Considerations in developing a specialized epilepsy employment program: A sponsor's playbook.

Specialized vocational rehabilitation (VR) programs in epilepsy have routinely performed more successfully than general or state-federal VR programs. This article presents the key areas of emphasis in successful epilepsy VR program development to include initial program drivers, choice of VR services model, perspectives on program elements, clients, staffing, service evaluation metrics, operational considerations, and the partnering sponsor's personnel support. Considerable emphasis is placed on the importance and diversity of funding in sustaining a specialized epilepsy VR program. This template of considerations provides potential program implementers with a general framework for successful epilepsy VR program development.

Estimulação elétrica do nervo vago na terapia adjuvante de pacientes pediátricos com epilepsia resistente a medicamentos, sem indicação para cirurgia ressectiva de epilepsia / Electrical stimulation of the vagus nerve in adjuvant therapy of pediatric patients with drug-resistant epilepsy, without indication for resection of epilepsy

CONTEXTO: A epilepsia é uma condição neurológica caracterizada por crises epilépticas recorrentes. A epilepsia resistente a medicamento (do inglês, Drug-Resistant Epilepsy ­ DRE) ocorre quando há persistência de crises epilépticas apesar do uso de dois fármacos anticonvulsivantes de primeira linha, em doses adequadas. O tratamento disponível no SUS inclui fármacos antiepilépticos (FAE) e a cirurgia cerebral que é recomendada pelo PCDT do Ministério da Saúde. A cirurgia pode ser considerada curativa para alguns tipos específicos de crises epilépticas, porém 20 a 30% dos pacientes, não evoluem bem ou não são candidatos à cirurgia. A utilização da terapia de eletroestimulação do nervo vago seria uma opção para estes pacientes. TECNOLOGIA: Estimulação elétrica do nervo vago com dispositivo implantável. PERGUNTA: O uso da terapia de eletroestimulação do nervo vago é eficaz, segura e custo-efetiva no tratamento de pacientes pediátricos com epilepsia resistente a medicamento para diminuição do número de crises quando comparado ao sham do método (estimulação em baixa frequência) ou aos FAE apenas? EVIDÊNCIAS CIENTÍFICAS: Há revisões sistemáticas (RS) com metanálises que avaliaram a terapia de eletroestimulação do nervo vago em população mista (adultos e crianças) e apresentam resultados favoráveis no desfecho de redução de ≥ 50% na frequência de crises epilépticas, principal desfecho avaliado. Entre os resultados das RS, verificou-se que a terapia está relacionada à um risco relativo (RR) de até 1,73 em comparação ao sham do método. No entanto, o ECR que incluiu apenas pacientes menores de 18 anos não verificou diferença estatisticamente significante entre os grupos avaliados (estimulação de alta frequência do nervo vago vs sham do método). O ECR que comparou a terapia de eletroestimulação do nervo vago ao tratamento com FAE, em pacientes menores de 17 anos, apresentou redução de ≥ 50% na frequência de crises em 39,4% dos pacientes do grupo tratado com a terapia e em 24,0% dos pacientes tratados com os FAE. AVALIAÇÃO ECONÔMICA: Foi realizada uma análise de custo-efetividade e apresentada uma razão de custo efetividade incremental (RCEI) de 84.666,02 em 10 anos e em 20 anos(caso base), uma RCEI de 51.088,55 com a utilização do dispositivo, em adição aos FAE. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: A análise estimou um impacto orçamentário incremental, considerando uma possível redução dos recursos em saúde, de R$ 63.036.945,75. RECOMENDAÇÃO PRELIMINAR: De acordo com o exposto, a CONITEC em sua 64ª reunião, no dia 08 de março de 2018, recomendou a incorporação no SUS do gerador de pulso para nervo vago na terapia adjuvante em pacientes pediátricos com epilepsia resistente a medicamentos, sem indicação para cirurgia ressectiva de epilepsia. A matéria foi disponibilizada em consulta pública. CONSULTA PÚBLICA: Foram recebidas 14 contribuições técnico-científicas e 33 contribuições de experiência ou opinião, sendo a maioria concordante com a recomendação preliminar da CONITEC. As contribuições, na sua totalidade, apontaram os benefícios da tecnologia analisada aos pacientes que apresentam epilepsia resistente aos medicamentos e descreveram pontos positivos e negativos da mesma. Os participantes também descreveram sua experiência negativa com medicamentos e a dieta cetogênica, utilizados no tratamento da epilepsia. A CONITEC entendeu que não houve argumentação suficiente para alterar sua recomendação inicial. RECOMENDAÇÃO FINAL: Os membros da CONITEC, na 66ª reunião ordinária em 10 de maio de 2018, deliberaram por recomendar a criação de um procedimento para estimulação elétrica do nervo vago para terapia adjuvante em pacientes com epilepsia resistente a medicamentos, sem indicação para cirurgia ressectiva de epilepsia, em Centros e Unidades Habilitados conforme Protocolo de Uso. Foi assinado o Registro de Deliberação nº 349/2018. A estimulação elétrica do nervo vago também foi avaliada em outro relatório, cuja solicitação foi proveniente da atualização do PCDT de Epilepsia, como terapia adjuvante ao tratamento farmacológico em crianças e adultos com epilepsia focal ou generalizada refratária a pelo menos dois esquemas com medicamentos anticonvulsivantes. DECISÃO: Incorporar o procedimento para estimulação elétrica do nervo vago para terapia adjuvante em pacientes com epilepsia resistente a medicamentos, sem indicação para cirurgia ressectiva de epilepsia no âmbito do Sistema Único de Saúde ­ SUS, dada pela Portaria nº 24 de 11 de setembro de 2018, publicada no DOU de 12/09/2018. A portaria de incorporação contemplou as duas indicações solicitadas.

