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Query: UMLS:C0036572 (seizures)
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Disease and mood states are important determinants of quality of life (QOL). Low QOL, due to mood states, can be expected especially in psychiatric disorders such as depression. However, patients with seizure disorders may be even more affected because of the combined burden of physical episodes, psychiatric comorbidities, and psychosocial factors (e.g., stigma). In this study, we compare the quality of life in seizure disorders and clinical depression. Based on our earlier findings, we hypothesize that epilepsy patients fare better than patients with psychogenic, nonepileptic seizures (PNES), and we speculate that QOL in PNES is also lower relative to clinical depression. We estimate the relationships between type of seizures (epilepsy vs PNES), depression, and QOL (SF-36) using multiple regression, and we compare the SF-36 scores of patients with epilepsy and PNES (n=194) with the normative data for clinical depression using one-sample t tests. Our findings indicate that depression contributes to the poor QOL in both epilepsy and PNES, but the patients with PNES, even those without depression, have worse QOL compared with both the epilepsy patients and the depression norms. We conclude that evaluating and treating mood states is as important as treating PNES itself when caring for patients with PNES, and it might be the first step toward improving their QOL.
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PMID:Seizure disorders, depression, and health-related quality of life. 1475 Dec 7

My life work with epilepsy has allowed me to learn a great deal. As an old soldier, I would like to give an account of some important milestones in my lifetime learning. The first factor that linked me to epilepsy was listening to a lecture delivered by Dr Yushi Uchimura on 'The pathogenesis of Ammon's horn sclerosis' at a conference of the Japanese Society of Neurology (now Japanese Society of Psychiatry and Neurology) in 1928 when I was a 4th year medical student at Tokyo University. The following year, I started to study under Dr Uchimura at the Department of Psychiatry, Hokkaido University School of Medicine. Another factor that linked me to clinical care and research of epilepsy as a psychiatrist was my encounter with the two volumes of 'Selected Writing of John Hughlings Jackson' edited by J. Taylor. Jackson's greatest asset and contribution to modern epileptology include (i) the discovery of 'Jacksonian epilepsy', (ii) 'conceptual revolution of epilepsy' by recognizing transient mental disorders as seizures, (iii) modern definition of epilepsy by defining epileptic seizures as discharges in the gray matter, and (iv) discovery of 'new epilepsy' (now temporal lobe epilepsy). In 1940, I reported clinical courses indistinguishable from schizophrenia in epilepsy cases. Through my studies, I disputed the then prevailing interpretation of this condition as epilepsy complicating schizophrenia, and proved that these cases were in fact epileptic mental disorders caused by epilepsy. Many patients with epilepsy require medical care as well as rehabilitation and welfare support. We need to further promote the facilities for rehabilitation and employment in the community for persons with epilepsy, such as co-operatives and welfare worksites. The issues that epileptology and epilepsy face in the 21st century is to realize the goals of liberating epilepsy from social stigma and protecting all the citizen's rights for persons with epilepsy.
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PMID:What I learnt from studying epilepsy: epileptology and myself. 1500 12

Epilepsy is one of the most common disorders encountered in children of developing countries. In Senegal, as in many other African countries, the disease is enrobed in superstition, discrimination, and stigma. There is a clear-cut lack of information programs in the developing world about seizures and epilepsy. Academic achievement of children with epilepsy is hampered by social barriers in addition to the burden of the disease and its treatment. The aim of this study was to evaluate teachers'knowledge, awareness, and current attitudes about epilepsy in order to obtain baseline data for the development of a school health education program on epilepsy. The study was carried out in Dakar. It was conducted by sending self-administered and anonymous questionnaires to 400 elementary school teachers; the data were randomly mapped, stratified, and chosen to produce a statistically representative sample of the teacher population of Dakar. The questionnaires contained 22 items related to knowledge of epilepsy, the attitude of teachers towards epilepsy, and their ability to provide first aid in case of seizures. A total of 373 teachers (93p.cent) completed the questionnaires. For 69p.cent, epilepsy arises in the brain, for 28.7p.cent it is a subnatural affliction. Epilepsy was considered to be contagious for 24p.cent and could be cured for 73p.cent. Although 66p.cent would help an epileptic pupil during a seizure, 53p.cent mentioned harmful measures. Eighty-four percent noticed that an epileptic child could go to a normal classroom, while 62.5p.cent would prefer a special school. Eighty-four percent said their knowledge on epilepsy was not sufficient and the majority (99p.cent) desired training on epilepsy. For 25.7p.cent, better collaboration between parents, doctors, and teachers would b helpful to achieve better management of epileptic children. This study demonstrated encouraging knowledge of teachers about epilepsy. However, some of their wrong attitudes may be attributed to superstitions and could be improved by informative actions and better training about epilepsy. Such education might be provided by local health professionals with the collaboration of parents, teachers, and non-governmental organizations.
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PMID:[A survey of school teachers' knowledge and behaviour about epilepsy, in a developing country such as Senegal]. 1503 47

