Patients' understanding of and adjustment to epilepsy: interim findings from a European survey

Knowledge of epilepsy, quality of life, and psychiatric comorbidities in Lebanese adults with epilepsy

INTRODUCTION

People with epilepsy (PWE) face a variety of psychosocial challenges. A lack of knowledge of epilepsy, a high level of depression and anxiety and a low quality of life (QoL) are among the major problems that affect most PWE. The objective of this study was to examine the association of sociodemographic characteristics, clinical factors and knowledge of epilepsy with the level of QoL, and the presence of psychiatric comorbidities.

METHOD

A cross-sectional study was conducted in Lebanon. The PWE were recruited from neurologists' clinics in Beirut and its suburbs. A questionnaire translated into Arabic was used and composed of four parts: sociodemographic factors, clinical characteristics, psychosocial characteristics (QoL, psychiatric disorders), and knowledge epilepsy scale. Backward logistic regression models were developed, the associations were estimated by odds ratio (OR), and the level of significance was set at p ≤ 0.05.

RESULTS

Four hundred and four PWE were recruited in this study. About a half of PWE had controlled epilepsy (46.3 %) and 40.3 % had epilepsy for less than 5 years. The QoL was low for 38.6 % of PWE and 30.2 % had psychiatric comorbidities. More than half of PWE had a good level of knowledge (71.5 %). Controlled epilepsy (OR = 1.8; 95 %CI: 1.2-2.9), and good knowledge about epilepsy (OR = 5.5; 95 %CI: 3.4-9.1) were associated with better QoL. Patients on polytherapy with anti-seizure drugs (OR = 0.6; 95 %CI: 0.4-0.9), experienced side effects of anti-seizure drugs (OR = 0.6; 95 %CI: 0.4-0.9) and with psychiatric comorbidities (OR = 0.6; 95 %CI: 0.3-0.9) had a lower QoL. A high number of nonpsychiatric comorbidities (OR = 2.5; 95 %CI: 2.0-3.1) and a polytherapy increased the risk of having psychiatric comorbidities (OR = 1.8; 95 %CI: 1.1-2.8).

CONCLUSIONS

Good knowledge of epilepsy and the absence of psychiatric comorbidities are important predictors of good QoL in Lebanese PWE. Educational programs are needed to reduce misconceptions about epilepsy and improve mental health of PWE.

Knowledge, Skills, and Attitudes Towards Children with Epilepsy Among Egyptian Parents: A Comparative Cross-Sectional Study

INTRODUCTION

Epilepsy is one of the most common neurological disorders affecting children. As a chronic disease, it affects not only the child but also the entire family. The attitudes towards the children suffering from epilepsy and the skills required to deal with acute seizures are influenced by the level of knowledge the parents have about that disease.

AIM

To evaluate the knowledge, attitudes, and skills toward epilepsy among parents of children diagnosed with epilepsy in comparison to parents of children without epilepsy.

METHOD

Data collected through a structured questionnaire that was designed, translated into Arabic, and analyzed statistically in a cross-sectional study for a total of 534 Egyptian parents as two groups, group I (n = 223) consist of parents with children with epilepsy and group II (n = 311) of parents with children without epilepsy. Parents with children with epilepsy were recruited from the Paediatric Neurology Outpatient Clinic of Alexandria University Children's Hospital (AUCH). Parents with children without epilepsy were recruited from other outpatient clinics or wards of AUCH.

RESULTS

This study showed a poor knowledge score percentage of (89.7 %) among parents with children with epilepsy and (83.3 %) among parents with children without epilepsy. The difference between both groups was statistically significant with fewer knowledge scores among parents of children with epilepsy. Parents of both groups showed a negative attitude score percentage; (69.5 %) of group I and (62.7 %) of group II. The difference between both groups was statistically significant with a more negative attitude score percentage among parents with children without epilepsy. Parents of both groups had poor practice score percentage of (66.8 %) of group I and (74.3 %) of group II having poor practice skills needed for emergency management of acute seizures. A high level of education was significantly associated with fair knowledge score percentage and positive attitude score percentage.

