Patients' perspectives on services for epilepsy: a survey of patient satisfaction, preferences and information provision in 2394 people with epilepsy

Patients' perspectives of epilepsy care by specialists and generalists: qualitative evidence synthesis

BACKGROUND

In the UK, epilepsy care involves both specialists (for example, neurologists) and generalists (for example, GPs). Policymakers typically consider that epilepsy care should be integrated and involve both specialists and generalists. However, few understand exactly how patients view and compare specialist and generalist care.

AIM

To explore patient perspectives of specialist care and generalist care for epilepsy in a qualitative evidence synthesis.

DESIGN & SETTING

A systematic review of patient perspectives of epilepsy care. A qualitative evidence synthesis was conducted using an identified framework.

METHOD

Systematic searches in five databases retrieved 17 eligible studies. Data were extracted and synthesised using framework analysis informed by the 'United Model of Generalism'.

RESULTS

The following three themes were developed: 'Epilepsy care can be burdensome' (for example, through care fragmentation); 'Patients' experiences of care is that care is not always accessible' (for example, lack of a continuum between standardised and interpretive care); and 'How care could change for people with epilepsy' (for example, clinicians currently have insufficient time to deviate from protocol-driven care to address psychosocial needs). People with epilepsy frequently observe that generalists lack expertise in epilepsy management.

CONCLUSION

This synthesis of patient experiences indicates recommendations should focus on improving communication and integration between specialists and generalists for epilepsy care. Patient experiences indicate specialist care risks being burdensome and generalist knowledge insufficient, requiring enhanced primary care clinician skills and improved awareness of patient psychosocial needs. The findings argue in favour of healthcare policies, materials, and tools to continually support patient perspectives in developing epilepsy services.

Patients' knowledge about epilepsy-related risks, morbidity, and mortality: A multicenter cohort study from Germany

INTRODUCTION

Patient education is a central component of quality care. Enhancing patient knowledge can improve patients' quality of life and facilitate successful self-management. We sought to identify patients' knowledge levels and knowledge gaps regarding epilepsy-related risks, morbidity, and mortality.

METHODS

Adult patients with epilepsy presenting to the university hospitals in Frankfurt, Greifswald, and Marburg between February 2018 and May 2020 were asked to participate in this questionnaire-based study.

RESULTS

A total of 238 patients (52% women), with a mean age of 39.2 years (range: 18-77 years), participated in this study. Spontaneously, the majority of patients (51.3%) named driving a car, and other traffic-related accidents as possible causes of morbidity and mortality, and 23.9% of patients reported various causes of premature death, such as suffocation, drowning, and respiratory or cardiac arrest due to seizures. Falls due to epilepsy (19.7%) and injuries in general (17.6%) were named as further causes of morbidity and mortality. The vast majority were aware that alcohol (87.4%), sleep deprivation (86.6%), and risky activities in daily life (80.3%) increased the risk of seizure occurrence or increased morbidity and mortality. Regarding overall mortality, 52.1% thought that people with epilepsy were at greater risk of premature death, whereas 46.2% denied this fact to be true. Only 29.4% were aware of status epilepticus, and 27.3% were aware of sudden unexpected death in epilepsy (SUDEP). Driving ability, working ability, and seizure risk were named as major or moderate concerns among patients, but the risk of premature mortality was not a major concern. One-quarter of all patients (26.9%) indicated that they were not counseled about any risk factors or causes of morbidity or mortality by their physicians.

CONCLUSIONS

A lack of knowledge concerning premature mortality, SUDEP, and status epilepticus exists among adult patients with epilepsy. A substantial number of patients indicated that these issues were not discussed adequately by their physicians.

Managing lower urinary tract symptoms in primary care: qualitative study of GPs' and patients' experiences

Background

Lower urinary tract symptoms (LUTS) are common in males aged ≥40 years and have a considerable impact on quality of life. Management can be complex, and although most LUTS could be treated effectively in primary care, referrals to urology outpatients are increasing.

Aim

To explore GPs’ experiences of managing LUTS together with patients’ experiences of and preferences for treatment in primary care.

Design and setting

Telephone interviews were conducted with GPs and male patients presenting to primary care with bothersome LUTS.

Method

Eleven GPs and 25 male patients were purposively sampled from 20 GP practices in three UK regions: Newcastle upon Tyne, Bristol, and South Wales. Interviews were conducted between May 2018 and January 2019, and were analysed using a framework approach.

Results

Difficulty establishing causes and differentiating between prostate and bladder symptoms were key challenges to the diagnosis of LUTS in primary care, often making treatment a process of trial and error. Pharmacological treatments were commonly ineffective and often caused side effects. Despite this, patients were generally satisfied with GP consultations and expressed a preference for treatment in primary care.

Conclusion

Managing LUTS in primary care is a more accessible option for patients. Given the challenges of LUTS diagnosis, an effective diagnostic tool for use by GPs would be beneficial. Ensuring bothersome LUTS are not dismissed as a normal part of ageing is essential in improving patients’ quality of life. Greater exploration of the role of non-pharmacological treatments is needed.

Chronic effects of different quercetin doses in penicillin-induced focal seizure model

AIM

The aim of the present study was to examine the effects of different quercetin pretreatment doses on focal epileptiform activity induced by penicillin in adult male rat cortex.

METHOD

Twenty-eight male Wistar rats weighing 200-235 g were randomly divided into four groups: control (only penicillin-injected group) and penicillin + 25, 50 or 100 mg/kg quercetin doses. All quercetin-treated rats had a daily single dose of 25, 50 or 100 mg/kg intraperitoneally administered quercetin for 21 days, and the last dose was given 30 min before the penicillin injection. Epileptiform activity was induced by a single intracortical (i.c.) microinjection of penicillin (500 units/2.5 μl) into left motor cortex. After penicillin injection ECoG was recorded for the following 180 min.

RESULTS

Quercetin pretreatments of 25, 50 and 100 mg/kg significantly increased the duration of latency (initial spike activity) and decreased spike frequency of the epileptiform activity compared to the control group (p < 0.05). Duration of latency was significantly longer in 25 mg/kg quercetin pretreatment group compared to 100 mg/kg group (p < 0.05). Spike amplitude of epileptiform activity was not different in the study groups (p > 0.05).

CONCLUSION

Quercetin had an anticonvulsant activity in penicillin-induced focal seizure model in the present study. In addition, lower quercetin doses had highest anticonvulsant effect in this model.

