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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Failure to comply with drug regimes is prevalent amongst patients with epilepsy and the consequence of this is often an increased risk of further seizures. This paper describes the level of, and influences upon, non-compliance with antiepileptic drug (AED) treatment. A postal questionnaire was sent to an unselected, community-based population of patients with epilepsy. This instrument included questions about patients' AED treatment, any related side-effects, and AED-taking behaviour. Univariate analysis showed that factors associated with compliance were patient age, how important patients felt it was to take drugs as prescribed, whether patients reported feelings of stigma, whether on mono- or polytherapy, whether they were experiencing any side-effects because of AEDs, whether patients had a regular arrangement to see their GP about epilepsy and how easy they found their GP to talk to. Multivariate analysis showed that the strongest predictors of non-compliance were feeling it was not very or not at all important to take AEDs as prescribed, being a teenager, being aged under 60 and being on monotherapy. Further implementation of educational programmes for people with epilepsy would help to improve levels of compliance thereby reducing the risk of unnecessary seizures.
Seizure 1997 Apr
PMID:Factors influencing compliance with antiepileptic drug regimes. 915 19

This pilot study finds that parents who think that their child will be stigmatized and who perceive that epilepsy limits their child, report higher levels of four child behavioural problems than reported by other parents of children with epilepsy. Those children with epilepsy who report that their parents use an over-controlling psychological approach to parenting report higher levels of four behavioural problems than those children with epilepsy who do not report over-controlling behaviour from their parents. The effects of simple partial seizures and of seizure severity on children's behavioural problems are completely mediated by perceived stigma, perceived limitations, and perceived parenting. Seizure frequency, absence seizures, and treatment with ethosuximide have direct effects on three children's behavioural problems; the effects of these medical variables are generally unaffected by control for parent's and children's perceptions.
Seizure 1997 Oct
PMID:The effects of perceived stigma and psychological over-control on the behavioural problems of children with epilepsy. 966 2

The employment experiences of 245 respondents with epilepsy as their main diagnosis were examined as part of a study into the rehabilitation needs of an epilepsy outpatient clinic. It was found that 9% of the sample was unemployed and a further 16% were in receipt of a disability pension. Patients with seizures in remission were more likely to be employed and less likely to have experienced job problems, to feel limited by the epilepsy or to experience stigma. Job problems per se were experienced by 35% of the population. Of those with uncontrolled seizures, 50% had had job problems; however, 22% thought that their current employment situation had not been unduly influenced by epilepsy. It was those respondents who were younger or who were diagnosed early with epilepsy who were most likely to perceive their current situation as a result of having epilepsy. The survey suggests that unemployment is not the major problem it was once thought to be but that discrimination at work is a more serious problem which could lead to under-employment and restricted career development. Career planning should be instigated early and employment services should include information, practical advice and emotional support.
Seizure 1998 Aug
PMID:Factors associated with the employment problems of people with established epilepsy. 973 5

Epileptic disorders have been neglected for a long time by neurologists and practically ignored by pediatricians, satisfied with a diagnosis of infantile convulsions. Results of animal experimentation, huge progress in ancillary tests, potent antiepileptic drugs and efficacious neurosurgical procedures have considerably improved the condition of epileptic patients. However, much remains to be done. Even if numerous and varied, data given to physicians and patients are still insufficient. Stigma linked to the word epilepsy is present in many cases. It adds a supplementary burden to people who are not lacking in problems. Too often, epilepsy remains a word used in the singular, but epileptic seizure is not synonymous with epilepsy. The outcome and hence the consequences of epilepsies are quite various. A diagnosis of seizure may be difficult, and its classification not easy in all the cases. To place it in context, that is to find its causes and consequences is even more difficult. A good knowledge of epileptic disorders and efforts to use it are necessary, but one of them, or both, can be absent. This is unfortunate, because of the frequency and duration of conditions in which seizures are a symptom, and also because their outcome mostly depends on therapeutic choices. Only clinical, pragmatic aspects of the issue are considered here.
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PMID:[Epilepsies. Did you say 'epilepsy'?]. 1033 88

