstandings. We also discuss the relevance of multicultural issues to clinicians working in developed countries.

Fostering epilepsy self management: the perspectives of professionals

Epilepsy clinical, academic, and human service professionals (N = 101) were surveyed regarding the challenges people with epilepsy face managing their condition. 30% of the respondents had personal experience with epilepsy. Interviews were transcribed and coded into themes. Response differences by profession and personal experience were examined using chi-squared tests. The two greatest challenges reported most frequently for people with epilepsy were finding high quality health care and managing psychological and emotional effects. The two most important epilepsy outcomes were seizure control and quality of life. The two greatest challenges facing clinicians were too little time with patients and limited clinical focus. The two main weaknesses in the field were insufficient research and narrow approaches to addressing epilepsy. Significant differences in responses across professions were evident as were differences according to personal experience with epilepsy. Few clinicians cited quality of care as a major challenge (p<0.0001) compared to other professions. Few respondents with personal experience with epilepsy cited stigma as a challenge (p = 0.006).

Familiarity with, understanding of, and attitudes toward epilepsy among people with epilepsy and healthy controls in South Korea

This study identifies differences between people with epilepsy (PWE) and healthy controls in South Korea with respect to their familiarity with, understanding of, and attitudes toward epilepsy. PWE and controls older than 18 years of age were recruited from outpatient clinics and health promotion centers, respectively, associated with five university hospitals located throughout the country. Structured questionnaires consisting of 18 items were administered in face-to-face interviews. The sample consisted of 1924 participants (PWE: 384, controls: 1540). The groups did not differ with respect to age, sex, and place of residence. However, the groups did differ significantly in educational, marital, and occupational status (P=0.000). Familiarity with seizures and epilepsy (two items) did not differ significantly between the groups. Questions pertaining to understanding seizures and epilepsy (seven items) showed that controls had significantly greater misunderstanding of the etiology and long-term prognosis of epilepsy compared with PWE. Attitudes expressed toward PWE were significantly different in response to six of seven questions. Control subjects expressed more negative attitudes toward PWE than did PWE themselves, particularly concerning potential relationships with their children (e.g., friendships, marriage). In conclusion, we found significant differences between PWE and controls, particularly with respect to understanding of and attitudes toward epilepsy. We recommend the development of different strategies for PWE and controls to improve understanding of and attitudes toward epilepsy and to reduce the knowledge gap between these groups. Nationwide educational programs conducted by associated organizations and the government may provide the solution to this problem.

A health literacy assessment of the epilepsy.com website

Current healthcare guidelines identify low health literacy as a major barrier to optimal health communication. Health literacy is defined as the degree to which individuals can obtain, process and understand basic health information and services needed to make appropriate health decisions. An estimated 90 million people in the U.S. have marginal health literacy. The Institute of Medicine and the U.S. Department of Education recommend that health related information be written at the 6th-8th grade level to address low health literacy. Epidemiological studies demonstrate that persons with epilepsy have significantly lower educational attainment and lower incomes placing them at risk for low health literacy and limited Internet access. While Internet users tend to have higher educational attainment, previous research indicates even good readers prefer simpler rather than more complex medical information. Health educational content that could be printed and given to patients addresses an important need in clinical epilepsy care. Previous reviews of health websites found they exceed recommended readability levels. Two online programs were used to assess the reading level of 1327 web pages on the www.epilepsy.com website using established readability formulas. Based on the Flesch Reading Ease assessment, only 3% of epilepsy.com web pages are written for a 6th grade reading level or below. If 8th grade level or below is used as the standard, only 15% are adequate. Recommendations and examples are provided for improving the readability of epilepsy-specific health education content.