[Work and epilepsy--facts and phantasies]. / Arbeit und Epilepsie--Fakten und Fantasien.

Epilepsies can affect ability to work in a certain workplace and reintegration capacity not only due the seizures, but also due to possible accompanying neurological, neuropsychological and psychiatric symptoms. Epileptic seizures can lead to injuries of the patient himself and of other persons. Assessment of this aspect in a certain workplace requires not only a detailed knowledge of the nature of this job, but also of the semiology and frequency of seizures must be considered. Both attacks and concomitant symptoms (e.g. memory impairment, depression, etc.) have to be assessed with regard to prognosis and treatment status. As part of the patient's duty to cooperate with the social insurance system it is expected that he is concerned about the regular intake of antiepileptic pharmacotherapy, possibly also of psychiatric medications. Epilepsy surgery is, however, not regarded as a reasonable treatment.

[Epidemiological and socio-economic support patients living with epilepsy in Dakar, Senegal]. / Profil épidémiologique et prise en charge socioéconomique des patients vivant avec l'épilepsie à Dakar, Senegal.

BACKGROUND: Epilepsy remains a major public health problem especially in developing countries where access to new therapies remains limited. OBJECTIVE: The aim of this work was to study the socio-demographic profile of patients living with epilepsy in Dakar and supported. METHODS: We conducted a cross-sectional study over a period of eight months from November 2009 to June 2010 at Fann University Hospital and Health Center Pikine through research on adherence. RESULTS: The study involved patients living with epilepsy aged over 15 years, diagnosed clinically with epilepsy and/or confirmed by an electroencephalogram and put under antiepileptic drug for more than 3 months. We recruited 411 patients aged 15-74 years with a mean age of 28.93 years. The age range was 15-24 years with 44.6 % majority. The male sex predominated with 52.3 % and the sex ratio was 1.09. Singles outnumbered with 64.7 %. The level of education was the most representative secondary with 29.4 % and patients without profession were 35.5 %. Most of the patients was from semi-urban areas with 47.7 %. Generalized seizures were more frequent with about 70 %. Most of the patients was supported either by their family or by themselves. CONCLUSION: The management should be multisectoral for epilepsy out of darkness.

Risk factors for early disability pension in patients with epilepsy and vocational difficulties - Data from a specialized rehabilitation unit.

PURPOSE: The purpose of this study was to assess the risk factors for early disability pension (EDP) in adult patients with epilepsy in a specialized epilepsy rehabilitation setting. METHODS: In a retrospective study, 246 patients with epilepsy and employment difficulties leading to referral to an inpatient rehabilitation unit were evaluated with a questionnaire on admission and after a mean of 2.5years after discharge. Patients already receiving EDP at baseline were excluded. Epilepsy-related, demographic, and employment-related data as well as cognitive functioning and psychiatric comorbidity were assessed as risk factors for EDP at follow-up and analyzed using logistic regression models. RESULTS: Seventy-six percent of the patients had uncontrolled epilepsy, and 66.7% had psychiatric comorbidity. At follow-up, 33.7% received an EDP. According to multivariate logistic regression analysis, age>50years (odds ratio (OR) 5.44, compared to age<30years), application for an EDP prior to admission (OR 3.7), sickness absence>3months in the previous year (OR 3.30, compared to sickness absence<3months), and psychiatric comorbidity (OR 2.79) were significant risk factors for an EDP at follow-up, while epilepsy-related factors and cognitive impairment showed an effect only in the univariate analyses. CONCLUSIONS: Potential risk factors for EDP in patients with epilepsy were evaluated using multivariate analysis. Knowledge of such factors may help to develop appropriate criteria for rehabilitation candidacy and interventions to reduce the risk for EDP. This might lead to an amelioration of both psychosocial burden of patients and economic burden on society.