Acute repetitive seizures, also known as cluster or serial seizures, may present considerable health risks, including death, to patients with epilepsy and often are a cause of psychosocial stigma. Fortunately, new formulations and drug-delivery systems approved by the Food and Drug Administration (FDA) over the past 5 years offer patients and health care providers greater control over acute repetitive seizures and emergency situations. Drugs that can be given intravenously, such as diazepam, phenytoin and valproate sodium solution, typically have the most rapid onset but are limited to use in clinical settings by health care professionals authorized to use them. In contrast, diazepam rectal gel can be administered to patients by their caregivers or family members in the home or in other non-hospital settings. Studies have shown that rectal diazepam used in such settings can reduce the number of emergency room visits, costs associated with emergent care and stress on the patient and family. Health education is necessary to help patients and families understand new treatment options and use them successfully. Additionally, facilitating patient compliance with prescribed treatment regimens may reduce the frequency and consequences of seizure emergencies.
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PMID:New therapies in the management of acute or cluster seizures and seizure emergencies. 1055 70

Epilepsy is a common cause of psychosocial disability and has been perceived to have a profound impact on the social functioning of individuals with epilepsy. In Zimbabwe a combination of developing world economic priorities (with provision of social and health services for disabled people not a major goal) and culturally mediated perceptions of epilepsy as a non-medical and feared stigma may further disadvantage people with epilepsy (PWE) in this respect. In order to assess both the level of psychosocial functioning of individuals with epilepsy and their own perception of it, three groups of people were sampled: attenders at a specialized epilepsy clinic and members of two community-based support groups. All completed a brief quality-of-life questionnaire with activities of daily living added. Those carers present completed the same questionnaire at the time of sampling. The results indicated that 36 of 38 people with epilepsy sampled, and their carers, did not perceive themselves to have sufficient cognitive impairment to interfere with social functioning, work performance or relationships with other as assessed by a subsection of the WHO SIDAM (objective evaluation of cognitive performance) interview. However, an adapted activities of daily Living Questionnaire (ADLQ) showed that three-quarters of carers (and two-thirds of PWE) felt that functioning was mildly to moderately reduced, particularly in the areas of solving daily problems and speed of thinking. One-quarter of PWE experienced problems with relationships to others, just less than one-fifth of PWE reported more than four areas of reduced functioning. Of special interest was the fact that 25 (66%) reported sexual functioning as not applicable, although only four of these were of an age group which is not sexually active (less than 15 years old). In addition one-third of the central Hospital Group reported difficulties with using public transport, but none of the Community Support Group members, implying that the use of Public transport becomes an issue when it is necessary to travel long distances and that PWE curtail their travel but do not necessarily view this as a restriction. The samples chosen were from groups which, compared with PWE as a whole, are likely to include more disabled individuals, because attenders at a specialized epilepsy clinic and members of support groups self-select for more symptomatic epilepsy and a visibility. Therefore the proportion of PWE perceived to have difficulties with ADL in this project is not representative for PWE as a whole. The implications of our study are firstly that there is a significant need for selected groups of PWE in Zimbabwe to receive attention to psychosocial abilities and secondly that there are certain specific areas such as sexual functioning and the use of transport which deserve special attention. A much more detailed inventory of neuro-psychological tests will be of value to plan treatment strategies for those selected by the crude screening instruments used in this project. An important future comparison will be a survey of ADL and psychosocial functioning amongst PWE in rural communities, because it is uncertain whether PWE in rural communities are generally more or less disabled than those in the city.
Seizure 2000 Jun
PMID:The impact of epilepsy on the quality of life of people with epilepsy in Zimbabwe: a pilot study. 1088 Feb 85