Best care for older people with epilepsy: A scoping review

There are two peaks of diagnosis of epilepsy: in childhood and in people over 65. Older people may have complex needs like co-morbidity, polypharmacy, frailty, and social isolation. This scoping review focusses on the care of older people with epilepsy beyond diagnosis and medical treatment. We sought to identify areas within the UK health service needing development either in clinical practice or through further research. The search returned 4864 papers with 33 papers included in the review. The papers were grouped into psychosocial, self-management and services themes. Only one randomised controlled trial was found. Research was mainly based on cohort and case-control studies. Older people require more information to self-manage epilepsy and more psychological support to help with symptoms of anxiety and depression. People reported experiencing stigma and a reluctance to disclose their condition. This may increase the risk of isolation and difficulties in managing epilepsy. Studies reported that older people are referred less to neurologists, suggesting there may be a gap in care provision compared to younger people. Generalist health professionals may be better placed to provide holistic care, but they may need additional training to alleviate uncertainties in managing epilepsy. Care plans could help provide information, particularly for co-morbidity, but few had one. Our findings highlight psychological and self-management needs for managing epilepsy in older people. Health service staff may require upskilling to shift epilepsy management from neurologists to generalists. More research is needed regarding psychological and self-management interventions, particularly in the form of randomised controlled trials.

Impact of an Epilepsy Educational Programme on Coping Mechanism, Attitude, Knowledge and Awareness: A Rural Sabah Experience

Epilepsy is a disabling disease which has not been adequately emphasised as a public health concern. Patients are often left in the dark about their disease, affecting their ability to cope and live a normal life. This study aimed to explore and evaluate the effects of a structured epilepsy education programme (EEP) on awareness, knowledge and attitude (AKA) and coping mechanism of patients. Recruited participants were required to complete the modified Malay AKA epilepsy questionnaire and Malay brief coping orientation to problem experienced (Brief COPE)-27. Upon completion, they received a structured EEP conducted by trained personnel using validated materials. Participants were then followed up for a period of 6 months and reassessed at 1, 3 and 6 months to measure any changes in their AKA and coping mechanisms. Twenty-two participants were successfully recruited. Total AKA score of participants showed a significant increase (mean score difference = 16.3, p = 0.021, 95% CI: 3.0, 28.1) at 6 months post-EEP. This improvement was mostly contributed by the increase in both knowledge and attitude scores. Religion was the most preferred coping mechanism (82.5%), followed by instrumental support, emotional support, active coping and acceptance at 75.0%, respectively. Only three domains showed significant differences after the educational programme: planning: 62.5% versus 77.5%, p = 0.026; denial: 57.5% versus 37.5%, p = 0.004; venting: 62.5% versus 52.5%, p = 0.004. The EEP was effective in improving attitude and knowledge while bringing about changes in coping skills of patients over a period of time. Educational programmes should be part of epilepsy standard of care, especially as they are inexpensive and brief yet impactful

Patients admitted to more research-active hospitals have more confidence in staff and are better informed about their condition and medication: Results from a retrospective cross-sectional study

RATIONALE, AIMS AND OBJECTIVES

Clinical research activity in hospitals is associated with reduced mortality and improved overall care quality. In England, the latter is a compound score of several elements and both staff and inpatient feedback form part of the Care Quality Commission (CQC) ratings. The objective of this study was to determine if NHS Trusts' National Institute for Health Research (NIHR) study activity data correlates with specific outcomes from national NHS staff and patient surveys.

METHOD

Retrospective cohort design involving data for 129 English NHS hospital Trusts, including scores from recent national NHS staff and inpatient surveys and NIHR data. Statistical approach involved Spearman correlation analyses, with cut-off P value ≤ 0.01 for qualification for subsequent principal component analysis (correlation coefficient cut-off value 0.20).

RESULTS

Outcomes of one staff survey question (staff recommendation of the organization as a place to work or receive treatment) and multiple outcomes of inpatient survey questions were positively associated with increased NIHR-adopted clinical research activity. Better quality of information provision to patients was the dominant theme, though a higher degree of observed staff teamwork, more confidence in the treating doctors, and a better overall inpatient experience also correlated significantly. The number of different studies contributed more to positive associations with survey outcomes compared with the number of recruited participants into research.

CONCLUSIONS

Survey elements of the CQC appraisal of English NHS Hospital Trusts are significantly associated with increased clinical research activity levels; it appears to drive better information provision to inpatients-particularly around medicine management-and contribute to a better inpatient experience overall, whilst staff are more likely to recommend their own organization. Despite clinical research activity forming a very small fraction of overall NHS activity, it has an indirect positive effect on staff and Trust performance that is measurable at patient level.

What really matters? A mixed methods study of treatment preferences and priorities among people with epilepsy in the UK

The widening range of treatment options for epilepsy, and their potential outcomes, mean decisions about treatment for people with epilepsy (PWE) are often complex. While antiepileptic drugs (AEDs) represent the mainstay of treatment, other potential nondrug interventions are gaining in importance. These treatments all have the potential for harming those using them, as well as bringing benefits. This study examined the views and experiences of PWE about a range of treatment options. We used both qualitative and quantitative approaches - a series of depth-narrative interviews, followed by a large-scale survey. Treatment options and healthcare priorities deemed important by at least 10% of interview participants were then addressed as a series of statements in the follow-on survey questionnaire. Quantitative responses supported healthcare priorities identified through the qualitative interviews. The key goal of treatment among study participants was to be able to live 'a normal life'. Important physical, psychological, and life benefits of treatment were identified - most being the direct consequence of improved seizure control. One psychological benefit, reduced worry, was also identified as an important treatment goal. All participants viewed AEDs as appropriate first-line treatment; and since adverse effects of AEDs had implications for individual levels of daily function and wellbeing, their appropriate management was considered important. In contrast, surgery was almost always regarded as the treatment of last resort. Despite lack of research evidence supporting their use, participants were interested in complementary therapies as adjunctive treatment and a means of coping with having epilepsy, with yoga and meditation of particular interest. An important finding was the desire for targeted services to help with memory problems, as was the call to increase availability of psychological/counseling services. Our findings emphasize the importance of providing treatment responsive to the life context of individual patients. They highlight not only the level of demand for specific treatment options, but also the need for high-quality evidence to support future investment in their provision.

A qualitative study of the communication and information needs of people with learning disabilities and epilepsy with physicians, nurses and carers

Background

Living with a chronic condition such as epilepsy can have a debilitating effect on the individual and their carers. Managing epilepsy among people with learning disabilities may present a challenge because of limited communication and may require a multidisciplinary approach. The study investigated the communication and information needs of people with learning disabilities with epilepsy and their physicians, nurses and carers.

Methods

Qualitative designed was adopted to collect data from 15 community-based people with mild learning disabilities with epilepsy and 13 carers. Recorded data were transcribed verbatim and analysed thematically.

Results

A range of findings emerged related to patient communication and information needs. These included: Knowledge regarding epilepsy; involvement; honesty and openness when giving information and consistency in provision of information.

