Complementary and alternative medicine in epilepsy: A global survey of physicians' opinions

Physical exercise habits in people with epilepsy: A survey from Brazilian population

This survey evaluated the Brazilian population's physical exercise habits and compared them with those from two decades ago. In this cross-sectional study, 432 people with epilepsy (PWE) assessed the questionnaire. Of these, 387 (age: 33 ± 10.58, 81.4 % women) completed the questionnaire. Among them, 60.5 % were involved in regular physical activities. Among those who exercise regularly, the majority (96.5 %) exercised between 2 and 5 times weekly and had been physically active for at least two years. Only 23.3 % were prohibited by their doctors from participating in physical activities. Only 10 % reported that seizures occur during exercise, and about half of them (55.8 %) believed that exercise improves or has no effect on seizure frequency. Most (79.06 %) did not or rarely believe exercise can trigger seizures. More than half (57.3 %) were not afraid to have seizures during exercise or were not afraid of injury during exercise due to a seizure (69 %). Most believed exercise improves cognition (80.9 %), depression, and anxiety (93.8 %). We visited this scenario two decades early. In our previous study, only 15 % exercised regularly, while in this survey, 58.4 % routinely exercised. Our findings also align with our initial survey, indicating a low seizure frequency during regular exercise, a belief that physical activity reduces seizure frequency, and a reduction in the fear that exercise might trigger seizures. In conclusion, our results show that after two decades, there have been several improvements in physical and sports activity participation among PWE. Implementing strategies to reduce barriers to exercise for PWE and educating them on the benefits of physical activity can help improve this scenario.

Determination of complementary and alternative medicine use frequency and related factors in children with epilepsy: A descriptive Cross-Sectional study from eastern Turkey

PURPOSE

The aim of this study is to determine the complementary and alternative medicine (CAM) methods used in epilepsy patients admitted to a paediatric neurology clinic in Turkey and to examine the factors affecting these methods.

METHODS

This study was conducted between October 2022 and March 2023 by using a questionnaire form prepared in line with the literature to the parents (n = 172) of children who were under the age of 18 and who had been diagnosed with epilepsy for at least 1 year and who were followed up in the paediatric neurology outpatient clinic of a secondary care hospital in Van province of Turkey. The principles of scientific ethics and confidentiality of data were complied with in all stages of the study.

RESULTS

The study included 172 parents of 172 children with a mean age of 2.95 ± 0.93 years. In the study, it was found that 37.2 % of the parents had previously used CAM themselves, almost all of the parents (98.8 %) had not discussed the use of CAM with their physician or nurse, half of the parents considered CAM to be dangerous, and 28.2 % wanted to receive counselling to learn more about CAM. It was also found that 28.5 % of the parents used CAM in the treatment of their children. The most commonly preferred CAM among parents in the treatment of epilepsy was religious healing (79.6 %) which is among mind/body practices. It was found that the most common technique used by parents was regular praying (71.4 %). Religious beliefs were effective in the use of CAM in our patient population, while confidence in medical treatment was effective in not using CAM. More than half of the parents who used CAM in their child's treatment reported benefits and reduced seizure frequency. The factors significantly associated with CAM use in children with epilepsy were parental education level, parental CAM use and disease duration. In univariate and multivariate analyses, it was found that a degree below high school increased the likelihood of CAM use by 0.017 and 0.024 times, respectively, compared to being illiterate.

CONCLUSIONS

Pediatric nurses' routine examination of CAM methods used in paediatric epilepsy patients and the factors affecting these methods is very important in terms of preventing negative effects on child health, effective management of the disease process, ensuring safe use and strengthening communication to improve the quality of care.

Perceptions and attitudes regarding complementary, alternative, and integrative medicine among published neurology authors: a large-scale, international cross-sectional survey

BACKGROUND

While many patients with neurological disorders and conditions use complementary, alternative, and integrative medicine (CAIM), little is known about the use, perceptions, and attitudes regarding CAIM among published neurology authors. With the increasing popularity of CAIM, our objective was to assess practices, perceptions, and attitudes towards CAIM among published neurology authors.