CONCLUSIONS

Poor knowledge, negative attitudes, and poor skills required for the management of acute seizures were found among both parents of children with epilepsy and those with children without epilepsy. Educational programs are needed to eliminate all the misconceptions and myths and to change attitudes of the Egyptian parents towards epilepsy.

Knowledge and awareness among patients with epilepsy observed at Jordan University Hospital

The objective of this study was to assess the level of knowledge and awareness about epilepsy among patients with epilepsy (PWE) and to determine the correlation with sociodemographic and disease-related factors. A prospective cross-sectional study was set, and it included PWE attending the adult neurology clinic at Jordan University Hospital (JUH), Amman, Jordan. A structured questionnaire was utilized, which consisted of 3 parts: sociodemographic factors, disease characteristics, and an epilepsy knowledge scale - the Epilepsy Knowledge Profile-General (E.K.P-G) scale. There was a total of 108 patients, 43 males and 65 females with an age range from 16 to 63 years. The average score of the subjects in the E.K.P-G scale was 16.4/34 (48%). Twenty out of the 34 questions were answered correctly by less than 50% of the respondents. There was an overall poor understanding of the etiology of epilepsy. A higher E.K.P-G score was significantly correlated with higher levels of education, higher household income, controlled seizures for more than 2 years, and living in urban areas. On the other hand, there was no significant correlation between the level of knowledge and age, gender, marital status, occupational status, type of seizure, duration of epilepsy, source of information, number of antiepileptic drugs (AEDs), and family history of epilepsy. In conclusion, the study showed a significant lack of knowledge about epilepsy among PWE at JUH. A public educational program is necessary in Jordan to educate PWE about their disorder.

The efficacy of a pharmacist implemented educational treatment programme for people with epilepsy: A report of a randomised controlled trial

PURPOSE

To evaluate the efficacy of a pharmacist implemented educational treatment programme in improving knowledge and perception of epilepsy among people with the condition.

METHOD

A randomized controlled study was conducted on patients with epilepsy recruited from the medical and neurology out-patient clinics of two tertiary hospitals. Patients in the intervention group were offered an educational treatment programme implemented by a clinical pharmacist. The impact of the educational intervention was evaluated by using an epilepsy knowledge scale and the brief illness perception questionnaire.

RESULTS

There was a statistical significant difference between the control and intervention group over time on the knowledge of epilepsy, as the knowledge of epilepsy among patients in the intervention group significantly increased; F (2154) = 150.15, p = 0.000, Partial η² = 0.661. Also, there was a statistical significant difference between the control and intervention group over time on the perception of epilepsy, as the perception of epilepsy among patients in the intervention group significantly improved; F (2, 154) = 12.386, p = 0.000, Partial η² = 0.138.

CONCLUSION

The Pharmacist implemented educational intervention improved patients' knowledge and perception of epilepsy. This finding has revealed the potential positive impact of pharmacists' involvement in the management of epilepsy.

Self-Management education for adults with poorly controlled epILEpsy [SMILE (UK)]: a randomised controlled trial

BACKGROUND

Epilepsy is a common neurological condition resulting in recurrent seizures. Research evidence in long-term conditions suggests that patients benefit from self-management education and that this may improve quality of life (QoL). Epilepsy self-management education has yet to be tested in a UK setting.

OBJECTIVES

To determine the effectiveness and cost-effectiveness of Self-Management education for people with poorly controlled epILEpsy [SMILE (UK)].

DESIGN

A parallel pragmatic randomised controlled trial.

SETTING

Participants were recruited from eight hospitals in London and south-east England.

PARTICIPANTS

Adults aged ≥ 16 years with epilepsy and two or more epileptic seizures in the past year, who were currently being prescribed antiepileptic drugs.

INTERVENTION

A 2-day group self-management course alongside treatment as usual (TAU). The control group received TAU.