Conclusion

People with learning disabilities with epilepsy and their carers would like to know more about epilepsy, to be more involved decision makings through communication in the management of epilepsy to enable them feedback information regarding their health.

Knowledge of women issues and epilepsy among doctors in Sudan

OBJECTIVE

The objective of this study was to assess the knowledge of doctors in Sudan about women issues related to epilepsy.

METHODS

In this cross-sectional study that was conducted in Sudan during the period from October 2017 to December 2017, we used Google forms to collect data from 154 doctors using Knowledge of Women Issues and Epilepsy (KOWIE) II standardized questionnaire.

RESULTS

Our studied group included house officers (n = 34), medical officers (n = 60), registrars (n = 52), and specialists (n = 8). The majority of participants were aware of the role of folic acid in reducing teratogenicity of antiepileptic drugs (AEDs) (89%) and that women with epilepsy (WWE) should not stop taking their AEDs during pregnancy (76.6%). Two-thirds of participants knew that most WWE have healthy children (68.2%) and that enzyme-inducing AEDs may reduce effectiveness of some contraceptives (72.1%). Half of participants were aware of the association between AEDs and osteomalacia (50%), and more than one-third (38.3%) knew that women taking AEDs can safely breastfeed (38.3%). Few of them (20.1%) knew that WWE have a higher incidence of sexual dysfunction compared with women without epilepsy, and only some (15.6%) knew that estrogen has a proconvulsant effect while progesterone has anticonvulsant qualities. The mean score of our participants was 5.53 out of 10 (standard deviation (SD) ± 1.64). Only registrars with the highest mean knowledge (6.15 ± 1.26) were statistically different from the rest of the medical degree groups.

CONCLUSIONS

In this small cross-sectional study, Sudanese doctors' knowledge was not satisfactory regarding the majority of questions on KOWIE II. Further education and training are indicated to decrease this knowledge gap and to improve care of WWE.

Which information on women's issues in epilepsy does a community pharmacist need to know? A Delphi consensus study

OBJECTIVE

The aim of this study was to develop and achieve consensus on a core list of important knowledge items that community pharmacists should know on women's issues in epilepsy.

METHODS

This was a consensual study using a modified Delphi technique. Knowledge items were collected from the literature and from nine key contacts who were interviewed on their views on what information community pharmacists should have on women's issues in epilepsy. More knowledge items were suggested by five researchers with interest in women's issues who were contacted to rate and comment on the knowledge items collected. Two iterative Delphi rounds were conducted among a panel of pharmacists (n=30) to achieve consensus on the knowledge items to be included in the core list. Ten panelists ranked the knowledge items by their importance using the Analytical Hierarchy Process (AHP).

RESULTS

Consensus was achieved to include 68 knowledge under 13 categories in the final core list. Items ranked by their importance were related to the following: teratogenicity (10.3%), effect of pregnancy on epilepsy (7.4%), preconception counseling (10.3%), bone health (5.9%), catamenial epilepsy (7.4%), menopause and hormonal replacement therapy (2.9%), contraception (14.7%), menstrual disorders and infertility (8.8%), eclampsia (2.9%), breastfeeding (4.4%), folic acid and vitamin K (5.9%), counseling on general issues (14.7%), and sexuality (4.4%).

CONCLUSION

Using consensual knowledge lists might promote congruence in educating and/or training community pharmacists on women's issues in epilepsy. Future studies are needed to investigate if such lists can improve health services provided to women with epilepsy (WWE).

Seizure-related hospital admissions, readmissions and costs: Comparisons with asthma and diabetes in South Australia

PURPOSE

Seizures are listed as an Ambulatory Care Sensitive Condition (ACSC), where, in some cases, hospitalisation may be avoided with appropriate preventative and early management in primary care. We examined the frequencies, trends and financial costs of first and subsequent seizure-related hospital admissions in the adult and paediatric populations, with comparisons to bronchitis/asthma and diabetes admissions in South Australia between 2012 and 2014.

METHODS

De-identified hospital separation data from five major public hospitals in metropolitan South Australia were analysed to determine the number of children and adults admitted for the following Australian Refined Diagnosis Related Groups: seizure related conditions; bronchitis/asthma; and diabetes. Additional data included length of hospital stay and type of admission. Demographic data were analysed to identify whether social determinants influence admission, and a macro costing approach was then applied to calculate the financial costs to the Health Care System.

RESULTS

The rate of total seizure hospitalizations was 649 per 100,000; lower than bronchitis/asthma (751/100,000), yet higher than diabetes (500/100,000). The highest proportions of subsequent separations were recorded by children with seizures regardless of complexity (47% +CSCC; 17% -CSCC) compared with asthma (11% +CSCC; 14% -CSCC) or diabetes (14% +CSCC; 13% -CSCC), and by adults with seizures with catastrophic or severe complications/comorbidity (25%), compared with diabetes (22%) or asthma (14%). The mean cost per separation in both children and adults was highest for diabetes (AU$4438/$7656), followed by seizures (AU$2408/$5691) and asthma (AU$2084/$3295).

CONCLUSIONS

Following the lead of well-developed and resourced health promotion initiatives in asthma and diabetes, appropriate primary care, community education and seizure management services (including seizure clinics) should be targeted in an effort to reduce seizure related hospitalisations which may be avoidable, minimise costs to the health budget, and maximise health care quality.

Anticonvulsant Effects of Aerial Parts of Verbena officinalis Extract in Mice: Involvement of Benzodiazepine and Opioid Receptors

To evaluate the anticonvulsant activity of the aerial parts of Verbena officinalis used traditionally by local Iranians for the treatment of convulsion. The anticonvulsant activity of the extract was assessed in pentylenetetrazole (PTZ) and maximal electroshock (MES) induced seizures in mice. Diazepam was used as reference drug. In addition, for investigating the mechanism of V officinalis in PTZ model, flumazenil and naloxone were injected before V officinalis. The extract showed no toxicity and significantly increased the period taken before the onset and decreased the duration of the seizures induced by PTZ. In the MES test, V officinalis displayed significant reduction in hind limb tonic extension duration in a dose-dependent manner. The results propose that V officinalis ethanolic extract has anticonvulsant activity against seizure. It seems that these effects may be related to potentiating of GABAergic system. Moreover, this study supports the use of this plant by local Iranians in order to treat convulsion.