METHODS

We conducted an anonymous online survey of authors who had published articles in neurology journals indexed in MEDLINE. We emailed potential participants our cross-sectional electronic survey after extracting their email addresses from one of their publications in our sample of journals. Basic descriptive statistics were drawn from quantitative data, and thematic content analysis was used to analyse qualitative data from any open-ended questions.

RESULTS

The survey was completed by 783 published neurology authors (1.7% response rate, 83.9% completion rate). Overall, respondents perceived CAIM to be promising in preventing, treating, and/or managing neurological diseases. Mind-body therapies received the most positive responses, indicated by over half of respondents cumulatively agreeing that they are promising (n = 368, 59.0%) and safe (n = 280, 50.3%). Whole medical systems and biofield therapy were less favourable. Most neurology clinicians reported a lack of formal (n = 211, 70.3%) and supplementary training (n = 158, 52.5%) on CAIM. Nearly half of clinicians did not feel comfortable counselling patients about CAIM therapies (n = 121, 44.5%), and over half did not feel comfortable recommending them (n = 161, 59.3%). A lack of scientific evidence for CAIM's safety and efficacy was reported as the greatest challenge to CAIM (n = 515, 92.5%). The majority of respondents believed there is value to conducting research on this topic (n = 461, 82.0%) and supported increasing allocation of research funding towards CAIM (n = 241, 58.9%).

CONCLUSIONS

Although many participants found CAIM to be promising to the field of neurology, the vast majority did not feel open to integrating CAIM into mainstream medical practices on account of a perceived lack of scientific evidence for its safety and efficacy. Future studies can use our findings to gather more detailed insights, improve educational resources on CAIM within neurology, as well as examine what effects a tailored CAIM education has on the perceptions and attitudes of published neurology authors towards CAIM.

The relationship between medication adherence and complementary medicine use in epilepsy patients

OBJECTIVE

The aim of this research is to examine the usage of Complementary and Integrated Medicine (CIM) in individuals with epilepsy and the impact of CIM usage on medication adherence.

MATERIALS AND METHODS

This descriptive and cross-sectional study was conducted in a university hospital in northern Turkey between July and October 2023, involving 101 individuals with epilepsy (PWE). Descriptive information forms and the Morisky Medication Adherence Scale-4 (MMS-4) were used as data collection tools. Descriptive statistics, t-tests, ANOVA, and post-hoc LSD analyses were employed for data evaluation.

RESULTS

The participants consisted of 65.3 % males, 25.7 % were not working due to epilepsy, and 61.4 % with generalized epilepsy. The average MMS-4 score was found to be 3.08 ± 0.96. MMS-4 scores showed significant differences based on epilepsy type (F = 3.998, p = 0.021; η2 = 0.07). 76.2 % (n = 21) of the participants who used at least one CIM technique preferred "having a religious person read a prayer."

CONCLUSION

Medication adherence in PWE was at a moderate level. Individuals with focal and secondary generalized epilepsy showed better medication adherence compared to those with generalized types. Of those participant who used at least one CIM technique to improve their general health or control seizures, the most common was "having a religious person read a prayer."

Adult epilepsy

Epilepsy is a common medical condition that affects people of all ages, races, social classes, and geographical regions. Diagnosis of epilepsy remains clinical, and ancillary investigations (electroencephalography, imaging, etc) are of aid to determine the type, cause, and prognosis. Antiseizure medications represent the mainstay of epilepsy treatment: they aim to suppress seizures without adverse events, but they do not affect the underlying predisposition to generate seizures. Currently available antiseizure medications are effective in around two-thirds of patients with epilepsy. Neurosurgical resection is an effective strategy to reach seizure control in selected individuals with drug-resistant focal epilepsy. Non-pharmacological treatments such as palliative surgery (eg, corpus callosotomy), neuromodulation techniques (eg, vagus nerve stimulation), and dietary interventions represent therapeutic options for patients with drug-resistant epilepsy who are not suitable for resective brain surgery.

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.

