An educational campaign toward epilepsy among Italian primary school teachers: 1. Survey on knowledge and attitudes

Understanding teachers' perspectives on students with epilepsy in Germany: A survey examining knowledge, experience, and affective, cognitive, and behavioral attitudes to inform teacher training

The comprehensive teacher survey (N = 210 teachers), conducted in Germany, focused on a broad range of student needs (medical, instructional, and emotional), and captured teachers' knowledge about epilepsy and experiences with students with epilepsy (SWE), alongside multiple attitudes towards SWE. Results reveal gaps in teachers' understanding of appropriate responses to seizures, exemplified by 33 % believing an object should be put into the mouth during a seizure. Misconceptions about the risks of physical activity for SWE are prevalent among teachers (6.3-10.6 %). Misbeliefs and misconceptions about learning difficulties and deviant behavior of SWE are rare (0.5-3.4 %) and only a small subset of teachers (2.9 %) recommends special education schooling for SWE. The results highlight mixed feelings and thoughts (affective and cognitive attitudes), including negative emotions (45.5 %-66.7 %) and insecurities (25.1-50.5 %) about supervising SWE during activities. Some teachers (7.7-20.4 %) are inclined, with safety concerns in mind, to exclude SWE from activities (behavioral intention). Not all teachers exhibit sufficient confidence in seizure first aid (10.5-31.4 %), seizure-specific classroom management (27.3-47.8 %), and emotional support skills (10-28 %). These different attitude traits were identified through exploratory factor analysis. Knowledge about epilepsy and experiences with SWE are linked to favorable attitudes towards SWE, with correlations ranging from -0.27 to 0.19 for knowledge and from -0.37 to 0.26 for experiences (negative correlations with negative emotions and insecurities, and positive correlations with confidence in skills). Equipping teachers to handle both the medical and psychosocial aspects of epilepsy is crucial for ensuring the well-being of SWE at school.

Knowledge, awareness, and attitudes towards epilepsy among elementary schoolteachers in the Kingdom of Bahrain

BACKGROUND

Teachers' awareness of epilepsy and attitudes toward students with epilepsy (SWE) largely affect their health, behavior, and academic performance. This study aimed to assess elementary schoolteachers' background knowledge and attitudes toward epilepsy in the Kingdom of Bahrain.

METHODS

A 23-item online questionnaire was distributed to elementary school teachers in all public schools in Bahrain between September 2022 and February 2023. The questionnaire included three sets of questions about teachers'1) demographics and teaching experience, 2) knowledge and experience with epilepsy, and 3) attitude towards SWE.

RESULTS

Three hundred and sixty-seven teachers responded to the questionnaire. Only 82 participants (22.3%) thought they had enough information about epilepsy. Approximately 25% had previously taught SWE. Even though 9.3% have witnessed a seizure before, only 2.2% received seizure first aid training courses. Most respondents (68.7%) knew that epilepsy is caused by abnormal brain electrical activity and is not contagious (95.1%). Regarding seizure types, 76.6% were aware of uncontrollable jerky movements, while staring spells were recognized by 45%. Most first-aid responses were inappropriate, as 59.7% would open the patient's mouth. Only 39.5% agreed on patient transfer to the hospital if the seizure lasted ≥5 min. Epilepsy was thought to cause mental retardation by 32.4%. Also, the belief that SWE were more prone to bullying was reported by 57.2%.

CONCLUSION

The knowledge and attitudes of schoolteachers in Bahrain towards epilepsy are relatively good but with remaining improvement potential. They do not fully grasp all seizure types nor adequate first-aid measures promoting future epilepsy educational programs.