MAIN OUTCOME MEASURES

The primary outcome is QoL in people with epilepsy at 12-month follow-up using the Quality Of Life In Epilepsy 31-P (QOLIE-31-P) scale. Other outcomes were seizure control, impact of epilepsy, medication adverse effects, psychological distress, perceived stigma, self-mastery and medication adherence. Cost-effectiveness analyses and a process evaluation were undertaken.

RANDOMISATION

A 1 : 1 ratio between trial arms using fixed block sizes of two.

BLINDING

Participants were not blinded to their group allocation because of the nature of the study. Researchers involved in data collection and analysis remained blinded throughout.

RESULTS

The trial completed successfully. A total of 404 participants were enrolled in the study [SMILE (UK), n = 205; TAU, n = 199] with 331 completing the final follow-up at 12 months [SMILE (UK), n = 163; TAU, n = 168]. In the intervention group, 61.5% completed all sessions of the course. No adverse events were found to be related to the intervention. At baseline, participants had a mean age of 41.7 years [standard deviation (SD) 14.1 years], and had epilepsy for a median of 18 years. The mean QOLIE-31-P score for the whole group at baseline was 66.0 out of 100.0 (SD 14.2). Clinically relevant levels of anxiety symptoms were reported in 53.6% of the group and depression symptoms in 28.0%. The results following an intention-to-treat analysis showed no change in any measures at the 12-month follow-up [QOLIE-31-P: SMILE (UK) mean: 67.4, SD 13.5; TAU mean: 69.5, SD 14.8]. The cost-effectiveness study showed that SMILE (UK) was possibly cost-effective but was also associated with lower QoL. The process evaluation with 20 participants revealed that a group course increased confidence by sharing with others and improved self-management behaviours.

CONCLUSIONS

For people with epilepsy and persistent seizures, a 2-day self-management education course is cost-saving, but does not improve QoL after 12-months or reduce anxiety or depression symptoms. A psychological intervention may help with anxiety and depression. Interviewed participants reported attending a group course increased their confidence and helped them improve their self-management.

FUTURE WORK

More research is needed on self-management courses, with psychological components and integration with routine monitoring.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN57937389.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 21. See the NIHR Journals Library website for further project information.

What patients think about psychogenic nonepileptic seizures in Buenos Aires, Argentina: A qualitative approach

PURPOSE

To analyse the methods of reasoning with regard to patients' experiences of living with psychogenic nonepileptic seizures (PNES) in Buenos Aires, Argentina.

METHOD

A qualitative approach using semi-structured interviews was used to gain an in-depth and contextual understanding of the perspectives of five patients with PNES. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis.

RESULTS

Explanatory models and prototypes were identified from the patients' narratives. Four patients related their suffering regarding psychosocial causes -family conflicts, sexual harassment, and life changes, among others-. Hereditary and organic hypotheses appeared to be unspecific. Folk explanations were common to all participants (magic, witchcraft, energetic causes). Four patients used the term epilepsy as an illness prototype, focusing on seizures and the use of antiepileptic drugs. Three of them also compared their illness to other people's "attacks" (heart attacks, panic attacks, nervous breakdown). Only one of them referred to someone who was suspected of having epilepsy.

CONCLUSION

Patients' psychosocial explanatory models are different from the results of previous studies because these studies indicate that most patients support somatic explanations. Patients also use folk explanations related to traditional medicine, which highlights the interpersonal aspects of the disease. Doctor-patient communication is essential for a correct understanding of PNES, resulting in better outcomes. It could also help to reduce the cultural distance between professionals and patients, leading to narrowing inequalities present in multicultural healthcare services.

Attitudes towards epilepsy among a sample of Turkish patients with epilepsy

OBJECTIVE

The attitude of patients with epilepsy towards their disease is an important factor in disease management and quality of life. The aim of this study was to define the attitudes of patients with epilepsy towards their disease and the factors that affect their attitudes.