Effect of Naringenin (A naturally occurring flavanone) Against Pilocarpine-induced Status Epilepticus and Oxidative Stress in Mice

BACKGROUND

Epilepsy is a disorder of the central nervous system characterized by recurrent seizures. It is a very common disease in which approximately 30% of patients do not respond favourably to treatment with anticonvulsants. Oxidative stress is associated with neuronal damage arising from epileptic seizures. The present study investigated the effects of naringenin in pilocarpine-induced epilepsy in mice. Naringenin, one of the most frequently occurring flavanone in citrus fruits, was evaluated for its shielding effect against the pilocarpine induced behavioural, oxidative and histopathological alterations in rodent model of epilepsy.

METHODOLOGY

Epilepsy was induced by giving pilocarpine (300mg/kg) and sodium valproate (300mg/kg) was given as standard anti-epileptic drug Pilocarpine was administered (300 mg /kg body weight) intraperitoneally to the mice on 15th day while naringenin was administered orally (20 and 40 mg/kg body weight) for 15 days prior to administration of pilocarpine.

RESULTS

The intraperitoneal administration of pilocarpine enhanced lipid peroxidation, caused reduction in antioxidant enzymes, viz., catalase, superoxide dismutase and glutathione reductase. Treatment of mice orally with naringenin (20 mg/kg body weight and 40 mg/kg body weight) resulted in a significant decrease in lipid peroxidation. There was significant recovery of glutathione content and all the antioxidant enzymes studied. Also in case of behavioural parameters studied, naringenin showed decrease in seizure severity. All these changes were supported by histological observations, which revealed excellent improvement in neuronal damage.

CONCLUSION

The higher dose of naringenin was more potent in our study and was comparable to the standard drug (sodium valproate) in effectiveness.

SUMMARY

Naringenin ameliorated the development of ROS formation in hippocamus.Naringenin helped in recovery of antioxidant enzymes.Naringenin decreased seizure severity.Naringenin treatment reduced lipid peroxidation. Abbreviations used: 6-OHDA: 6-hydroxydopamine, AED: Anti epileptic drugs, AIDS: Acquired immune deficiency syndrome, ANOVA: Analysis of variance, ATP: Adenosine triphosphate, CA: Cornu ammonis, CAT: Catalase, DG: Dentate gyrus, EDTA: Ethylenediamine tetra acetic acid, GR: Glutathione reductase, GSH: Glutathione reduced, HCl: Hydrochloric acid, IL-1β: Interleukin 1 beta, LPO: Lipid peroxidation, MDA: Malondialdehyde, NADPH: Nicotinamide adenine dinucleotide phosphate, PMS: post mitochondrial supernatant, SE: Status epilepticus, SEM: Standard error of the mean, SOD Superoxide dismutase, TBA: Thiobarbituric acid, TBARS: Thiobarbituric acid reactive substance, TLE: Temporal lobe epilepsy, TNF-α: Tumor necrosis factor alpha.

Effect of Naringenin (A naturally occurring flavanone) Against Pilocarpine-induced Status Epilepticus and Oxidative Stress in Mice

Background:

Epilepsy is a disorder of the central nervous system characterized by recurrent seizures. It is a very common disease in which approximately 30% of patients do not respond favourably to treatment with anticonvulsants. Oxidative stress is associated with neuronal damage arising from epileptic seizures. The present study investigated the effects of naringenin in pilocarpine-induced epilepsy in mice. Naringenin, one of the most frequently occurring flavanone in citrus fruits, was evaluated for its shielding effect against the pilocarpine induced behavioural, oxidative and histopathological alterations in rodent model of epilepsy.

Methodology:

Epilepsy was induced by giving pilocarpine (300mg/kg) and sodium valproate (300mg/kg) was given as standard anti-epileptic drug Pilocarpine was administered (300 mg /kg body weight) intraperitoneally to the mice on 15th day while naringenin was administered orally (20 and 40 mg/kg body weight) for 15 days prior to administration of pilocarpine.

Results:

The intraperitoneal administration of pilocarpine enhanced lipid peroxidation, caused reduction in antioxidant enzymes, viz., catalase, superoxide dismutase and glutathione reductase. Treatment of mice orally with naringenin (20 mg/kg body weight and 40 mg/kg body weight) resulted in a significant decrease in lipid peroxidation. There was significant recovery of glutathione content and all the antioxidant enzymes studied. Also in case of behavioural parameters studied, naringenin showed decrease in seizure severity. All these changes were supported by histological observations, which revealed excellent improvement in neuronal damage.

Conclusion:

The higher dose of naringenin was more potent in our study and was comparable to the standard drug (sodium valproate) in effectiveness.

SUMMARY

Naringenin ameliorated the development of ROS formation in hippocamus.

Naringenin helped in recovery of antioxidant enzymes.

Naringenin decreased seizure severity.

Naringenin treatment reduced lipid peroxidation.

Abbreviations used: 6-OHDA: 6-hydroxydopamine, AED: Anti epileptic drugs, AIDS: Acquired immune deficiency syndrome, ANOVA: Analysis of variance, ATP: Adenosine triphosphate, CA: Cornu ammonis, CAT: Catalase, DG: Dentate gyrus, EDTA: Ethylenediamine tetra acetic acid, GR: Glutathione reductase, GSH: Glutathione reduced, HCl: Hydrochloric acid, IL-1β: Interleukin 1 beta, LPO: Lipid peroxidation, MDA: Malondialdehyde, NADPH: Nicotinamide adenine dinucleotide phosphate, PMS: post mitochondrial supernatant, SE: Status epilepticus, SEM: Standard error of the mean, SOD Superoxide dismutase, TBA: Thiobarbituric acid, TBARS: Thiobarbituric acid reactive substance, TLE: Temporal lobe epilepsy, TNF-α: Tumor necrosis factor alpha

Persons with Epilepsy: Between Social Inclusion and Marginalisation

Background. Epilepsy is a chronic neurological disorder that can lead to complex psychosocial consequences. Epilepsy can change the social status of persons with epilepsy (PWE) and has an effect on their social inclusion as well as their perception of social inclusion. This study aims to explore subjective experiences with social inclusion of PWE in Slovenia. Methods. This study takes a qualitative approach. Eleven semistructured interviews were conducted with eleven participants. Interviews were analysed using thematic analysis. Results. Epilepsy has physical, emotional, and social consequences. Physical consequences of epilepsy are mainly tiredness and exhaustion following an epileptic episode, frequently accompanied by headaches. Emotional consequences are different forms of fear. The main social consequence identified is a negative effect on PWE's social network, which leads to (self-)isolation and social distrust. Conclusion. PWE experience of social inclusion depends on various psychosocial factors and differs from person to person. The consequences of epilepsy are shown in PWE social contacts and their sense of social inclusion and autonomy.

Antiepileptic and antipsychotic activities of standardized Śilājatu (Shilajit) in experimental animals

Background:

Śilājatu (Shilajit; SJ) is claimed in traditional Indian medical practice to be useful in the treatment of nervous disorders, epilepsy and as antistress.

