Marriage in epilepsy: The impact of the question in knowledge, attitude, and practice surveys

Psychological and social aspects of people with epilepsy expressed through drawing: Pilot study

INTRODUCTION

Frequently, the psychological and social aspects of PWE go unnoticed in medical consultations. Even in spite of having seizure control, some people can experience a poor quality of life. The objective of the study was to determine if drawing facilitates the expression of the psychological and social difficulties of PWE.

METHODS

Hermeneutic, qualitative, situated knowledge study located in the city of Medellín, Colombia. The participants were asked to make one or several drawings under the question "what it is like to live with epilepsy". The drawings were analyzed with criteria of Gestalt psychology, semiotics, image-word relationship and context.

RESULTS

Sixteen drawings of ten participants were obtained. The drawings revealed the construction of an identity of otherness and negative emotionality due to epilepsy. The social concepts of restriction, prohibition, dependency, and exclusion appear in the drawings. The authors expose the ways to face adversity.

CONCLUSION

Drawing can expose and facilitate the expression of the psychological and social difficulties of PWE, which often go unnoticed in the medical office. Free drawing is an easy-to-use global tool that has been underused in the medical field.

On epilepsy perception: Unravelling gaps and issues

Epilepsy is one of the most common neurological diseases, but it can sometimes be under-reported or have a time delay in diagnosis. This data is not surprising if we consider that a person often seeks medical attention only after presenting a generalized tonic-clonic seizure. Epilepsy diagnostic delay is caused by several factors: under-reporting by patients, under-diagnosed epileptic manifestations by inexperienced clinicians, and lack of time in the emergency setting. The consequences of this delay are increased accidents, a high rate of premature mortality, and economic expanses for the healthcare system. Moreover, people with epilepsy have a higher probability of comorbidities than the general population, such as mood disorders or cognitive problems. Along with recurrent seizures, these comorbid diseases promote isolation and stigmatization of people with epilepsy, who suffer from discrimination at school, in the workplace, and even in social relationships. Public awareness of epilepsy and its comorbidities is necessary to prevent diagnostic delays and overcome social and professional iniquities for people with 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.

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.

Does public attitude change by labeling a person as epileptic, person with epilepsy or the acronym PWE? A systematic review

PURPOSE

It is still unknown if attitudinal differences by diverse labeling of persons with epilepsy could be universally accepted with the actual literature evidence. The manner in which questions are constructed could also have an impact in final results. The purpose of this systematic review was to examine the published articles regarding changes in public´s attitude towards epilepsy by labeling a person as epileptic, person with epilepsy or with the acronym PWE.

METHODS

We undertook a systematic review of the literature using common databases with specific keywords and combinations searching for original articles, meta-analysis and systematic reviews. Sociodemographic variables, attitude results and questions style were analyzed in included articles.

RESULTS

Four original articles were found. Significant attitudinal changes were described in three studies with the label person with epilepsy. One study failed to demonstrate an attitudinal change by distinct labeling of a person with epilepsy. All questions were formulated in a personal way. Few neutral and mostly induced questions were found in the studies.

CONCLUSION

By the use of the label "person with epilepsy" there is a trend towards positive changes in public's attitudes, although evidence is scarce to consider this tendency as universally applicable. More studies are needed considering widespread social and cultural backgrounds and patient opinion. Language power by wording type could be a key consideration for future studies.

Knowledge, attitudes and practice towards epilepsy among medical staff in Southern China: Does the level of hospitals make a difference?

PURPOSE

To assess knowledge, attitudes, and practice (KAP) toward epilepsy among medical staff from different levels of hospitals in Southern China.

METHOD

An adapted and structured questionnaire was administered to medical personnel from tertiary (n = 451) and basic-level (n = 448) hospitals in Southern China. The questionnaire comprised of three domains which consisted of 6 items for awareness, 12 items for knowledge and a 14 item scale for attitudes.

RESULTS

Almost 40% of medical staff in basic-level hospitals held that epilepsy could be caused by evil spirits/eyes, or transmitted from other patients, which was almost 6 times higher than that of tertiary hospitals. The mean score from general knowledge about epilepsy was higher among medical staff in tertiary hospitals than in basic-level hospitals. The mean scores in the general and personal domain of the Chinese Public Attitudes Toward Epilepsy (CPATE) scale were both significantly lower among medical staff in tertiary hospitals, when compared to those of basic-level hospitals.

CONCLUSIONS

The overall KAP from medical staff in response to seizures, was found to be better in tertiary hospitals than those of basic-level hospitals in Southern China, which was associated with the education level and impact of traditional culture. To date, there is a need for effective public intervention programs in China to improve the awareness of epilepsy and reduce discrimination among medical workers, especially for those working in basic-level hospitals in rural regions, to finally promote a better living environment for patients with epilepsy in China.