PATIENTS AND METHOD

This descriptive study was performed on patients admitted to an epilepsy outpatient clinic of a university hospital between May and September 2015. The sample consisted of 70 patients over 18years of age with a diagnosis of epilepsy and no health problem other than epilepsy. Patients with no seizure in the last two years were excluded. The Epilepsy Attitude Scale was used to evaluate attitudes of the patients towards epilepsy; the Epilepsy Knowledge Scale, Rotter's Locus of Control Scale, Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy-10 (QOLIE-10) were used to investigate the attitude-related factors.

RESULTS

Among the 70 participants, 43 were female, and the mean age was 31.4years. The educational level of the patients was lower (primary school) in 38.6% of the sample, and 18.6% were unemployed. Time since diagnosis was 15.1years, 75.7% of the participants had generalized type of seizures, and more than half had seizures more frequently than once a month. The mean score of the attitude scale was 59.7±6.62 (range: 14-70). The attitudes of the patients towards epilepsy were found to be related to their educational status, living alone, and the attitudes of their families. The attitude scores were also related to the level of knowledge on epilepsy, stigma, and depression. Furthermore, the attitude was found to be correlated with quality of life.

CONCLUSION

Patients with epilepsy had moderate-to-good attitude towards their disease. It was observed that the attitude was related to the knowledge, stigma, and depression rather than to demographic factors and the seizures, and furthermore, the attitude was found to be correlated with quality of life.

Determinants of felt stigma in epilepsy

The present study aimed to determine the level of felt stigma, overprotection, concealment, and concerns related to epilepsy in different life domains by using culturally-specific scales for Turkish individuals with epilepsy. Also, it aimed to detect relations among the study variables and to determine the variables which predict felt stigma. For this purpose, felt stigma scale, overprotection scale, concealment of epilepsy scale, and concerns of epilepsy scale were administered to two hundred adult persons with epilepsy (PWE). The results showed that almost half of the participants reported felt stigma, overprotection, concealment of epilepsy, concerns related to future occupation, and concerns related to social life. Almost all the study variables show correlations with each other. Concealment of epilepsy, concerns related to social life, and concerns related to future occupation were found as the predictors of felt stigma.

Knowledge, attitude and practices of school teachers towards epileptic school children in Karachi, Pakistan

Objective: To assess the knowledge and attitude of school teachers towards an epileptic child.

Methods: This cross-sectional study was conducted among teachers of primary, middle and high schools from different communities in Karachi, Pakistan. A total of 120 self-administered KAP questionnaires were distributed in schools selected through convenience sampling. Data was analyzed using SPSS version 19.

Results: Out of the total sample size, 90.9% (n=100) had heard about epilepsy. Sixteen (14.5%) teachers considered epilepsy to be contagious while 72.7% (n=80) teachers were of the view that epileptics can succeed as other normal children and sixty nine (62.7%) teachers were willing to help a child experiencing a fit, though only 15.5% (n=17) received knowledge about epilepsy during their training years.

Conclusion: The research was conclusive for assessing the knowledge and attitude of teachers towards epileptic children. It highlighted the lack of awareness and negative attitude still existing among teachers. However, many were in the favor of mass education through awareness programs.

Patients' knowledge about their disorder: perspective of patients with epilepsy in a tertiary health facility in southwestern Nigeria

OBJECTIVE

Previous studies have shown that patients with epilepsy do not have adequate knowledge about their disorder, suggesting that patient education is a vital part of comprehensive care for epilepsy. The goal of this study was to evaluate what Nigerian patients with epilepsy know about their disorder.

METHODS

Forty-six patients with EEG- and clinically confirmed epilepsy participated in the study. The patients completed the Epilepsy Patients Knowledge Questionnaire. The questionnaire includes topics related to etiology of epilepsy, safety, compliance, legal issues of driving, and employment. The questionnaire scores were correlated with demographic variables, duration of epilepsy, and level of education of the patients.