Aim:

To investigate whether SJ possesses antiepileptic and antipsychotic activities in rodents.

Materials and Methods:

Isonicotinyl hydrazine (INH), pentylenetetrazole (PTZ), apomorphine, phenytoin, diazepam, haloperidol and other chemicals of analytical grade were procured from standard companies. The antiepileptic activity of SJ was assessed using maximal electro shock (MES)-induced seizures in rats, INH and PTZ-induced seizures in mice. The antipsychotic effect of SJ was evaluated using apomorphine-induced climbing and stereotyped behaviours respectively, in mice and rats.

Settings and Designs:

SJ (25 and 50 mg/kg, p.o.) was given orally once daily for 15 days in all the rodent models. On the test day, SJ was administered 1 h prior to electric shock or chemical inducers (INH/PTZ/apomorphine) in experimental animals; the animals were then observed for different phases of seizures and psychotic behaviours. In addition, gamma-aminobutyric acid (GABA) content in the brain of rats and mice was estimated in seizure models.

Statistical Analysis:

The data were expressed as mean ± standard error of mean. Statistical comparisons were performed by one-way ANOVA followed by Tukey's post-test using Graph Pad Prism version 5.0, USA. A P < 0.05 was considered significant.

Results and Conclusions:

SJ pretreatment significantly inhibited the seizures induced by MES, INH and PTZ in a dose dependent manner. Further, SJ augmented brain GABA levels to normal, decreased by INH and PTZ in mice brain. SJ pretreatment also significantly inhibited the climbing and stereotyped behaviours induced by apomorphine. The present data seems to confirm the antiepileptic activity of SJ which may be because of enhancing the GABAergic system. The antipsychotic activity observed may be due to anti-dopaminergic and/or GABA-mimetic actions.

The potential of critical social theory as an educational framework for people with epilepsy

Effective education can support people with epilepsy to develop the attributes and skills required to function as equal partners with clinical service providers, make informed decisions, and competently self-manage their healthcare. However, despite knowledge deficits, unmet information needs, and a poor sense of empowerment, the study of education for people with epilepsy is often neglected and is a poorly understood component of holistic practice within epilepsy healthcare. Historically, the only debate with regard to education and people with epilepsy has been guided either within a positivist or within a constructivist philosophy. We argue that new pedagogies are warranted, recognizing the views of people with epilepsy regarding their illness. Therefore, this paper explores the potential of an educational framework for people with epilepsy based upon critical social theory (CST). By utilizing a CST approach for education, people with epilepsy are engaged with as active 'participants'. This is a key difference that distinguishes CST from other metatheoretical frameworks. It has the potential to support people with epilepsy to acquire the skills and confidence to manage the biopsychosocial challenges associated with their condition.

Association of knowledge about epilepsy with mood and self-efficacy in Korean people with epilepsy

PURPOSE

We determined the level of knowledge about epilepsy in Korean people with epilepsy (PWE) and evaluated whether this is associated with self-efficacy, perceived stigma, anxiety, and depressive mood in these patients.

METHODS

This was a cross-sectional multicenter study. A total of 530 PWE participated from 31 secondary or tertiary hospitals in Korea. Knowledge about epilepsy was assessed using 34 medical items (EKP-M) of the Epilepsy Knowledge Profile-General. Additional questionnaires included the Epilepsy Self-Efficacy Scale (ESES), Stigma Scale, and Hospital Anxiety and Depression Scale (HADS). Multiple linear regression analyses were used.

RESULTS

The mean EKP-M score was 22.2 (SD: 4.1). By univariate analyses, the EKP-M was related to ESES (r=0.220, p<0.001) and HADS-D (r=-0.154, p<0.001) scores but not to the Stigma Scale or HADS-A. By linear regression analyses, after adjusting for the confounding variables, the higher EKP-M scores were independently related to both higher ESES (p<0.001) and lower HADS-D scores (p<0.05).

CONCLUSION

Korean PWE have a relatively low level of knowledge about their condition. Knowledge about epilepsy is associated with a high level of self-efficacy and less depressive symptoms in affected individuals.

Childhood long-term conditions in primary care: a qualitative study of practitioners' views

BACKGROUND

Improving child health and wellbeing in England was the key focus of the Chief Medical Officer's Annual Report 2012, which recommended that all children with long-term conditions (LTCs) have a named GP responsible for their care. Little is known, however, about practitioners' views and experiences of supporting children with LTCs in primary care.

AIM

To explore practitioners' views of supporting children with LTCs and their families in primary care.

DESIGN AND SETTING

Qualitative interview study in primary care settings in South Yorkshire, England.

METHOD

Interviews explored practitioners' views and experiences of supporting children with asthma, cystic fibrosis, type 1 diabetes, and epilepsy. Interviews were audiotaped, transcribed verbatim, and analysed using the framework approach.

RESULTS

Nineteen practitioners were interviewed: 10 GPs, five practice nurses, and four nurse practitioners. The GPs' clinical roles included prescribing and concurrent illness management; nurse practitioners held minor illness clinics; and practice nurses conduct asthma clinics and administer immunisations. GPs were coordinators of care and provided a holistic service to the family. GPs were often unsure of their role with children with LTCs, and did not feel they had overall responsibility for these patients. Confidence was dependent on experience; however, knowledge of GPs' own limits and accessing help were felt to be more important than knowledge of the condition.

CONCLUSION

Primary care has a valuable role in the care of children with LTCs and their families. This study suggests that improving communication between services would clarify roles and help improve the confidence of primary care practitioners.

The social context and the need of information from patients with epilepsy: evaluating a tertiary referral service

Objective Characterize the social profile and the need of information from patients with refractory epilepsy. Method A semi-structured questionnaire was applied to 103 patients to investigate sociodemographic aspects, pharmacotherapy and any doubts about epilepsy. Results Patients were highly dependent on having a free and accessible supply of antiepileptic drugs. Sixty-eight percent of the population was unemployed, and 26% confirmed receiving social security benefits due to epilepsy. Twenty-nine percent of the population reached high school. Eighty-five percent of the patients had at least one doubt about epilepsy; treatment and epilepsy aspects in general were the main topics. Conclusion : As observed in developed countries, patients with refractory epilepsy from a developing country also have high rates of unemployment and low educational levels. The results raise a concern about the need of information about epilepsy by patients and their families, urging the necessity to invest in strategies to solve this deficiency in knowledge.

Epilepsy services in Ireland: 'A survey of people with epilepsy in relation to satisfaction, preferences and information provision'

BACKGROUND

A challenge facing modern health care systems is to develop and implement new models of service that deliver increased capacity while providing a higher-quality, more cost-effective service within resource constraints. Incorporating the experience of people with epilepsy must be seen as central to the effectiveness of service design and delivery. This paper, therefore, reports the views of people with epilepsy with regards to health service delivery in Ireland.