Assessment of risk to benefit ratio in patients with epilepsy is crucial in determining the need for treatment, the choice of drugs and the use of monitoring tools such as laboratory tests and other investigations. Active epilepsy per se carries significant risks in terms of increased mortality, susceptibility to psychopathology and physical injury, and reduced quality of life as a result of restricted lifestyle, stigma and prejudice. By preventing the occurrence of seizures, antiepileptic drugs (AEDs) attenuate or eliminate altogether seizure-related risks, but other risks may arise due to the side effects of the drugs, all of which have a relatively narrow therapeutic index. While there are no major differences in the degree of efficacy between AEDs which are effective in any given seizure type, side effect profiles differ considerably from one agent to another and represent a major factor in determining choice of treatment. Assessment of risk to benefit ratio should also take into consideration patient-specific factors such as type and severity of the epilepsy, age, sex, childbearing potential, medical and drug history, associated disease, use of concomitant medication (including the contraceptive pill) and the prospected patient's compliance. In some benign epilepsy syndromes, such as idiopathic partial epilepsy with centro-temporal spikes, the risk of side effects from AEDs may outweigh potential benefits in terms of seizure control, and treatment is generally not indicated. At the opposite end of the spectrum, the serious morbidity and mortality associated with severe epileptic encephalopathies, such as the Lennox-Gastaut syndrome, justifies aggressive treatment even with drugs associated with a relatively high risk of life threatening side effects such as felbamate. The present article will provide an overview of specific risks associated with epilepsy and with the various drugs used for its treatment, and will attempt to evaluate the complex balance between these risks and therapeutic benefits in different categories of patients.
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PMID:Assessing risk to benefit ratio in antiepileptic drug therapy. 1094 Jun 14

This article examines the impact of epilepsy and its treatment on employment status and the extent of stigma among patients with epilepsy. Clinical and demographic data concerning patients examined during a recent epidemiological survey were obtained from medical notes and postal self-completed questionnaires. Information was collected from 90 patients aged 16-70 years. A third of the respondents had been seizure-free during the last year. Thirty-nine percent were working full-time, 24% were working part-time and 11% were unemployed. Sixty-three percent from those working part-time or unemployed considered their epilepsy to be a significant reason for this. Overall, 55.4% believed they had been treated unfairly at work or when trying to get a job. Fifty-one percent of respondents felt stigmatized by epilepsy, 14% of them highly so. The level of employment among epileptic people was not lower than in the general population. The percentage of stigmatization in general and the percentage of the severely stigmatized was as high or even higher than in other studies. Occurrence of stigma and its severity depended first and foremost on the type of seizures. The frequency of seizures was not clearly related to this.
Seizure 2000 Sep
PMID:Felt stigma and impact of epilepsy on employment status among Estonian people: exploratory study. 1098 95

The present study tested the hypothesis that the stigma of being disabled and that of minority ethnic status yield more negative psychosocial outcomes for black than white persons with epilepsy. Black (n=55) and white (n=53) urban participants from a larger sample were matched for socioeconomic status and seizure frequency. Differences in these and key demographic variables were tested using chi(2) and t-tests and found to be non-significant. Group differences in psychosocial outcome variables were analyzed with the following results: (1) white subjects were more likely to have considered suicide and to have higher scores on the family background scale of the Washington Psychosocial Seizure Inventory (WPSI); (2) black subjects had significantly lower scores on the Beck Hopelessness Scale and significantly more optimistic attributional styles; and (3) no between-group differences were found on other psychosocial measures. The nature of family and community supports may determine intergroup differences.
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PMID:Black-white differences in the psychosocial outcomes of epilepsy. 1099 7

Epilepsy is a common disorder that effects millions of persons worldwide and costs billions of dollars for direct medical care. Despite the importance of epilepsy from a public health perspective, the physiological and psychosocial outcomes from epilepsy are incompletely understood and are in some ways controversial. The paroxysmal nature and the immense social stigma of the disorder have contributed to misunderstanding of its associated health outcomes. This article reviews the issues surrounding the assessment of health outcomes from the epilepsies and the interventions used to treat recurrent seizures.
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PMID:Health outcomes in persons with epilepsy. 1135 52


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