RESULTS

The mean age of the respondents was 26.78 ± 9.27 years; there were 27 males and 19 females. The mean duration of epilepsy in the group was 7.6 ± 7.5 years. The mean rates of correct responses to the issues of safety and compliance were 31.6 and 76.8%, respectively. The mean scores on legal issues of driving and employment were 45.7 and 42.4%, respectively. The lowest score (10.9%) was on the etiology of epilepsy.

CONCLUSION

Nigerian patients with epilepsy lack adequate knowledge about their disorder, and there is a need for improved educational intervention in these patients.

Awareness, knowledge and attitudes towards epilepsy among rural populations in East Coast Peninsular Malaysia: a preliminary exploration

This study was carried out to gauge the preliminary insight regarding epilepsy among the rural society. The purposes of this study were: (1) to determine general level of awareness, knowledge and attitudes (AKA) towards epilepsy among rural communities, (2) to compare the AKA level based on socio-demographic characteristics and (3) to investigate rural cohort's perception of the best epilepsy treatment, preference for epilepsy information delivery and preference for mode of transportation to seek medical treatment. This prospective, cross sectional study included a sample of 615 rural residents enrolled via cluster sampling in East Coast region of Peninsular Malaysia (mean age=41.6+/-18.02, female=56.6%, married=65.5%, Malay=94.0%, monthly income < or = RM 500=56.9%). The Total AKA level was generally low (2.66+/-0.7). Gender-wise no significant difference was shown regarding AKA level (p>0.05). However, respondents with higher education significantly possessed better attitudes and higher Total AKA level compared to those with lower education level (p<0.001). Employed respondents reported significantly more favourable attitudes than unemployed respondents (p=0.011). Additionally, higher income rural cohorts possessed both significantly better attitudes and better AKA. These rural communities perceived modern medicine as the best epilepsy treatment (56.60%), preferred to obtain direct epilepsy-related information from health personnel (60.4%) and chose to use their own car to seek medical treatment in hospital (76.30%). The outcomes of this preliminary study signified the need to devise a dedicated epilepsy education program for implementation among rural residents. Increased AKA level in the society could enhance the people's acceptance, reduce stigmatisation and improve health-related quality of life (HRQoL) for epilepsy patients and their family.

Evaluation of WebEase: an epilepsy self-management Web site

People with epilepsy have various education needs and must adopt many self-management behaviors in order to control their condition. This study evaluates WebEase, an Internet-based, theory-driven, self-management program for adults with epilepsy. Thirty-five participants took part in a 6-week pilot implementation of WebEase. The main components of WebEase are My Log, a behavioral journal, and the Medication, Stress and Sleep Modules, which provide tailored information and feedback designed to prompt participants to assess their status with self-management behaviors, think about their behaviors and make a goal. In this article, we discuss the results of the feasibility, acceptability and usability assessments and the behavioral outcomes. The process results indicate that theoretical components that served as the program framework were successfully integrated into the program and that participants viewed WebEase as relevant, acceptable and easy to use. Additionally, participants showed some improvement in epilepsy self-management, adherence, sleep quality, self-efficacy and social support following the program. The initial results are encouraging and continued development of WebEase has the potential to facilitate education and self-management strategies among people with epilepsy.

Knowledge gaps and uncertainties about epilepsy: findings from an ethnographic study in China

Epilepsy represents one of the major brain disorders worldwide. In China, research into how much people with epilepsy know about their condition appears limited. Drawing on data collected as part of a large ethnographic study, we present the experiences and views of Chinese people with epilepsy and their family members, to identify knowledge gaps and uncertainties about epilepsy within selected urban and rural communities. We also examine how respondents' demographic characteristics influence their knowledge, understanding, and beliefs about epilepsy. We found knowledge and understanding of epilepsy to be uneven and context specific. Hereditary factors were most frequently cited as a potential cause, although their impact remained unclear. Western medicalization of epilepsy appears less evident in the reports of rural informants, where traditional beliefs continue to shape definitions and treatment. Societal differences within these communities set boundaries on knowledge acquisition. Plotted against these differences, we suggest strategies for proposed educational/psychosocial intervention programs.