Development and Validation of Epilepsy Life Skills Guidelines for Primary School Learners and Teachers in Limpopo and Mpumalanga Provinces

Epilepsy is a disorder that disturbs nerve cell activity in the brain, resulting in seizures. It was noted that it occurs mostly in children, especially at the primary school level, and could result from a genetic condition. The aim of this study was to develop and validate life skills education guidelines for primary school learners of Limpopo and Mpumalanga provinces in South Africa to educate them about epilepsy with the aim of reducing stigma and discrimination towards people with epilepsy. The guidelines were developed by adapting the World Health Organization (WHO) guideline development guide, which included the formulation of PICOS (population, intervention, comparison, outcome, study design) questions, conducting a systematic review of the literature, and using GRADE (grading of recommendations assessment, development, and evaluation) to develop evidence-based recommendations. The recommendations that informed the guideline development were that epilepsy education should be included in the primary school life skills curriculum to improve learners' understanding, attitudes, and skills related to epilepsy. This epilepsy education should be tailored to the needs of primary school learners and cover topics such as seizure recognition, management, medication, and coping strategies. Collaboration between healthcare providers, educators, and policymakers is crucial to developing culturally appropriate and evidence-based epilepsy education guidelines. Teachers and healthcare providers should also receive training on how to support learners living with epilepsy. The resulting guidelines provide clear and concise guidance on epilepsy education in life skills for primary school learners, caregivers, and teachers. The guidelines are expected to improve the quality of epilepsy life skills education and contribute to the overall well-being and inclusion of learners with epilepsy in Mpumalanga and Limpopo provinces, South Africa.

The 50th anniversary of the Italian League Against Epilepsy (Lega Italiana Contro l’Epilessia)

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We describe the 50-year history of the Italian League Against Epilepsy (LICE).

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LICE promotes high-quality epilepsy care, education and research into epilepsy.

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LICE maintains close relations with ILAE and other professional societies.

This article was prepared to outline the article collection submitted on behalf of Lega Italiana Contro l’Epilepsia, or LICE, for the 50th anniversary of the founding of the ILAE Italian Chapter, and provides a brief summary of the history, with its landmark achievements and challenges. LICE is a multidisciplinary, inclusive, educational, informative and multifaceted organization. Initially in 1955 and then formally in 1972, LICE was born in Milano, with the mission to devote itself to people suffering with epilepsy and by promoting appropriate treatment and care, integration into society, to promote and pursue all kinds of activities designed to achieve those aims. The LICE is currently composed of more than 1000 members including neurologists, pediatric neurologists, neurosurgeons, neurophysiologists, and neuropsychologists who function throughout Italy dealing mainly or exclusively with the diagnosis and treatment of people with epilepsy.

Assessing knowledge and attitudes toward epilepsy among schoolteachers and students: Implications for inclusion and safety in the educational system

Several studies have evidenced inadequate knowledge about epilepsy and inappropriate seizure management, influencing quality of life and social inclusion of patients with epilepsy. Aim of the study was to estimate the knowledge and the attitudes toward epilepsy in schoolteachers and students in Italy. Custom-designed and validated questionnaires in Italian on general and specific knowledge, and social impact of epilepsy have been administered in a random sample of schoolteachers and students. Overall, 667 schoolteachers and 672 students have been included. Among teachers and students, consider epilepsy a psychiatric disorder (16.8% and 26.5%) or an incurable disease (43.9% and 33%). The 47.5% of teachers declared to be unable to manage a seizing student, 55.8% thought it requires specific support and 21.6% reported issues in administer antiseizure medications in school. Healthcare professionals should have an active role in the educational system, dispelling myths, preparing educators and students with appropriate attitudes in the event of a seizure and prevent over limitations in patients with epilepsy. These findings highlight still poor knowledge and attitudes about epilepsy among teachers and students although the 99.4% claimed to have heard/read something about epilepsy. Therefore, improving existing dedicated educational/training interventions could be necessary.

Empowering seizure management skills: Knowledge, attitudes, and experiences of school staff trained in administering rescue drugs in Northern Italy

PURPOSE

The administration of rescue medication at school concerns students for which it may be essential, on doctor's prescription, to take therapy during school hours. In this case, since the parents are absent, the first rescuer is necessarily the school staff, who should be properly trained because prolonged seizures can cause severe harm and even death.

