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Kwon CS, Jacoby A, Ali A, Austin J, Birbeck GL, Braga P, Cross JH, de Boer H, Dua T, Fernandes PT, Fiest KM, Goldstein J, Haut S, Lorenzetti D, Mifsud J, Moshe S, Parko KL, Tripathi M, Wiebe S, Jette N. Systematic review of frequency of felt and enacted stigma in epilepsy and determining factors and attitudes toward persons living with epilepsy-Report from the International League Against Epilepsy Task Force on Stigma in Epilepsy. Epilepsia 2022; 63:573-597. [PMID: 34985782 DOI: 10.1111/epi.17135] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the evidence of felt and enacted stigma and attitudes toward persons living with epilepsy, and their determining factors. METHODS Thirteen databases were searched (1985-2019). Abstracts were reviewed in duplicate and data were independently extracted using a standardized form. Studies were characterized using descriptive analysis by whether they addressed "felt" or "enacted" stigma and "attitudes" toward persons living with epilepsy. RESULTS Of 4234 abstracts, 132 met eligibility criteria and addressed either felt or enacted stigma and 210 attitudes toward epilepsy. Stigma frequency ranged broadly between regions. Factors associated with enacted stigma included low level of knowledge about epilepsy, lower educational level, lower socioeconomic status, rural areas living, and religious grouping. Negative stereotypes were often internalized by persons with epilepsy, who saw themselves as having an "undesirable difference" and so anticipated being treated differently. Felt stigma was associated with increased risk of psychological difficulties and impaired quality of life. Felt stigma was linked to higher seizure frequency, recency of seizures, younger age at epilepsy onset or longer duration, lower educational level, poorer knowledge about epilepsy, and younger age. An important finding was the potential contribution of epilepsy terminology to the production of stigma. Negative attitudes toward those with epilepsy were described in 100% of included studies, and originated in any population group (students, teachers, healthcare professionals, general public, and those living with epilepsy). Better attitudes were generally noted in those of younger age or higher educational status. SIGNIFICANCE Whatever the specific beliefs about epilepsy, implications for felt and enacted stigma show considerable commonality worldwide. Although some studies show improvement in attitudes toward those living with epilepsy over time, much work remains to be done to improve attitudes and understand the true occurrence of discrimination against persons with epilepsy.
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Affiliation(s)
- Churl-Su Kwon
- Departments of Neurosurgery, Neurology and Population Health Sciences & Policy, Icahn School of Medicine, New York, New York, USA
| | - Ann Jacoby
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Amza Ali
- Kingston Public Hospital and University of the West Indies, Kingston, Jamaica
| | - Joan Austin
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Gretchen L Birbeck
- Epilepsy Division, University of Rochester, Rochester, New York, USA
- Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia
| | - Patricia Braga
- Facultad de Medicina, Institute of Neurology, Universidad de la República, Montevideo, Uruguay
| | - J Helen Cross
- Developmental Neurosciences Programme, UCL-NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Hanneke de Boer
- SEIN - Epilepsy Institute in the Netherlands Foundation, Heemstede, The Netherlands
| | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Paula T Fernandes
- Department of Sport Science, Faculty of Physical Education, UNICAMP, Campinas, Brazil
| | - Kirsten M Fiest
- Department of Critical Care Medicine and Department of Community Health Sciences, Hotchkiss Brain Institute, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Goldstein
- Departments of Neurology and Population Health Sciences & Policy, Icahn School of Medicine, New York, New York, USA
| | - Sheryl Haut
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Diane Lorenzetti
- Department of Community Health Sciences, University of Calgary and Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Janet Mifsud
- Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Solomon Moshe
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
- Department of Pediatrics and Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Karen L Parko
- Department of Neurology, University of California at San Francisco, San Francisco, California, USA
- Epilepsy Center, San Francisco VA Medical Center, San Francisco, California, USA
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Samuel Wiebe
- Department of Clinical Neurosciences and Department of Community Health Sciences, Hotchkiss Brain Institute, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Nathalie Jette
- Departments of Neurology and Population Health Sciences & Policy, Icahn School of Medicine, New York, New York, USA
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Arts-based knowledge translation in aerial silk to promote epilepsy awareness. Epilepsy Behav 2019; 93:60-64. [PMID: 30831404 DOI: 10.1016/j.yebeh.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/02/2018] [Accepted: 12/08/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Arts-based knowledge translation (ABKT) strategies represent an innovative approach to disseminate results of qualitative studies, especially to tackle social issues, such as stigma and prejudice, due to knowledge gaps. Epilepsy affects 1% of the world population and brings a strong psychosocial impact to the patient, family members, and caregivers. People with epilepsy have difficulties to establish social relationships due to stigma. METHODS In this study, we narrate the construction of an aerial and contemporary dance based on the results of a qualitative study with patients with epilepsy, their families, and health professionals, called "'Dialogue with Emotions' to overcome barriers and to improve quality of life in epilepsy". Under the ABKT classification, this study is defined as a strategy of subjective key messages, which are presented as active performances (contemporary dance and aerial acrobacies). RESULTS In this sense, the choreography called "Perspective" presented elements that relate to suffering, pain, fear, social isolation, followed by mutual support, resilience, adaptation, and happiness. Through its scenic poetry and acrobatics combined with special lighting effect and soundtrack, this choreography represents the potential to overcome suffering and experience happiness if people embrace a different perspective over epilepsy. CONCLUSION This presentation conveyed perceptions on epilepsy in a way to create an experience for its audience. It represented an opportunity to stimulate reflection, discussion, and knowledge construction between members of the academy, as well as patients and caregivers. Thus, this artistic presentation was able to promote discussions about epilepsy, disseminating research results, promoting empathy and compassion.