A telephone-based self-management program for people with epilepsy

The study was conducted to test the feasibility of a telephone-based self-management program for adults with epilepsy. The program was based on social cognitive theory and principles of motivational interviewing (MI). Twenty-two adults with epilepsy were recruited from hospital-based epilepsy clinics. The mean age of participants was 43 years, and 68% were men. Participants were randomly assigned to the intervention or control group. Those in the intervention group received a five-session intervention with a nurse trained in MI counseling. Following an in-person introductory session, the remaining four sessions were conducted by phone. Ninety-five percent of the 55 planned MI sessions and the 44 planned courtesy calls for those in the control group were completed, demonstrating high acceptance of the program. Participants were very satisfied with the program and noted the benefits of the telephone delivery method. Analysis of outcomes provided support for continued development and testing of the program.

Stigma scale of epilepsy: the perception of epilepsy stigma in different cities in Brazil

PURPOSE: To assess the perception of epilepsy stigma in different regions of Brazil. METHOD: The Stigma Scale of Epilepsy (SSE) questionnaire was applied to people in different Brazilian urban settings. The survey was performed on individual basis; an interviewer read the questions to the subjects and wrote down the answers. The same procedure was applied to all the subjects and took around 10 minutes. RESULTS: 266 questionnaires were completed in four different towns of Brazil (Curitiba=83; São Paulo=47; Vila Velha=79; Ipatinga=57). The overall stigma score was 49.7 (median). Different scores were obtained in each locality. Vila Velha=42; Curitiba=49; São Paulo=52; Ipatinga=54 (ANOVA [2.262]=3.82; p=0.01). CONCLUSION: This study showed differences in the perception of stigma, which may depend on cultural and regional aspects. The concept of stigma has cultural perspectives, depending on the region and the context where each person lives. The understanding of this aspect of epilepsy is important to promote better de-stigmatization campaigns, considering the cultural and social differences.

Developing two different measures for assessing knowledge of and attitudes toward epilepsy for the Turkish population

The aim of this study was to develop two new scales for assessing Turkish public's knowledge of epilepsy and attitudes toward it. A 26-item knowledge scale and a 15-item attitude scale were first developed and then tested using a random selection of adults aged 18 n = 613) from different parts of Istanbul. After item and factor analyses of the knowledge scale, 10 items were omitted. Varimax rotation resulted in three underlying components that explained 35.7% of the variance. As a reliability assessment, the Kuder-Richardson-20 coefficient was 0.72. For the attitude scale one item was excluded after factor analyses. Varimax rotation revealed two underlying components that explained 46.31% of the variance. Cronbach's alpha was found to be 0.84. Additionally, it was found that subjects with more knowledge of epilepsy had more positive attitudes toward epilepsy (r = .36, P<0.01).

Knowledge and attitudes toward epilepsy amongst students in the health area: intervention aimed at enlightenment

It is known that there is a lack of knowledge about epilepsy amongst the population in general, with consequent prejudice and discrimination towards epileptic patients. Considering the importance of health professionals in the diffusion of knowledge about this neurological condition, the objective of the present study was to evaluate modifications in the knowledge and attitudes of students in the health area with respect to epilepsy, after an intervention including the presentation of specific audio-visual material and a discussion on the basic aspects of epilepsy. Simple self-administered questionnaires were applied to one hundred and sixteen health area students before and after the session of enlightenment. After the session there was significant (p<0.05) improvement in answers to different questions about etiology, epidemiology, education, work, and attitude during the seizure. The results suggest the need to include a routine low complexity educational activity in the curriculum of various courses in the health area.

Epilepsy stigma perception in an urban area of a limited-resource country

OBJECTIVE

To estimate the perception of stigma attached to epilepsy in an urban society of a limited-resource country, Brazil.

METHODS

We applied a validated Stigma Scale of Epilepsy (SSE) cross-sectionally to 1850 people from all regions within the metropolitan area of Campinas, following a sampling selection methodology (95% confidence interval and error of 2.3).