METHODS

Every year, the Local Health Unit "TO3" in Northern Italy, provides training for school staff to administrate rescue medication at school. From December 2019 to February 2020, the same questionnaire was administered to school staff trained for seizures at the end of the course, while the staff trained for other diseases completed it before the course.

RESULTS

About 60% of the sample (N = 123) had been trained in seizure management at least once in their lifetime. Median knowledge score in subjects with no seizures training was 7 (Q25/Q75: 5/8), while it was 9 (Q25/Q75: 6/10) in subjects with seizures training (p < 0.001). The self-reported level of confidence in their skills to administer rescue medication was high in 10.2% of subjects not trained for seizures and in 62.9% of those trained (p < 0.001).

CONCLUSION

Results suggest that medical training for school staff increases knowledge scores and levels of self-confidence relating to the administration of rescue medication. Moreover, after the training, the school staff changed attitude toward seizures, no longer considering them a problem, and became more aware, less fearful, and more inclined to act in case of need, making school a better place for all students.

Stigma reduction interventions for epilepsy: A systematized literature review

OBJECTIVE

Epilepsy is a disease that is stigmatized globally. Several studies have introduced sensitization efforts to reduce stigma towards people with epilepsy (PWE) in various settings. Although sensitization efforts have shown some evidence of improved attitudes towards epilepsy, progress has been limited. This systematized literature review summarizes the existing literature concerning interventions that reduce stigma towards PWE. By conducting an overview of existing interventions, we aimed to consolidate knowledge and outcomes of existing efforts as well as highlight gaps and directions for future interventions.

METHODS

We searched MEDLINE (via PubMed) and Embase for English-language studies published between January 1, 1970 and November 15, 2017 that focused on stigma reduction strategies for PWE in any global setting. Studies were included if they described a stigma reduction intervention for epilepsy. Studies were excluded if they were reviews, editorials, conference proceedings, abstracts, or did not discuss a stigma reduction intervention. We thematically grouped studies based on type(s) of intervention(s) addressed and summarized interventions, outcome measures, and results for each study included in the review.

RESULTS

Of the 1975 initial citations, 32 studies met our inclusion criteria. Interventions clustered into four broad categories including public awareness interventions, policy-based interventions, school-based interventions, and interventions that targeted PWE themselves as well as their caregivers and peers. Efficacy of these interventions as reported by the authors was mixed. Many studies did not use validated outcome measures to assess stigma.

CONCLUSIONS

Although intervention efforts have been made towards epilepsy stigma reduction at many levels, stigma towards and discrimination against PWE prevail worldwide. About 75% of the studies included in this review were conducted in high-income countries (HICs) despite the disproportional need in low- and middle-income countries (LMICs). Furthermore, robust outcome measures to assess efficacy in stigma reduction for interventions are lacking, calling into question the validity of reported outcomes for both positive and null findings. Therefore, more work is needed in both developing effective stigma reduction strategies, especially in LMICs, and validating tools to measure their efficacy. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".

Epilepsy knowledge, attitude, practice, and associated factors among primary, secondary, and preparatory schoolteachers in Lay-Armachiho District, Northwest Ethiopia

