A qualitative study exploring caregivers' experiences, perspectives, and expectations for precision medicine in epilepsy in South Africa

Caregivers' and Family Members' Knowledge Attitudes and Practices (KAP) towards Epilepsy in Rural Limpopo and Mpumalanga, South Africa

Epilepsy, a common neurological disease, has a significant impact on people living with epilepsy (PLWE), their caregivers, and their family members. Research has consistently shown that the quality of life of PLWE is low. To expand on this knowledge, a non-experimental quantitative survey study was conducted to explore the knowledge, attitudes, and practices (KAP) of caregivers and family members towards epilepsy and epilepsy-related seizures. The study sample consisted of 519 participants from two South African provinces (Limpopo and Mpumalanga), mostly aged 26-35 years. The study revealed that most respondents in Limpopo had no formal education, whereas in Mpumalanga, most had a secondary education. Most respondents (32.4%) reported always using a spoon to prevent tongue biting during seizures. However, 62.4% of respondents reported feeling unprepared to handle an epileptic seizure. Additionally, the majority (54.7%) showed a moderate level of knowledge about epilepsy. Many respondents had a negative attitude towards epilepsy, and there was uncertainty about proper practices during a seizure. In summary, the research highlights unsatisfactory knowledge and practices towards epilepsy and emphasizes the need for increased education and awareness among caregivers and family members. Significant educational investment is needed from medical services to improve epilepsy care, knowledge, and attitudes.

Status of epilepsy in the tropics: An overlooked perspective

Epilepsy is one of the most common serious chronic neurological diseases affecting people of all ages globally. It is characterized by recurrent seizures. About 50 million people worldwide have epilepsy. Indubitably, people with epilepsy (PWE) may be without access to appropriate treatment. Many studies have examined the molecular mechanisms and clinical aspects of epilepsy; nonetheless, the treatment gap exists in some special areas. In the tropics, the specific geographical and ecological conditions and a lack of medical resources result in neglect or delay of diagnosis for PWE. Herein, we summarized the epidemiology of epilepsy in the tropics and discussed the disease burden and existing problems, aiming to offer a medical environment for patients in need and highlight the importance of reducing the epileptic disease burden in tropical countries.

Preferences and User Experiences of Wearable Devices in Epilepsy: A Systematic Review and Mixed-Methods Synthesis

BACKGROUND AND OBJECTIVES

To examine the preferences and user experiences of people with epilepsy and caregivers regarding automated wearable seizure detection devices.

METHODS

We performed a mixed-methods systematic review. We searched electronic databases for original peer-reviewed publications between January 1, 2000, and May 26, 2021. Key search terms included "epilepsy", "seizure", "wearable", and "non-invasive". We performed a descriptive and a qualitative thematic analysis of the studies included according to the technology acceptance model. Full texts of the discussion sections were further analyzed to identify word frequency and word mapping.

RESULTS

Twenty-two observational studies were identified. Collectively, they comprised responses from 3299 participants including patients with epilepsy, caregivers and healthcare workers. Sixteen studies examined user preferences, five examined user experiences, and one examined both experiences and preferences. Important preferences for wearables included improving care, cost, accuracy, and design. Patients desired real-time detection with a latency of ≤15 minutes from seizure occurrence, along with high sensitivity (≥90%) and low false-alarm rates. Device related costs were a major factor for device acceptance, where device costs of <$300 USD and a monthly subscription fee of <$20 USD were preferred. Despite being a major driver of wearable-based technologies, sudden unexpected death in epilepsy (SUDEP) was rarely discussed. Among studies evaluating user experiences, there was a greater acceptance towards wristwatches. Thematic coding analysis showed that attitudes towards device use, and perceived usefulness were reported consistently. Word mapping identified 'specificity', 'cost', and 'battery' as key single terms, and 'battery life', 'insurance coverage', 'prediction/detection quality', and the effect of devices on 'daily life' as key bigrams.

DISCUSSION

User acceptance of wearable technology for seizure detection was strongly influenced by accuracy, design, comfort, and cost. Our findings emphasise the need for standardised and validated tools to comprehensively examine preferences and user experiences of wearable devices in this population, using the themes identified in this study. Greater efforts to incorporate perspectives and user experiences in developing wearables for seizure detection, particularly in community-based settings are needed.

PROSPERO REGISTRATION

CRD42020193565.

Meanings of quality of life among people living with epilepsy in Ghana; a qualitative exploratory study

PURPOSE

The purpose of this study was to explore the meanings of quality of life among people living with epilepsy (PLWE) in Ghana.

METHODS

An exploratory-qualitative study design was adopted. Face-to-face in-depth interviews, using a semi-structured interview guide, were conducted on 15 PLWE who were purposively selected for the study. The interviews were audio recorded and transcribed verbatim. The content analysis approach was then used to analyze the data.

RESULTS

Four themes - "acceptance", "support", "seizure control", and "self-reliance" emerged from the study as meanings of Quality of life (QoL). Quality of life meant unconditional acceptance from family, friends, acquaintances at home, school, and work, and by the public despite epilepsy. Receiving support in the form of protection from injury during a seizure, financial assistance to meet individual and family demands, emotional warmth, and spiritual support through prayers and encouragement, was QoL for PLWE. Achievement of control over seizures and being self-reliant in terms of selfcare and daily activities in addition to having some form of financial independence meant QoL.

CONCLUSION

Meanings of quality of life among PLWE is associated with being accepted and supported by family and friends as well as being in control of seizures and attaining a status of independence.

Demonstrating the feasibility of digital health to support pediatric patients in South Africa

OBJECTIVE

Resources for management of epilepsy in Africa are extremely limited reinforcing the need to develop innovative strategies for optimizing care. Studies have shown that the prevalence of epilepsy in low- and middle-income countries is substantially greater than in more resourced countries. The objective of this report was to demonstrate that mobile Health (mHealth) technologies have the potential to improve the management of epilepsy in Africa.

METHODS

The feasibility of technology-based home monitoring was investigated in an observational study of 40 children with refractory epilepsy or epilepsy associated with intellectual disability and/or behavior difficulties in South Africa. Technology-based home monitoring was implemented for six months. Physical activity, sleep, and heart rate were continuously monitored with a wearable device. Caregivers completed regular mobile Patient Reported Outcomes (mPROs) and reported seizures and ad hoc events using a dedicated app. Feasibility was assessed and descriptively measured for recruitment, retention, and engagement of the participants.

RESULTS

The mHealth technology was able to capture important information that gives an impression of the overall experience of the children and their caregivers. Thirty-seven participants (94.9%) reported at least one clinical event. Seventy-nine percent of caregivers reported seizure events in their children, which were the primary event anticipated. Median engagement with the wearable device and monthly mPROs was 30.8% and 57.1%, respectively. However, most participants (87%) had to be given smartphones for them to have Bluetooth capabilities and access to the study app. Tolerability to the device was impacted by the difficult living circumstances of caregivers that induced fear of loss or theft.

SIGNIFICANCE

The study showed how the use of remote patient monitoring in the form of mHealth can benefit epilepsy patients, despite highly variable engagement with the technology. The combination of mPROs and wearable devices generated informative datasets that will allow clinicians but also the children and their caregivers to better understand and manage the disease.