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Ferreira LS, Pallhares D, Seguti VF, Gava M, Marasciulo ACE. Epilepsia e Previdência Social: a decisão médico-pericial. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2012. [DOI: 10.1590/s0303-76572012000200014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A maior dificuldade encontrada no manejo de pacientes com epilepsia frente aos seguros saúde é que, apesar de todo o aparato tecnológico de que se dispõe atualmente, o diagnóstico continua sendo predominantemente clínico, não havendo critérios objetivos na definição da incapacidade laborativa. Este ensaio tem como propósito discutir necessidades e parâmetros e apresentar uma proposta de aperfeiçoamento de relatório a ser preenchido pelo médico assistente a fim de traçar estratégias para que o perito médico defina, com maior segurança, a incapacidade laborativa em segurados portadores de epilepsia. A proposta discute aspectos relacionados a diagnóstico, tratamento e prognóstico, assim como fatores que interferem na capacidade de trabalho, visando auxiliar a decisão médico-pericial acerca da concessão ou não de benefícios.
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Affiliation(s)
| | | | | | - Marília Gava
- Instituto Nacional do Seguro Social (INSS), Brasil; Instituto Nacional do Seguro Social (INSS)
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Ferrari CMM, Castro LHM, Settervall CHC, de Moura RM, Coutinho PA, Oshiro IES, Alves RB, de Sousa RMC. Validity and reliability of the Portuguese version of the Epilepsy Medication Treatment Complexity Index for Brazil. Epilepsy Behav 2011; 21:467-72. [PMID: 21664877 DOI: 10.1016/j.yebeh.2011.04.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/14/2011] [Accepted: 04/17/2011] [Indexed: 12/26/2022]
Abstract
We evaluated the reliability and validity of a Brazilian-Portuguese version of the Epilepsy Medication Treatment Complexity Index (EMTCI). Interrater reliability was evaluated with the intraclass correlation coefficient (ICC), and validity was evaluated by correlation of mean EMTCI scores with the following variables: number of antiepileptic drugs (AEDs), seizure control, patients' perception of seizure control, and adherence to the therapeutic regimen as measured with the Morisky scale. We studied patients with epilepsy followed in a tertiary university-based hospital outpatient clinic setting, aged 18 years or older, independent in daily living activities, and without cognitive impairment or active psychiatric disease. ICCs ranged from 0.721 to 0.999. Mean EMTCI scores were significantly correlated with the variables assessed. Higher EMTCI scores were associated with an increasing number of AEDs, uncontrolled seizures, patients' perception of lack of seizure control, and poorer adherence to the therapeutic regimen. The results indicate that the Brazilian-Portuguese EMTCI is reliable and valid to be applied clinically in the country. The Brazilian-Portuguese EMTCI version may be a useful tool in developing strategies to minimize treatment complexity, possibly improving seizure control and quality of life in people with epilepsy in our milieu.
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Affiliation(s)
- Carla Maria Maluf Ferrari
- Department of Neurology, Hospital das Clinicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil.
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Tedrus GMAS, Fonseca LC, Oliveira EM, Fonseca ALAD, Carneiro ACR, Carvalho RM. Factors associated with the employment situation and driving license of patients with epilepsy. ACTA ACUST UNITED AC 2010. [DOI: 10.1590/s1676-26492010000400004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION: It is estimated that approximately 50% of patients with epilepsy have difficulty finding employment. OBJECTIVE: Evaluate the employment situation and driving license of patients with symptomatic or probably symptomatic focal epilepsy and correlate it with clinical and socio-demographic aspects. METHODS: Ninety-two patients were classified into 3 groups: "employed", "unemployed" and "retired/on leave". The relationship between employment and socio-demographic aspects and those of epilepsy was studied, and also whether the patients were holders of national driving licenses. RESULTS: Thirty-one (33.7%) of the patients were employed, 19 (20.7%) unemployed and 33 (35.9%) retired/on leave. Patients with formal education of less than 9 years predominated (p<0.05) in the "retired/on leave" group and non-white patients were more frequently unemployed. Of 58 patients who lost their jobs, 27 (46.6%) reported that epilepsy was the main reason (p<0.05). There was a significant relationship between the occurrence of ES at work and unemployment and "leave/retirement" (p<0.05). There was no relationship between clinical aspects and the employment situation. Nineteen (33.9%) of the 56 surveyed reported being holders of driving licenses. DISCUSSION: There was a high index of unemployment and retired/on leave individuals. There was a relationship between unemployment and the occurrence of ES at work and with a low scholastic level. CONCLUSION: The low scholastic level/professional qualifications and the stigma aggravated the employment perspectives of these individuals, contributing to their social exclusion.
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Fonseca LC, Tedrus GMAS, Costa ACF, Luciano PQ, Costa KC. Conhecimentos e atitudes sobre epilepsia entre universitários da área da saúde. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:1068-73. [PMID: 15608971 DOI: 10.1590/s0004-282x2004000600025] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Lineu Corrêa Fonseca
- Faculdade de Medicina, Pontifícia Universidade Católica de Campinas, SP, Brazil.
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