Epilepsy is one of the most common neurological disorders encountered worldwide. It is poorly understood by the community, and it has been associated with numerous beliefs and misconceptions. Social stigma towards epilepsy is common in developing countries especially in Ethiopia, and its social, economic, and psychological consequences have become a major public health problem. The aim of this study was to assess epilepsy knowledge, attitude, practice, and associated factors among primary, secondary, and preparatory schoolteachers in Lay-Armachiho District, Northwest Ethiopia. An institution-based cross-sectional study design was conducted with 568 teachers working in ten schools of the district, using self-administered questionnaires. Descriptive analysis, binary, and multivariable logistic regression analyses were applied to analyze the data. In this study, 52.8% of the teachers had good knowledge (confidence interval (CI): 48.7, 56.9), 52.1% of the teachers had an unfavorable attitude (CI: 48.0, 56.2), and 55.3% of the teachers had a poor practice towards epilepsy (CI: 51.2, 59.3). After adjusting for covariates, being a male (adjusted odds ratio (AOR) = 1.5), urban resident (AOR = 2.4), degree holder (AOR = 2.3), above fourteen years teaching experience (AOR = 2.1), family history of epilepsy (AOR = 15.2), and previous first aid training (AOR = 1.8) were positively associated with the knowledge of epilepsy. The odds of having a positive attitude for epilepsy were 3.1 and 3.4 times higher among the teachers whose age is above 42 years and degree holders, respectively. Moreover, the odds of having a good practice for epilepsy were 2.1, 3.5, and 1.7 times higher among teachers of degree holders, a history of previous first aid training, and a history of providing first aid for students with epilepsy in the time of need, respectively. The main findings indicated that the majority of schoolteachers had good knowledge about, but unfavorable attitude and poor practice towards epilepsy. Therefore, the authors recommend that incorporating special need course in the educational curriculum with the help of first aid training and health promotion intervention to all levels of schoolteachers is very important.

Knowledge and attitudes among preschools staff in Shanghai, China, regarding epilepsy

Background

Epilepsy is one of the most common neurological problems among children. The aim of this survey was to assess the knowledge and attitude among preschool staff in Shanghai regarding epilepsy.

Methods

A cross-sectional survey was carried out among the staff at selected preschools. A stratified random sampling method was first used to identify suitable subjects. Data were obtained using a self-completed questionnaire. A standardized collection of demographic information was performed, and participants were given a questionnaire about their knowledge and attitudes regarding epilepsy.

Results

A total of 1069 subjects completed the questionnaire. In this survey, 387 (36.2%) staff members had previously participated in related training. 17.6% of teachers knew how to provide appropriate first aid for seizures. Correct responses regarding first aid for seizures, such as laying the person on his or her side (24.9%), moving harmful objects out of the way (20.7%), protecting the head (36.1%), waiting until the seizure ends (7.9%), and dialing the emergency number (40.1%), were low. The staff members had different attitudes towards children with epilepsy: some subjects had a positive attitude, some had a negative attitude.

Conclusions

The level of first-aid knowledge among preschool staff in Shanghai relevant to epilepsy was low. There is an urgent need to educate staff about epilepsy and appropriate first-aid practices for seizures.

Impact of epilepsy training on school teachers and counselors: An intervention study in Lebanon

This study aimed to evaluate the immediate impact of an epilepsy training through the administration of a questionnaire (in Arabic) before and immediately after the intervention in Lebanese public and private schools. This project is part of an awareness campaign applied to 3 groups of teachers and counselors and consisted of a pretest, a unified conference and a posttest. The statistical analysis used the McNemar and Stuart Maxwell tests (statistical significance level of 0.05). 73 participants completed the questionnaires. The majority were female (68.5%), aged less than 39 years (57%) and familiar with epilepsy. A positive impact of the training was found regarding the effect of epilepsy on schooling, seizures manifestations, psychological effects, seizure first aid and the possibility of curing epilepsy with surgery. Most of our participants recognized that children with epilepsy have a comparable IQ to others. They did not exhibit a discriminatory attitude against people with epilepsy in terms of the direct attitude towards them, employment or marriage. This is one of few studies done worldwide demonstrating an immediate positive effect of epilepsy training among school teachers. Future research should be undertaken to develop robust training models to destigmatize epilepsy.

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An epilepsy training in Lebanese schools had an immediate positive impact.

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In total 73 teachers and counselors completed the pre and posttest questionnaires.

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Participants didn't exhibit a discriminatory attitude against people with epilepsy.

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Participants recognized that children with epilepsy have a comparable IQ to others.

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Training improved awareness on seizure first aid and epilepsy cure by surgery.