RESULTS

The overall score for epilepsy stigma perception was 42 (range, 3-98; SD, 14). The SSE score for women was higher (43) than that for men (40). With respect to religion, Spiritism had the lowest SSE score (35) compared with Catholic, Evangelical, other, and no religion. Level of education was inversely related to SSE scores; illiterate people had higher SSE scores (45) than people with higher education (37).

CONCLUSION

This is one of the first systematic assessments of epilepsy stigma perception in an urban area of a limited-resource country. It was found that the magnitude of stigma is different within segments of the local society, highlighting that sociocultural factors such as gender, religion, and level of education may be important predictors of stigma.

Percepção de estigma na epilepsia

INTRODUÇÃO: Pessoas com epilepsia frequentemente vivenciam o estigma, muitas vezes mais prejudicial que a própria condição em si. De maneira geral, pode-se dizer que a epilepsia é uma das condições que mais afeta o comportamento e a qualidade de vida, não só da pessoa que tem epilepsia, mas também da família toda, especialmente devido ao estigma existente. Por isso, dizemos que a epilepsia causa um impacto bio-psicosocial na vida das pessoas. Porém, este aspecto do estigma na epilepsia é pouco abordado, especialmente em países em desenvolvimento, como o Brasil, onde superstições, atitudes negativas e falta de informação dificultam a relação da comunidade com a epilepsia. OBJETIVO: Este artigo tem o objetivo de discutir aspectos relevantes do estigma na epilepsia: conceituação e modelos de estigma na área médica e social; estigma e qualidade de vida; fatores operantes; aspectos neurobiológicos e estratégias para se lidar com o estigma na epilepsia. CONCLUSÕES: Este artigo mostrou uma visão geral do estigma englobando seus diferentes aspectos. Pelo fato de ser um conceito multifatorial, o combate ao estigma requer também uma intervenção ampla, envolvendo as áreas médica, psicológica e social. O entendimento do processo do estigma contribui para uma mudança da interpretação social da epilepsia, rumo a construção de uma sociedade mais justa e tolerante, na qual as diferenças sejam respeitadas.

Evidence of cultural hybridity in responses to epilepsy among Pakistani muslims living in the UK

OBJECTIVES

To examine how people from Bradford's Pakistani Muslim community experience living with epilepsy. Specifically, the paper addresses social interactions and negotiations with care providers and considers how different understandings of epilepsy are integrated.

METHODS

Interviews were conducted with a sample of Bradford's Pakistani Muslim community (n = 20). Interviews were analysed to identify themes and significant areas of shared concern.

RESULTS

This paper identifies popular, professional and folk sectors contributing to an individual's 'health system'. Where sectors overlap, zones of hybridity are created: that is, a person might simultaneously seek help from a doctor and from a religious healer, or might offer explanations for seizures that include neurological and spiritual components.

DISCUSSION

While there are many similarities between the experiences of these minority ethnic community members and published work on the lived experience of epilepsy in other communities, there are also important differences that service providers need to recognize and respond to. Differences include forms of cultural expression and specific language needs. Improving communication between professionals and persons with epilepsy needs to be prioritized.

Conhecimentos e atitudes sobre epilepsia entre universitários da área da saúde

Vários estudos em diversos paises mostram em relação à epilepsia a falta de conhecimentos, os preconceitos e as repercussões negativas para os pacientes. Avaliamos os conhecimentos e atitudes de universitários da área da saúde no início e ao final dos cursos. Foram aplicados questionários contendo 15 questões em relação à epilepsia a 564 universitários (290 do primeiro e 274 do último ano) de cinco cursos (ciências farmacêuticas, fisioterapia, medicina, nutrição e terapia ocupacional). Os estudantes de último ano tiveram maior familiaridade com epilepsia, melhor conhecimento de suas causas e de seu tratamento. Também em questões relacionadas ao trabalho e à conduta durante as crises, ao final dos cursos cresceram as posturas positivas. Não obstante, porcentagem significativa dos universitários do último ano ainda apresentou importantes lacunas de conhecimento em relação à epilepsia o que sugere a necessidade de ações dirigidas a minorar essa situação.