METHOD

A cross-sectional descriptive survey design involving both quantitative and qualitative items was administered to a convenience sample of one hundred and two people with epilepsy (n=102) attending an epilepsy specialist centre.

RESULTS

Despite high levels of satisfaction with hospital and primary care, participants offered several suggestions to improve healthcare delivery, such as: less delay in accessing specialist care and hospital appointments; better communication; and easier access to investigatory services. Findings demonstrate that for people with epilepsy the burden of the disorder is substantial and complex encompassing social, psychological and structural difficulties. Poor information provision particularly among women is reported. Furthermore, a lack of empowerment in people with epilepsy is highlighted.

CONCLUSION

This study has implications for the reform and development of epilepsy services in relation to practice, education and research. It provides a basis for an evaluation of current practice and identifies opportunities for future service reorganization to improve the quality and efficiency of healthcare provision.

Anticonvulsant effect of ferula assa-foetida oleo gum resin on chemical and amygdala-kindled rats

Background:

In Iranian traditional medicine, Ferula assa-foetida oleo gum resin (asafoetida) have been used as anti-convulsant agents.

Aims:

This study was designed to evaluate the anti-convulsant effect of asafoetida on chemical and amygdala -kindled rats.

Materials and Methods:

In chemical model, rats received orally asafoetida at dose of 50 and 100 mg/kg 90 minutes prior to Pentylenetetrazol injection in dose of 35 mg/kg intraperitoneally (i.p.) and control group received normal saline. Convulsive behavior was recorded for 30 minutes. For amygdala kindle model, bipolar stimulating and monopolar recording electrodes were implanted stereotaxically. After kindling, the effect of asafoetida (50 and 100mg/kg) on after discharge duration, duration of stage 5 seizure and latency to the onset of bilateral forelimb clonuses was measured.

Results:

Pretreatment animals with asafoetida significantly reduced the mean seizure stage during the 20 kindling injection of Pentylenetetrazol. Seizure parameters in amigdala kindle model improved in treatment animals at both dose 50 and 100 mg/kg. The number of stimulations in stage 3, 4, and 5 in asafoetida-treated rats at both doses significantly increased.

Conclusions:

These results showed that asafoetida could prevent seizure in both chemical and electrical kindling model and this effect may partially be related to the terpenoids compounds.

The contribution of British general practice to our knowledge of epilepsy and its effects on people

INTRODUCTION

British general practice is a good base for epidemiological research which is evidenced by the study of epilepsy.

SOURCES OF DATA

A comprehensive search of PubMed using various keywords for articles on epilepsy research performed in British general practice.

AREAS OF AGREEMENT

Studies in the setting of general practice have contributed significantly to knowledge in the field of epilepsy, especially in relation to epidemiology, studies of prognosis and treatment patterns and psychosocial aspects.

AREAS OF CONTROVERSY

The extent to which epilepsy can be managed in general practice.

GROWING POINTS

The importance of primary care research and the importance of collaborative studies between general practice, hospital and university departments.

AREAS TIMELY FOR DEVELOPING RESEARCH

The effects of interventions at general practice level on seizure control, morbidity and mortality.

Characteristics of patients with epilepsy who use a website providing healthcare information about epilepsy in South Korea

We studied characteristics of epilepsy patients who use 'Epilia', a healthcare website for epilepsy patients, and the impact of 'Epilia' on patient satisfaction and attitude about epilepsy. A total of 153 epilepsy patients from 'Epilia' (online group) and 367 patients from epilepsy clinics (offline group) were recruited. A survey was done to investigate their socio-demographic, epilepsy-related, and psychological characteristics, as well as attitude alterations after beginning to use 'Epilia'. Factors affecting attitude were also identified in the online group. Online group had more severe and more frequent seizures, more adverse effects, more anxiety and depression, and worse quality of life than offline group. Online group patients who are more satisfied, who take two or more antiepileptic drugs, who visit to 'Epilia' more and longer had a greater positive attitude change than those without these characteristics. A healthcare website can contribute to self-management by providing useful information and education for epilepsy patients.

UPLC-TOF-MS analysis of Galium spurium towards its neuroprotective and anticonvulsant activities

ETHNOPHARMACOLOGICAL RELEVANCE

Galium species have been reported to be used against epilepsy in traditional Turkish folk medicine.

AIM OF STUDY

The present work was undertaken to evaluate the in vivo anticonvulsant and in vitro neuroprotective effects of Galium spurium L. and to determine the major constituents by UPLC-TOF-MS.

MATERIALS AND METHODS

Anticonvulsant activity of the aerial parts of Galium spurium was investigated using pentylenetetrazole, picrotoxin, and maximal electroshock-induced seizure animal models. In order to evaluate the safety, neurotoxicity (Rota rod test) of the ethanol extract was also determined. In vitro neuroprotective effect of the ethanol extract of Galium spurium was assessed by acetylcholinesterase and butrylcholinesterase inhibitions. Ultra Performance Liquid Chromatography-Time of Flight Mass Spectrometer (UPLC-TOF-MS) was used to identify the major compounds in the extract.

RESULTS

In pentylenetetrazole-induced seizure, the ethanol extract at doses of 250 and 1000mg/kg prolonged the onset of seizures. Similarly, Galium spurium (250 and 500mg/kg) significantly delayed the onset of picrotoxin-induced seizures in mice and these doses also exhibited 12.5% and 17% protection, respectively, against picrotoxin-induced seizures. Furthermore, Galium spurium extract showed a significant protective effect against maximal electroshock-induced seizures at doses of 250 and 1000mg/kg (50% and 37.5%, respectively) and also all tested doses prolonged the onset of seizures. No motor co-ordination was observed with intraperitoneal injection of Galium spurium extract at doses of 500 and 1000mg/kg. The extract exhibited 16.2% inhibition against butrylcholinesterase at 200μg/mL concentration, whereas it did not inhibit acetylcholinesterase. Phytochemical analysis of the extract based on the MS data by UPLC-TOF-MS, ten major compounds (phenolic and triterpenic acids, flavonoids and iridoids) were determined.

CONCLUSIONS

The results indicate that Galium spurium may have anticonvulsant activity against picrotoxin and maximal electroshock-induced seizures in mice. Phenolic acids, flavonoids and iridoids might be responsible for anticonvulsant activity. The results offer possible beneficial effects by the plant's aerial parts and may suggest a realistic explanation for its traditonal usage in epilepsy.