Epilepsy, Physical Activity and Sports: A Narrative Review

People with epilepsy (PWE) are less physically active compared with the general population. Explanations include prejudice, overprotection, unawareness, stigma, fear of seizure induction and lack of knowledge of health professionals. At present, there is no consensus on the role of exercise in epilepsy. This paper reviews the current evidence surrounding the risks and benefits associated with physical activity (PA) in this group of patients. In the last decade, several publications indicate significant benefits in physiological and psychological health parameters, including mood and cognition, physical conditioning, social interaction, quality of life, as well as potential prevention of seizure presentation. Moreover, experimental studies suggest that PA provides mechanisms of neuronal protection, related to biochemical and structural changes including release of β-endorphins and steroids, which may exert an inhibitory effect on the occurrence of abnormal electrical activity. Epileptic discharges can decrease or disappear during exercise, which may translate into reduced seizure recurrence. In some patients, exercise may precipitate seizures. Available evidence suggests that PA should be encouraged in PWE in order to promote wellbeing and quality of life. There is a need for prospective randomized controlled studies that provide stronger clinical evidence before definitive recommendations can be made.

Knowledge of and attitudes towards epilepsy among teachers: A systematic review

The objective of this study was to systematically review research that has focused on knowledge of and attitudes towards epilepsy among teachers. Embase, PubMed, PsycINFO, Google Scholar, and Cochrane library databases from 2000 to 2017 were searched. Cross-sectional and interventional studies were included and analyzed for quality. Thematic analysis was used to identify common themes in the results. Fifty-four eligible studies (17,256 total participants in 27 different countries) were identified in the search period including seven studies that focused on assessing attitudes and knowledge before and after an educational intervention. It was not possible to systematically analyze levels of knowledge and nature of attitudes because of the wide variety of mostly bespoke study specific instruments used. Few studies employed valid and reliable instruments. Thematic analysis revealed three main themes in the results: 1.) deficits in knowledge and negative attitudes were pervasive across all studies; 2.) teachers often had a negative attitude towards participation of children with epilepsy in physical activities/sport; and 3.) teachers often expressed limited knowledge of seizure management/emergency procedures. There was a lower level of knowledge and more negative attitudes among teachers towards epilepsy compared with other conditions. All studies focusing on interventions showed that at least some aspects of knowledge and attitudes improved as a result of teacher participation in an educational intervention, but study quality was universally rated as low. A higher level of education and experience of teaching a child with epilepsy was significantly associated with greater knowledge in a number of studies. Additionally, having experience of teaching a child with epilepsy and greater assessed knowledge of epilepsy were associated with more positive attitudes. The wide range of methods used makes it difficult to generalize regarding level of attitudes and knowledge among teachers towards epilepsy. Nevertheless, all studies indicate that there are some deficits in knowledge of and negative attitudes towards epilepsy among teachers. It would appear that knowledge and attitudes can be improved by educational interventions. Future research should focus on developing psychometrically sound assessment instruments that can be used globally and on identifying the most effective ways of delivering efficacious educational initiatives employing robust study designs.

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

BACKGROUND

Knowledge, attitudes, and practice (KAP) questionnaire-based surveys have captured negative attitudes towards marriage involving people with epilepsy (PWE). The attitudes may vary according to the nature of the question posed, whether personal or generic, in addition to many other covariates.

METHODS

We carried out meta-proportion and -regression analyses of epilepsy-related KAP surveys published between 1970 and 2016 in the medical literature analysis retrieval system online (MEDLINE) database.

RESULTS

The pooled estimate of the proportion of those responding positively to the marriage question was 0.45 (95% confidence interval (_95%CI): 0.35 to 0.54; I²_res = 99.89%). The pooled proportion of positive responders to a personal question (0.40; _95%CI: 0.35 to 0.46) was significantly lower than those responding positively to a generic question (0.64; _95%CI: 0.57 to 0.70) (P = 0.001). When modeled individually in regression analyses, only the continent of origin of the survey (P = 0.001; tau²: 0.06; I²_res: 99.8%; adjusted R²: 11.4%) and subject population type (P = 0.02; tau²: 0.07; I²_res: 99.9%; adjusted R²: 4.2%) were associated with the pooled estimate of positive responders to the question on marriage.

