Saints, demons, and faith - A review of the historical interaction between Christianity and epilepsy

Epilepsy knowledge and attitudes: A large observational study among the Palestinian general public

Background

Epileptic seizures are often misunderstood as supernatural power or satanic possession in different cultures around the world. Therefore, people with epilepsy (PWE) suffer discrimination, prejudice, and stigma. The epilepsy knowledge and attitude (EKA) of the Palestinian general public were not assessed before. Therefore, this study assessed the EKA of the Palestinian general public. In addition, the study identified the characteristics that were associated with EKA.

Methods

This was a large cross-sectional study that was conducted using a self-administered instrument. The study participants were invited and recruited from the Palestinian general public. The EKA were assessed using 16 knowledge items and 13 attitude items.

Results

In this study, responses were collected from 746 participants. Knowledge scores were significantly associated with having a university degree, satisfaction with household income, adequate knowledge about epilepsy, having acquaintances with epilepsy, and having witnessed someone experiencing epileptic seizures. Attitude scores were significantly associated with living in urban areas, being married, having a university degree, satisfaction with household income, adequate knowledge about epilepsy, having acquaintances with epilepsy, and having witnessed someone experiencing epileptic seizures.

Conclusion

Large knowledge gaps and negative attitudes toward PWE were identified among the Palestinian general public. These findings might be considered a call to increase knowledge and correct negative attitudes toward PWE. Decision-makers need to design and implement effective measures to increase knowledge and correct negative attitudes toward PWE. Further studies are still needed to assess the effectiveness of these measures in increasing knowledge and positive attitudes toward PWE.

A community-based awareness program improves knowledge and attitudes toward epilepsy: An interventional study

OBJECTIVE

Little interventional studies were conducted to improve knowledge, improve attitude, and eliminate stigma against patients with epilepsy. This study was conducted to investigate the effect of a community-based epilepsy awareness program (CBEAP) on knowledge, attitude, and stigma against patients with epilepsy among the Palestinian general public.

METHODS

This interventional study used a pre-post design. Knowledge and attitudes were assessed using a reliable and internally consistent questionnaire before and 1 month after receiving a CBEAP. Knowledge was assessed using a 16-item and attitudes were assessed using 13 items.

RESULTS

A total of 150 participants completed the questionnaire before the CBEAP. Of those, 136 (90.7 %) completed the CBEAP, and 129 (86.0 %) completed the questionnaire 1 month after receiving the CBEAP. The CBEAP significantly (p-value < 0.05) increased knowledge about the nature of epilepsy and seizures, triggers and treatment options, and patients with epilepsy. Similarly, the CBEAP significantly (p-value < 0.001) improved the attitudes of the participants toward epilepsy or having epilepsy, patients with epilepsy, relationships with patients with epilepsy, and working or staying with patients with epilepsy. Greater changes in knowledge and attitude scores were predicted by younger age and having a close friend or family member with epilepsy.

CONCLUSION

The CBEAP developed and implemented in this interventional study significantly increased the knowledge of the participants about epilepsy and improved their attitudes toward epilepsy and patients with epilepsy. Large-scale implementation of such interventional programs is still needed to increase knowledge and improve attitudes toward epilepsy and patients with epilepsy.

Assessment of self-stigma in epilepsy: Validation of the German version Epilepsy Self-Stigma Scale (ESSS-G)

OBJECTIVE

Self-stigma is the internalization of unfavorable public perceptions, which people with epilepsy (PWE) frequently experience. PWE with strong self-stigma have low self-esteem and are less likely to engage in treatment behavior. The Epilepsy Self-Stigma Scale (ESSS) has been developed and validated in Japan. We translated the ESSS into German for this study to examine its reliability and validity.

METHODS

We created the German version of ESSS (ESSS-G) based on the original Japanese version. From May to October 2022, we recruited out- and inpatients from Bethel Epilepsy Centre, University Hospital for Epileptology, for psychometric evaluation. Inclusion criteria were an age of ≥18 years, sufficient reading and speaking skills in German, and the ability to comprehend the German questionnaires. Participants also completed the Rosenberg Self-Esteem Scale (RSES), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Generalized Anxiety Disorder 7 (GAD-7), Epilepsy Knowledge Scale, and items on "overall quality of life (QOL)" and "overall health" (items from QOLIE-31).

RESULTS

One hundred twenty-eight of 146 patients asked to participate granted informed consent and completed the study questionnaire (87.7% response rate). 115 cases were analyzed since 13 did not match the inclusion criteria. The analysis revealed a single factor explaining 49.2% of the total variance. All factor loadings were >0.40, and the reliability was high (Cronbach's α = 0.80). Higher ESSS total scores were associated with higher anxiety (GAD-7, r = 0.54, P < 0.001) and depression (NDDI-E, r = 0.45, P < 0.001), lower self-esteem (RSES, r = -0.41, P < 0.001), overall QOL (r = -0.40, P < 0.001), and overall health (r = -0.35, P < 0.001), but not with knowledge about epilepsy (r = 0.03, P = 0.770). In Germany, females, younger individuals, patients with earlier seizure onset, and those with generalized epilepsy had significantly higher self-stigma.

SIGNIFICANCE

The German version of the ESSS proved reliable and valid. It allows to evaluate the efficacy of treatment strategies in lowering self-stigma and conducting intercultural comparisons of epilepsy self-stigma.