Patient's perspective on epilepsy: self-knowledge among Omanis

Improving patients' knowledge has been suggested to improve their symptoms and prognosis. Very little is known about epileptic patient's knowledge of their illness in cross-cultural settings. This pilot study investigated what Omani patients know about their disorder. Patients attending a tertiary hospital completed a structured knowledge questionnaire to elicit information pertaining to aetiology, safety, compliance with medication regimes, legal and employment issues concerning epilepsy.Although correctly endorsing issues related to their medication, this cross-cultural sample was found to have limited knowledge about their condition. In particular, most patients were unable to give accurate indications of epilepsy, neither were they able to give correct responses to questions pertaining to safety and compliance. There is a need for improving patient's knowledge. As with other chronic disorders, people with epilepsy in Oman should receive systematic health education about how to manage the condition most effectively.

Changes in quality of life in epilepsy: how large must they be to be real?

PURPOSE

The study goal was to assess the magnitude of change in generic and epilepsy-specific health-related quality-of-life (HRQOL) instruments needed to exclude chance or error at various levels of certainty in patients with medically refractory epilepsy.

METHODS

Forty patients with temporal lobe epilepsy and clearly defined criteria of clinical stability received HRQOL measurements twice, 3 months apart, using the Quality of Life in Epilepsy Inventory-89 and -31 (QOLIE-89 and QOLIE-31), Liverpool Impact of Epilepsy, adverse drug events, seizure severity scales, and the Generic Health Utilities Index (HUI-III). Standard error of measurement and test-retest reliability were obtained for all scales and for QOLIE-89 subscales. Using the Reliable Change Index described by Jacobson and Truax, we assessed the magnitude of change required by HRQOL instruments to be 90 and 95% certain that real change has occurred, as opposed to change due to chance or measurement error.

RESULTS

Clinical features, point estimates and distribution of HRQOL measures, and test-retest reliability (all > 0.70) were similar to those previously reported. Score changes of +/-13 points in QOLIE-89, +/-15 in QOLIE-31, +/-6.3 in Liverpool seizure severity-ictal, +/-11 in Liverpool adverse drug events, +/-0.25 in HUI-III, and +/-9.5 in impact of epilepsy exclude chance or measurement error with 90% certainty. These correspond, respectively, to 13, 15, 17, 18, 25, and 32% of the potential range of change of each instrument.

CONCLUSIONS

Threshold values for real change varied considerably among HRQOL tools but were relatively small for QOLIE-89, QOLIE-31, Liverpool Seizure Severity, and adverse drug events. In some instruments, even relatively large changes cannot rule out chance or measurement error. The relation between the Reliable Change Index and other measures of change and its distinction from measures of minimum clinically important change are discussed.

The impact of epilepsy from the patient's perspective I. Descriptions and subjective perceptions

This study surveyed the perceptions about and subjective experience of 1023 people with epilepsy in two community-based samples: one from a national postal survey; the other callers to the Epilepsy Foundation. Response to a mail survey was 49%. In comparison with US Census Bureau norms, respondents had received less education, were less likely to be employed or married, and came from lower income households. Complex partial seizures were the most prevalent seizure type, but a convulsion had occurred in 61%. Fifty percent of respondents reported incomplete control of their seizure disorder, although 25% of these had a seizure in the prior year. Thirteen percent had a longest inter-seizure interval of a year or greater, 37% of 3 months, 22% of 1 month, 10% of 1 week and 4% of 1 day. Respondents listed uncertainty and fear of having a seizure as the worst thing about having epilepsy. Lifestyle, school, driving, and employment limits were also listed as major problems. When asked to rank a list of potential problems, cognitive impairment was ranked highest. These data indicate that ongoing medical and psychosocial problems continue for those with epilepsy in the view of those questioned and their families, even in a sample where the majority report good control of their epilepsy.