CONCLUSIONS

Personal questions probing the possibility of marriage of self or family members to someone with epilepsy bring about negative attitudes more often than generic questions inquiring the marriage-worthiness of PWE.

Primary school female teachers' knowledge, attitude, and practice toward students with epilepsy in Riyadh, Saudi Arabia

BACKGROUND

Epilepsy is the most neurological condition prevalent in humanity and it is associated with stigma and discrimination. Knowledge and practice of primary care teachers toward students with epilepsy, especially at young age, is imperative for their development.

OBJECTIVES

This study was designed to assess the level of knowledge, attitude, and practice of female primary school teachers toward students with epilepsy in Riyadh, Saudi Arabia.

SUBJECTS AND METHODS

In this cross-sectional study, 582 female primary school teachers had volunteered. They were assessed on their knowledge, attitude, and practice toward students with epilepsy using a self-administrated questionnaire. The questionnaire was cross-culturally validated before the distribution.

RESULTS

The results suggest above-average familiarity with epilepsy (79.2%). Younger teachers are less likely to associate epilepsy with retardation (P = 0.038). In general, the attitude was positive among the teachers, and 36.9% felt that the students should be treated normally and 63.1% with compassion toward them. Only 14.3% answered that epileptic students should be transferred to special need schools. Highly educated teachers were less likely to feel that epileptic students can cause problems (P = 0.038). The practice was poor with 31.8% expressed the ability to provide first aid to epileptic students. Only 27.5% accepted to give the students prescribed medications.

CONCLUSION

The knowledge about epilepsy needs improvement among primary school teachers in Riyadh. Public level interventions through proper courses can provide a leverage. The higher level of knowledge can be pivotal in increasing the positive attitude and practice of teachers toward epileptic students.

The stigma experiences and perceptions of families living with epilepsy: Implications for epilepsy-related communication within and external to the family unit

OBJECTIVE

This paper presents the stigma experiences of children with epilepsy (CWE) and their parents and outlines the relationship between CWE's and parents' stigma perceptions, demographic and seizure variables, and epilepsy-related communication within and external to the family.

METHODS

A mixed-method design was employed. In phase one, 33 CWE and 40 parents participated in qualitative interviews. In phase two, 47 CWE and 72 parents completed a cross-sectional survey.

RESULTS

CWE and their parents experience felt and enacted stigma via social exclusion, activity restriction, teasing/bullying, internalised negative feelings to epilepsy, concealment of epilepsy and parental stigma-coaching. Higher CWE and parent stigma perceptions were significantly correlated with greater epilepsy concealment from others outside the family and greater negative affect around epilepsy-related communication within the home.

CONCLUSION

As CWE and their parents grapple with epilepsy-related stigma they may inadvertently contribute to the silence encircling epilepsy through diagnosis concealment, stigma-coaching and/or by engaging in limited family dialogue about epilepsy.

PRACTICE IMPLICATIONS

Healthcare professionals need to be cognisant of broaching the sensitive topic of epilepsy-related stigma during their engagements with families living with epilepsy. Assisting families to appropriately engage in dialogue surrounding epilepsy is likely to improve the psychosocial wellbeing of CWE and their parents.

Knowledge about epilepsy and attitudes towards affected people among teachers in training in the Czech Republic

The aim of this study was to compare knowledge about, confidence with, and attitudes towards epilepsy and affected people between groups of freshmen and senior teachers in training (preservice teachers) at the Faculty of Education in Pilsen, Czech Republic. Two hundred thirty-six freshmen and 138 seniors completed the 21-item Scale of Attitudes Towards People with Epilepsy (ATPE), an 18-item multiple-choice test measuring their knowledge about epilepsy, and a 5-item questionnaire focused on confidence with epilepsy in a school environment. We found that despite a higher level of knowledge about epilepsy among seniors (mean score of 9.6 points compared with 8.48 points for freshmen, p<0.001), attitudes towards epilepsy, and also confidence in how to manage children affected with this disease did not differ significantly. The presented findings suggest that epilepsy-related training of preservice teachers should be more effective especially with respect to their ability to resolve problems that may happen to children with epilepsy in a class.