Neurologists' knowledge of and attitudes toward physical exercise for people with epilepsy in Latin America

INTRODUCTION

Despite the favorable effects of exercise in people with epilepsy (PWE), the lower participation in physical/sports activities may be partly due to inadequate knowledge and attitudes of health professional about their benefits. In this regard, in 2016, the International League Against Epilepsy (ILAE) through its Task Force on Sports and Epilepsy published a consensus paper that provided general guidance concerning participation in exercise/sport activities for PWE. We investigated views and attitudes toward physical exercise practice among neurologists in Latin America.

METHODS

A 22-item cross-sectional online questionnaire-based study among neurologists included the following: (1) profile of participating neurologists, (2) doctors' attitudes and perceptions about physical/sport activities for PWE, and (3) neurologist experience concerning patient's report about their involvement in physical/sport activities.

RESULTS

In total, 215 of 519 neurologists from 16 different countries returned the questionnaire. Although about one-third of neurologists had no information about the effect of exercise on epilepsy, and 60% of them did not know the published recommendations of the ILAE Task Force on Sports and Epilepsy, the majority (92.5%) advised the practice of exercise, were aware of sport activities for their patients and agreed that exercise can reduce comorbidities associated with epilepsy (X² = 249.34; p < 0.001). Most of the neurologists did not believe that exercise is a seizure-inducing factor, but more than half would restrict their patients with uncontrolled seizures for exercise practice (X² = 250.77; p < 0.001). Most barriers considered by PWE in the past, currently are not viewed by neurologists and their patients (X² = 249.34; p < 0.001).

CONCLUSION

While this study reveals that neurologists have some knowledge gaps in attitudes toward physical exercise for PWE, encouraging attitudes were observed by neurologists. Considering that physicians can impact on patient confidence and decision, a better communication between neurologists and their patients concerning the benefits of exercise can increase PWE participation in physical/sports activities. To improve this scenario, more efforts should be made to increase the neurologists' knowledge and perceptions on this issue.

Acceptance and use of complementary and alternative medicine among medical specialists: a 15-year systematic review and data synthesis

BACKGROUND

Complementary and Alternative Medicine (CAM) has gained popularity among the general population, but its acceptance and use among medical specialists have been inconclusive. This systematic review aimed to identify relevant studies and synthesize survey data on the acceptance and use of CAM among medical specialists.

METHODS

We conducted a systematic literature search in PubMed and Scopus databases for the acceptance and use of CAM among medical specialists. Each article was assessed by two screeners. Only survey studies relevant to the acceptance and use of CAM among medical specialists were reviewed. The pooled prevalence estimates were calculated using random-effects meta-analyses. This review followed both PRISMA and SWiM guidelines.

RESULTS

Of 5628 articles published between 2002 and 2017, 25 fulfilled the selection criteria. Ten medical specialties were included: Internal Medicine (11 studies), Pediatrics (6 studies), Obstetrics and Gynecology (6 studies), Anesthesiology (4 studies), Surgery (3 studies), Family Medicine (3 studies), Physical Medicine and Rehabilitation (3 studies), Psychiatry and Neurology (2 studies), Otolaryngology (1 study), and Neurological Surgery (1 study). The overall acceptance of CAM was 52% (95%CI, 42-62%). Family Medicine reported the highest acceptance, followed by Psychiatry and Neurology, Neurological Surgery, Obstetrics and Gynecology, Pediatrics, Anesthesiology, Physical Medicine and Rehabilitation, Internal Medicine, and Surgery. The overall use of CAM was 45% (95% CI, 37-54%). The highest use of CAM was by the Obstetrics and Gynecology, followed by Family Medicine, Psychiatry and Neurology, Pediatrics, Otolaryngology, Anesthesiology, Internal Medicine, Physical Medicine and Rehabilitation, and Surgery. Based on the studies, meta-regression showed no statistically significant difference across geographic regions, economic levels of the country, or sampling methods.

CONCLUSION

Acceptance and use of CAM varied across medical specialists. CAM was accepted and used the most by Family Medicine but the least by Surgery. Findings from this systematic review could be useful for strategic harmonization of CAM and conventional medicine practice.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019125628.