To establish the effect of psychosocial and seizure factors on Depression and Neurotic Disorders among clinically diagnosed Nigerian patients, with epilepsy. This study utilized the multivariate statistical design to evaluate the associations between some psychosocial and seizure factors on increase depression and neurotic disorders. The Neurology outpatient clinics of two tertiary facilities in Nigeria: Aro Neuro-psychiatric Hospital/World Health Organization Collaborating Centre, Abeokuta and the University College Hospital Ibadan, were used for the study. Two hundred and sixty four (264) consecutive clinic attendees with a clinical diagnosis of epilepsy participated in the study. Perceived Stigma Scale (PSS); Washington Psychosocial Seizure Inventory (WPSI-Modified): Becks Depression Inventory (BDI) and Crown-Crisp Experiential Index (CCEI). Significant main effect for seizure control, stigma, emotional adjustment, vocational adjustment, interpersonal adjustment, adjustment to seizures but not for age at onset of epilepsy, financial adjustment and gender, were recorded on depression. Similarly significant main effect for seizure control, stigma, emotional adjustment, adjustment to seizures but not for age at onset of epilepsy, gender, vocational adjustment, financial adjustment and interpersonal adjustment were recorded for neurotic disorders. The study highlights some of the factors, which may contribute to the understanding of epilepsy-related psychopathologies and implication for psychotherapeutic intervention among individuals with epilepsy in Nigeria.
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PMID:Psychosocial and seizure factors related to depression and neurotic-disorders among patients with chronic epilepsy in Nigeria. 1549 Jul 93

In spite of remarkable progress in drug therapy, childhood and adolescent epilepsy is often a distressing condition lasting several years before possible recovery. Adaptation problems to the disease, and also to health recovery, are likely to occur. Stigma and discrimination may persist also after recovery. Learning problems involve a high number of patients. Neuropsychological problems related to localization of the epileptic focus may be present; intellectual deterioration in more severe cases and in some specific syndromes may occur. These problems are not unknown, but therapeutic effort is often directed only towards seizure control. The importance of counseling children and parents is stressed by the authors, and practical advice is given on planning doctor-patient dialogues, in order to prevent non-justified restrictions in day life, fears and negative reactions, and to ameliorate intrafamilial relation, integration in the school milieu and compliance towards drug intake. The role of neuropsychological evaluation and pedagogic advice is also emphasized. Children and adolescents with epilepsy and their families need more than medical therapeutic support to get an acceptable quality of life.
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PMID:Counseling children and parents about epilepsy. 1558 49

Persons with epilepsy need adequate advice and effective counselling about issues such as marriage, pregnancy, risks of inheriting epilepsy, driving, employment and antiepileptic drug withdrawal, because these persons are not receiving important information and education about their condition and possible adverse effects of treatment. Furthermore, women with epilepsy have increased rates of pregnancy complications and poor fetal outcomes including congenital malformations and developmental delay related to both their epilepsy and antiepileptic drugs. However, approximately 90% of all women with epilepsy undergo normal pregnancy and give birth to children free of birth defects. Pregnancy is generally safe in women with epilepsy. The study of long-term prognosis of childhood-onset epilepsy in Japan shows that the majority of these patients have lower levels of educational background as well as employment and marital status compared with the general population (Wakamoto H. et al). Of patients with epilepsy, 60% to 70% achieve control with antiepileptic medication. However, several antiepileptic drug withdrawal studies show variable rates of success, with relapse rates ranging from 12% to 63% (Britton J.W.). Driving is listed as major problem in persons with epilepsy. However, the patients with seizure-free more than two years have been able to get the driver's license since June, 2002. Social attitudes towards epilepsy cause more distress to the patient than the disease itself. We should realize that persons with epilepsy are normal or near-normal. To ameliorate the social stigma against epilepsy, continuous and repetitive educational efforts would be needed.
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PMID:[Social aspects of epilepsy: marriage, pregnancy, driving, antiepileptic drug withdrawal and against social stigma]. 1565 16