Teachers of various school grades and representations of epilepsy: problems, relational aspects and perspectives of life quality

Introduction

The analysis of the representations of the health of their students by teachers is key to the understanding of the attitudes and behaviors that, in general, take place inside the school community and the educational processes. In fact, social attitudes by teachers and individual within the school environment are often the result of simple categorization and stereotypes, which hinder the process of evolutionary change.

Aims

On these premises it was necessary to investigate the level of knowledge of the epilepsy syndrome, the representations by a group of teachers of the quality of life of people with epilepsy and the representations of the interpersonal relationships between students with epilepsy and their classmates.

Methodology

We used an ad hoc questionnaire, with 33 multiple choice answers, focusing on these variables: work seniority, experience with epileptic students, special education or main teacher.

Participants

The sample consisted of 113 female teachers with a mean age of 44.4.

Results

There aren’t significant differences between the answers of special education and main teachers: a) teachers with work seniority > 11 years showed a more than adequate knowledge of information about epilepsy. Moreover, in case of seizure in the classroom, first aid is to call an ambulance rather than administering rescue drugs; b) teachers, who have had a real experience, represent the epileptic student as more limited in the possibilities of getting married, having children, finding a job, and practising a sport; c) teachers, who have had a student with epilepsy don’t report interpersonal relationships with his/her classmates as being difficult. Moreover, they claim to have inadequate knowledge of the educational strategies needed to integrate the epileptic student with his/her classmates; d) there are some different answers for primary school teachers and for secondary school teachers.

Conclusions

Teachers demonstrate inaccurate information about epilepsy, its impact in educational contexts and management of seizures in the classroom. Also, critical areas have emerged indicating efforts should focus on education, sharing the role of teacher, awareness and integration in the class group.

To tell or not to tell: A systematic review of the disclosure practices of children living with epilepsy and their parents

Disclosing an epilepsy diagnosis to others is complex due to the condition's largely invisible nature and associated stigma. Despite this, little has been documented in terms of what this process involves for children living with epilepsy (CWE) and their parents. A systematic review was conducted to examine and synthesize evidence pertaining to: (i) the disclosure practices of CWE and their parents, (ii) enablers and barriers for disclosure, (iii) the impact of disclosure practices, and (iv) the relationship between disclosure management and other variables. The electronic databases PsycINFO, PubMed, MEDLINE, CINAHL, Scopus, and Web of Science were searched systematically. Any empirical, peer-reviewed journal articles with findings reported regarding the self- or proxy-reported disclosure practices of children aged 0-18years with any type of epilepsy and/or their parents were deemed eligible for inclusion. Two review authors completed all stages of screening, data extraction, and quality assessment independently with two additional review authors resolving any discrepancies. A total of 32 articles were included in the review. Only one dated study examined disclosure as a primary focus; in the remaining studies, disclosure was a subfocus of larger studies or pertinent qualitative themes/subthemes incidentally emerged. The limited evidence suggests that: 1) CWE and parents adopt varying disclosure management strategies - from concealment to voluntary disclosure; 2) disclosure decisions are challenging for CWE and parents; 3) many barriers to disclosure exist (e.g., fear of stigmatization and rejection); 4) only a limited number of factors that enable disclosure are known (e.g., openness by others to engage with and learn about epilepsy); 5) disclosure management is significantly related to a number of variables (e.g., child/maternal perceived stigma and seizure control); and 6) there are varying outcomes for CWE and/or their parents in accordance with the adoption of specific disclosure management strategies (e.g., disclosure resulting in greater acceptance and the receipt of support or evoking anxiety/fear in others; and concealment resulting in misunderstandings, embarrassment, and stigma-coaching), but the evidence remains inconclusive in terms of which disclosure management strategy is optimal. While some preliminary work has been conducted, disclosure of epilepsy is a topic that has been largely neglected to date. This is despite the fact that disclosure is a significant source of concern for CWE and parent populations. Future studies should focus on elucidating the unique contextual factors that inform disclosure decisions in order to develop a theoretical framework that can explain the epilepsy disclosure decision-making process.