Anticonvulsant activity of embelin isolated from Embelia ribes

Anticonvulsant activity of embelin (2.5, 5 and 10mg/kg, i.p.) was studied. It showed a significant inhibition of the seizures induced by electroshock and pentylenetetrazole in a dose dependent manner and the activity was comparable to phenytoin and diazepam. Significant decrease in locomotion revealing its CNS depressant activity was observed. The findings suggest that embelin possess anticonvulsant activity against both grand mal and petit mal epilepsy.

Factors contributing to concerns of persons living with epilepsy

PURPOSE

To describe the concerns of Korean adults living with epilepsy and to compare the concerns of individuals with controlled and uncontrolled seizures.

METHODS

Outpatients filled out questionnaires, including the Hospital Anxiety and Depression Scale, the Quality of Life in Epilepsy-10 questionnaire, the stigma scale, and a questionnaire on episodes of discrimination. Patients were asked to fill out the Epilepsy Foundation of America (EFA) Concerns Index and to list their concerns on a blank sheet of paper.

RESULTS

Of the 178 participants, 152 described a total of 470 concerns, which could be assorted into 25 distinct concerns. Worrying about the hereditability of their condition was the only concern that differed significantly between individuals with controlled and uncontrolled seizures. Three significant factors were identified on the total EFA Concerns Index score: level of anxiety/depression (34.4%), age (6.3%), and degree of social discrimination (4.3%), resulting in a total explained variance of 45.0%.

CONCLUSIONS

Korean adults with epilepsy had various concerns, with some differing from those in Western populations. Anxiety/depression, age and degree of discrimination were significantly associated with the degree of concern in Korean patients with epilepsy.

Quality of integrated chronic care measured by patient survey: identification, selection and application of most appropriate instruments

OBJECTIVE

To identify the most appropriate generic instrument to measure experience and/or satisfaction of people receiving integrated chronic care.

BACKGROUND

Health care is becoming more user-centred and, as a result, the experience of users of care and evaluation of their experience and/or satisfaction is taken more seriously. It is unclear to what extent existing instruments are appropriate in measuring the experience and/or satisfaction of people using integrated chronic care.

METHODS

Instruments were identified by means of a systematic literature review. Appropriateness of instruments was analysed on seven criteria. The two most promising instruments were translated into Dutch, if necessary, and administered to a convenience sample of 109 people with a chronic illness. Data derived from respondents were analysed statistically. Focus-group interviews were conducted to assess the semantic and technical equivalence as well as opinions of people about the applicability and relevance of the translated instruments.

RESULTS

From 37 instruments identified, the Patients' Assessment of Care for chronIc Conditions (PACIC) and the short form of the Patient Satisfaction Questionnaire III (PSQ-18) were selected as most promising instruments. Both instruments produced similar median scores across people with different chronic conditions. The overall PACIC and its subscales and the overall PSQ-18 were highly internally consistent, but not the PSQ-18 subscales. Overall, the PACIC demonstrated better psychometric characteristics. PACIC and PSQ-18 scores were found to be moderately correlated. Whereas more respondents preferred the PSQ-18, focus-group participants regarded the PACIC to be more applicable and relevant. The technical and semantic equivalence of both instruments were sufficient.

CONCLUSIONS

Because of its psychometric characteristics, perceived applicability and relevance, the PACIC is the most appropriate instrument to measure the experience of people receiving integrated chronic care.

Seizure control in patients with epilepsy: the physician vs. medication factors

BACKGROUND

Little is known about the relationship between types of healthcare providers and outcomes in patients with epilepsy. This study compares the relative effects of provider type (epileptologist vs. other neurologist) and pharmacologic treatment (newer vs. older antiepileptic drugs) on seizure control in patients with epilepsy.

METHODS

We conducted a retrospective study of patients with medication-resistant epilepsy. Consecutive charts of 200 patients were abstracted using a standard case report form. For each patient, data included seizure frequency and medication use prior to, and while being treated by an epileptologist. Changes in seizure frequency were modeled using a generalized linear model.

RESULTS

After transferring care from a general neurologist to specialized epilepsy center, patients experienced fewer seizures (p < 0.001) and were more frequently seizure-free (p < 0.001). The improved seizure control was not related to treatment with newer vs. older antiepileptic drugs (p = 0.305).

CONCLUSION

Our findings suggest an association between subspecialty epilepsy care and improved seizure control in patients with medication-resistant epilepsy. Further research should prospectively determine whether patients with medication-resistant epilepsy would benefit from being routinely referred to an epilepsy specialist.

The inhibitory effect of trimethylamine on the anticonvulsant activities of quinine in the pentylenetetrazole model in rats

Quinine specifically blocks connexin 36 (Cx36), one of the proteins that form gap junction channels. Quinine suppressed ictal epileptiform activity in in vitro and in vivo studies without decreasing neuronal excitability. In this study, we considered the possible mechanism of anticonvulsant effects of quinine (1, 250, 500, 1000 and 2000 microM, i.c.v.) in the pentylenetetrazole (PTZ) model of seizure. Thus, we used trimethylamine (TMA) (0.05 microM, 5 microM, 50 microM), a gap junction channel opener, to examine whether it could reverse the effects of quinine in rats. Intracerebroventricular (i.c.v.) injection of quinine affected generalized tonic-clonic seizure (GTCS) induced by PTZ by increments in seizure onset and reducing seizure duration. Additionally, pretreatment with different doses of TMA (i.c.v.) attenuated the anticonvulsant effects of quinine on the latency and duration of GTCS. It can be concluded that quinine possesses anticonvulsant effects via modulation of gap junction channels, which could contribute to the control of GTCS.

Anticonvulsive effects of intracerebroventricular administration of rutin in rats

Various synthetic derivatives of natural flavonoids are known to have neuroactive properties. The aim of the present study was to investigate the anticonvulsant effects of rutin (3, 3', 4', 5, 7-pentahydrohyflavone-3-rhamnoglucoside), a flavonoid which is an important dietary constituent of food and plant-based beverages. To this end, we assessed the anticonvulsant effects of rutin in rats treated with pentylenetetrazole (PTZ) (90 mg/kg, i.p.) and sought to clarify this mechanism. Intracerebroventricular (i.c.v.) injection of rutin dose-dependently affected minimal clonic seizures (MCS) and generalized tonic-clonic seizures (GTCS) induced by PTZ, through increments in seizure onset. Additionally, pretreatment with flumazenil (5 nM, i.c.v.) abolished the anticonvulsant effects of rutin during the onset of both seizures. These results indicate that rutin has anticonvulsant effects in the brain, possibly through positive allosteric modulation of the GABA(A) receptor complex via interaction at the benzodiazepine site.