The emotional response of adolescents to a chronic illness like epilepsy may differ across cultures. This study was aimed at investigating the prevalence of and risk factors for anxiety and depressive disorders in a group of Nigerian adolescents with epilepsy. Adolescents with epilepsy (n=102) aged between 12 and 18 were assessed for anxiety and depressive disorders with the Diagnostic Interview Schedule for Children Version IV (DISC-IV). An anxiety disorder was diagnosed in 32 (31.37%) of the adolescents and a depressive disorder was reported in 29 (28.43%). Predictors of anxiety and depressive disorders by regression analysis include uncontrolled seizures, polytherapy, and felt stigma. Family factors such as parents' psychopathology and family stress are also moderately significant. Results show that emotional disorders in adolescents with epilepsy cut across cultures. Adequate monitoring, education targeted at reducing felt stigma, and family intervention programs are needed for early intervention.
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PMID:Prevalence of and risk factors for anxiety and depressive disorders in Nigerian adolescents with epilepsy. 1582 Mar 41

Many studies in developed regions of the world have confirmed that stigma contributes substantially to the psychological and social burden of epilepsy. Relatively few studies of epilepsy-associated stigma have been conducted in Africa, where much of the world's burden of epilepsy exists. In sub-Saharan Africa (SSA), particularly in rural regions, close family ties, communal living situations, and traditional belief systems undoubtedly influence the expression of stigmatization. A review of the epidemiologic, anthropologic, and sociologic studies of epilepsy in SSA provides significant insights into how people with epilepsy (PWE) are perceived by their communities and families and how these perceptions translate into limited social and economic opportunities and possibly worsen the physical vulnerability of PWE in this region. The medical community is not exempt from the social process of stigmatization, and poor public health infrastructure and medical services undoubtedly contribute to the cycle of epilepsy-associated stigma through wide treatment gaps, poor seizure control, and high rates of seizure-related injury. In this review, we extrapolate data from existing studies of epilepsy in SSA coupled with our own experience providing epilepsy care in the region to give an overview of the social landscape of this common, devastating condition.
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PMID:Epilepsy-associated stigma in sub-Saharan Africa: the social landscape of a disease. 1597 74

Compared with the disability associated with repeated seizures or side-effects of antiepileptic medications, the social stigma associated with epilepsy is often a major handicap to people living with this condition. This study therefore looked at the knowledge, attitude and perception of teachers who see a lot of epileptics, relates on daily bases and have a high influence on students with epilepsy.Self-administered questionnaires were used to obtain information from 460 randomly selected teachers in primary, secondary and tertiary educational institutions in Kwara State-middle belt of Nigeria. The response rate was 75%. Almost all of the teachers had heard about epilepsy, but their awareness does not equate with the acceptance and understanding of epilepsy. About 30.5% believed that it could be contracted through the saliva of an epileptic, 27.7% thought it was synonymous with possession with evil spirit, while 10% misunderstood epilepsy for insanity. Close to one-fifth of the teachers were of the opinion that epileptic students have a below average mental capacity compared with other students and so cannot attainment the highest possible education. Negative attitude and bias towards epilepsy is still deeply ingrained among teachers in Nigeria. Apart from formal education, teachers need to have health education courses on common disease conditions such as epilepsy that are prevalent in school age. This might help to reduce prejudice and increase the acceptance of epileptic individuals into the classroom.
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PMID:Perception and attitude to epilepsy among teachers in primary, secondary and tertiary educational institutions in middle belt Nigeria. 1610 39

More than 50 years ago, Lennox and Markham urged physicians who treated patients with epilepsy to "match modern drug and surgical therapy with practical sociopsychological therapy" and to be "concerned not only with turbulent brain waves but with disturbed emotions". Indeed, while seizure frequency and severity correlate with quality of life and psychosocial outcomes for patients with drug-resistant epilepsy, numerous other epilepsy-related factors may also be significant determinants. These factors include medical and psychiatric co-morbidities, side effects of therapy, stigma, parental anxiety, employment status, seizure worry, self-esteem and self-mastery. Importantly, these epilepsy-related factors may be amenable to educational or therapeutic interventions, which if successful may benefit patients even without a concomitant reduction in seizure frequency or severity. Therefore, while further research is needed, physicians and other health care providers should comprehensively attend to these factors and refer patients with treatment-resistant seizures, when appropriate, for further evaluation and treatment to improve their quality of life beyond seizure control.
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PMID:Improving quality of life beyond seizure control. 1612 Apr 92


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