Knowledge and attitudes of school teachers, preschool teachers and students in teacher training about epilepsy and emergency management of seizures

PROBLEM

School and preschool teachers play a key role in the care of children with epilepsy. Yet, data about their knowledge on epilepsy are scarce.

METHODS

Assessment of knowledge and attitudes towards epilepsy in teachers by conducting a questionnaire survey in Leipzig and Blankenburg, Germany, from August 2013 to January 2014.

RESULTS

1243 questionnaires were completed by 302 school teachers, 883 preschool teachers, 56 students and two unclassified participants. Of the respondents, 140 (11%) stated to have already been actively involved in an epilepsy emergency situation, another 148 (12%) as observers. Only 214 (17%) of respondents felt sufficiently prepared for an emergency. A rescue medication had already been applied by 79 (6%) of respondents; only 186 respondents (15%) stated they would be willing to administer a prescribed rescue medication under any circumstances. In response to an open-ended question about the most common fatal outcomes of a seizure, status epilepticus and drowning were rarely mentioned. 233 (19%) of respondents assumed that epileptic seizures cannot result in death. 606 (49%) of respondents were concerned about the legal repercussions to an incorrect response to a seizure.129/403 (32%) of teachers with >20 years of professional experience claimed never to have had a child suffering from epilepsy in their care, even though the prevalence of childhood epilepsy indicates that they should. In total, 1066 (86%) respondents expressed a desire to gain more knowledge on epilepsy.

CONCLUSIONS

Training programmes for teachers should be established. Furthermore, a clear legal regulatory framework needs to be set up.

An educational campaign about epilepsy among Italian primary school teachers. 2. The results of a focused training program

A cohort of 582 Italian primary school teachers underwent a questionnaire survey to test their knowledge and attitudes toward epilepsy and verify whether an intensive and focused educational program could result in improvement of knowledge and attitudes. The program consisted of a presentation of the clinical manifestations of epilepsy and the distribution of informative brochures and an educational kit on the disease and its management to be used with their students. After several months, 317 teachers were retested using the same questions. Upon retest, the number of "don't know" answers decreased significantly for almost all questions. This was not the case for negative attitudes. The same holds true for teachers believing that epilepsy is a source of learning disability and social disadvantage. These findings support the beliefs that education on epilepsy is more likely to affect ignorance than prejudice and that stronger interventions are needed to counteract stigmatizing behaviors.

Parental knowledge, attitudes, and behaviors towards children with epilepsy in Belgrade (Serbia)

OBJECTIVE

The aim of our study was to assess knowledge, attitudes, and behaviors of parents whose children were diagnosed with epilepsy.

METHODS

This cross-sectional study included 213 consecutive parents who accompanied their children, diagnosed with epilepsy, at regular checkups in the outpatient department of the Child and Adolescent Neurology and Psychiatry Clinic in Belgrade. Data were obtained through a questionnaire before completion of the child's neurological checkup, while clinical parameters of children with epilepsy were taken from medical records.

RESULTS

Almost all respondents knew that epilepsy is not an infectious disease (99.5%), while the least proportion of parents (31.9%) knew that epilepsy is not, for the most part, hereditary. Parents felt that their family and friends should know that their child is suffering from epilepsy (average score: 4.3 out of 5). Also, parents felt the most confident in taking care of their child during seizures (4.7 out of 5), while they felt the least confident in letting their child go on school trips for several days (3.4 out of 5). Parental longer schooling (i.e., higher education level) was an independent predictor of higher epilepsy knowledge. Taking less number of medications was an independent predictor of more supportive parental behavior towards children with epilepsy.

CONCLUSION

Some epilepsy-related issues still require improvement in parental knowledge. Ensuring education and support at community and school levels for both parents and children with epilepsy should be the principal goal of health-care service.