The impact of a citywide audit with educational intervention on the care of patients with epilepsy

The care of patients with epilepsy historically has been well documented to be poor. Previous attempts to improve care through education have been unsuccessful. The New GP Contract in the UK introduced epilepsy as a core quality indicator from April 2004. This prospective audit assesses the impact of an audit with educational intervention on the process of care of patients with epilepsy. The case notes of 610 patients, of all ages, with epilepsy on treatment, in 13 general practices serving Chester and surrounding area were reviewed before and 2 years after an intervention, comprising (a) the provision of a comprehensive template, (b) individualised categorisation for each patient and (c) an educational session led by a Neurologist. The overall review rate increased in the first year from 41 to 49% (p<0.0001) and by 2 years to 63% (p<0.0001). Documented remission rate increased from 29 to 43% (p<0.0001). Admissions to accident and emergency fell significantly (p=0.0026). There was no fall in the non-compliance rate. Forty five percent of patients with documented poor control were not under shared care. Issues highlighted in the audit generated 77 referrals. There were clear health gains in 62 (13%) individuals from referrals and practice interventions related to the audit. This original audit identified significant improvements in review rate, documented remission rate and beneficial outcomes in individual patients. The changes were attributable to both the educational intervention and the coincidental acceptance of the New GP Contract. Remaining problems include lack of shared care for patients with active epilepsy.

Designing and delivering an epilepsy course for GPs to help meet their educational needs

BACKGROUND

With the recent publication of comprehensive evidence based guidelines and the inclusion of epilepsy in the new GMS contract in the UK the importance of epilepsy to primary care has become clear. There seem to be many deficiencies in GP service provision for epilepsy including a lack of structured review and poor information provision for patients. Therefore, it is likely that further education on epilepsy management is essential.

AIM

To ascertain what GPs wish to learn about epilepsy and their preferences as to which methods should be used to achieve this. To use this information to design and then deliver an epilepsy teaching programme for GPs.

DESIGN OF STUDY

Cross-sectional.

SETTING

Primary care, Lothian region, Scotland.

METHODS

A questionnaire was designed and delivered to 50 GPs to obtain information related to the aims of the study. These results were used to aid the design of an epilepsy teaching day for GPs. This course was then delivered in West Lothian, Scotland.

RESULTS

GPs seemed to prefer weekday, half-day teaching using multidisciplinary lectures and case studies. Drug treatment, referral guidelines and diagnosis were considered the most important topics and the teaching programme received mainly positive feedback from participants.

CONCLUSION

It would appear that a short course on epilepsy management, when designed with the preferences of participating GPs in mind, can be readily delivered and well received.

Chronic illness, reproductive health and moral work: women's experiences of epilepsy

BACKGROUND

The impact of chronic illness on families has long been noted in the literature, but in such studies families appear as ready-formed entities. This exploratory qualitative study addresses the largely unacknowledged work involved in the production of families and the maintenance of reproductive health by women with epilepsy, a condition whose symptoms and treatment have serious implications for all aspects of reproductive health.

METHODS

Qualitative in-depth interviews were conducted with a sample of 15 women aged 20-40 years diagnosed with epilepsy and recruited from across the UK. The women had a range of neurological symptoms and hence different diagnostic categories; most had been diagnosed during childhood or adolescence. Ten women had at least one child.

RESULTS

Women's experiences of healthcare services for key phases of reproduction are explored. While some women reported that they had received good healthcare, others reported that they were given inadequate information and that advice was offered too late to enable them to take appropriate action.

DISCUSSION

Management of both epilepsy and reproductive health involves work with a significant moral dimension, the accomplishment of which is contingent on appropriate and timely advice from healthcare practitioners.

Epilepsy patients' perceptions about stigma, education, and awareness: preliminary responses based on a community participatory approach

As individuals directly impacted by their experience of epilepsy and others' responses to it, epilepsy patients' opinions about education and awareness issues are needed. A community-based participatory approach was used to develop a survey of public and patient attitudes and perceptions about epilepsy, which was administered to persons with epilepsy. The majority of the 165 respondents (34% response rate) indicated they perceive misperceptions and stigma related to epilepsy in the general public, which they thought could be ameliorated through educational interventions. Respondents indicated potential avenues of educational intervention for the general public as well as for those with epilepsy, with recommended content and intervention type depending on target audience. The community-based participatory research process and the patients' perceptions gathered through the resulting survey indicate potential activities for overcoming stigma and increasing education and awareness related to epilepsy.

Initial Perspectives from Midwestern Neurologists: Epilepsy Patients' Barriers and Motivators for Seeking Treatment

PURPOSE

Epilepsy is a chronic neurological illness that affects 2.7 million people in the United States, but remains poorly understood. Care providers may not recognize their patients' need for epilepsy information, contributing to treatment barriers, such as stigmatization and poor patient-provider communication.

METHODS

The current study piloted a survey of epilepsy-related attitudes and perceptions of 33 Midwestern neurologists. The survey included questions about perceived barriers to and motivators for treatment, thoughts on misperceptions of epilepsy in the community and in the patient population, and potential interventions to address misperceptions.

RESULTS

Respondents perceived misinformation and lack of knowledge in patients and the general public that could be contributing to the barriers that exist to treat patients adequately. Respondents suggested potential methods for addressing misperceptions effectively.

DISCUSSION

This study of neurologists' perceptions about epilepsy barriers and needs provides an important perspective for the development of interventions to address misperceptions and barriers among patients and the public.

Prevalence of Active Epilepsy and Health-Related Quality of Life among Adults with Self-Reported Epilepsy in California: California Health Interview Survey, 2003

PURPOSE

To examine the prevalence of self-reported epilepsy and active epilepsy, associated burden of impaired health-related quality of life, risk factors, and access to care in adults with self-reported epilepsy, and those classified as having active epilepsy with and without recent seizures.

METHODS

We analyzed data from adults aged >or=18 years (n = 41,494) who participated in the 2003 California Health Interview Survey (CHIS).

RESULTS

In California, 1.2% of adults reported ever being told they had epilepsy or seizure disorder, and 0.7% were classified as having active epilepsy. About three-fourths of adults with active epilepsy with recent seizures reported fair or poor health status. Adults with active epilepsy with recent seizures reported almost two weeks of poor physical or mental health and activity limitation days compared with two to 4 days per month in those without epilepsy. Among adults with active epilepsy and recent seizures, about one-quarter reported not taking any medicine to control their seizure disorder or epilepsy. About one-third reported physical disability/unable to work compared to a small proportion of the general population. The majority of adults with active epilepsy reported having a regular source of medical care.

CONCLUSION

Our findings highlight the burden of epilepsy among adults in California. CHIS serves as a model demonstrating the value of including questions about epilepsy on public health surveillance systems to ascertain the burden of the disorder and to guide intervention research and public policy to improve HRQOL in people with epilepsy.