Rehabilitation for young adults with epilepsy and mild intellectual disabilities: results of a prospective study with repeated measurements.

PURPOSE: A residential rehabilitation program of the Bethel Institute in Germany for approximately three years is offered to young adults with epilepsy and mild intellectual disabilities. Participants aim at epilepsy improvements and want to gain more independence. The purpose of this study was to investigate effects of the program and their stability over the course of time. METHOD: Ninety-seven clients completed the program between 1999 and 2011. Data with repeated measurements (T1=four weeks after admission, T2=discharge, T3=at least two years after discharge) were only available for 51 of them. Outcome variables were seizure frequency, carer-ratings on their clients' success, assistance needs after the program (supported housing vs. long-term residential care) and client-ratings on activities of daily living, problems at work, on health-related and on global quality of life (QOL), on life satisfaction and on depression and psychological distress. RESULTS: Seizure frequency was significantly reduced, more than half of the clients moved to supported housing. Clients reported improvements in activities of daily living and some aspects of their QOL. These improvements remained constant over at least two years. Baseline data scarcely correlated with outcome measures. Analyses of subgroups demonstrated that changes of client-ratings correspond to changes of external parameters such as seizure frequency and professional assistance. CONCLUSION: Improvements with regard to more independent living, a better seizure control and more favorable self-ratings remained stable over the following years. From a social-welfare point of view, it is especially important that about half of the clients moved to supported housing after the program.

Bridging the gap between goal intentions and actions: a systematic review in patient populations.

PURPOSE: To evaluate the evidence for the effectiveness of if-then implementation intentions (if-then plans) in adult patient populations. Outcomes of interest included adherence, goal pursuit and physical health outcomes. METHODS: Keywords were used to search electronic databases without date or language restrictions (up to 30 April 2014). Studies were included if they (1) concerned a patient population; (2) used if-then plans as a sole intervention or as part of treatment, therapy or rehabilitation; (3) if they were randomised controlled trials. The PEDro scale was used to evaluate study quality. Guidance as set out by the Cochrane Collaboration was used. Two reviewers independently extracted data, discrepancies were discussed and if required referred to a third reviewer. RESULTS: In total, 18 of the 2141 articles were identified as potentially relevant and four studies of people with epilepsy, chronic back pain, stroke and obesity met the inclusion criteria. People who form if-then plans achieved better outcomes on epilepsy and stroke medication adherence and physical capacity than controls. CONCLUSIONS: Of the four studies that used an if-then plan, only one (people with epilepsy) looked at the intervention as a stand-alone strategy. Further research needs to explore if this simple approach improves rehabilitation outcomes and is a helpful and feasible strategy for people experiencing disabilities. Implications for Rehabilitation Steps involved in achieving goals, such as doing exercises or completing other goal related tasks, can be compromised for people with chronic health conditions particularly resulting from difficulties in self-regulating behaviour. If-then plans are implementation intention tools aimed at supporting people to deal more effectively with self-regulatory problems that might undermine goal striving and goal attainment, and have been found to be effective in health promotion and health behaviour change. This systematic literature review identified four studies completed with patient populations, with three demonstrating effectiveness. If-then plans provide an opportunity for clinicians to develop better ways of implementing rehabilitation.

Association between sociodemographic status and antiepileptic drug prescriptions in children with epilepsy.

PURPOSE: We investigated whether in Sweden sociodemographic differences are associated with access to expert health care and antiepileptic drug (AED) prescriptions in children with epilepsy. METHODS: Data on epilepsy, prescription of AEDs, and sociodemographic variables were obtained from several national administrative registers. We linked individual data to examine whether access by pediatric epilepsy patients to neuropediatricians and the prescription of individual AEDs differed according to gender, age, parental education, place of residence, parental region of birth, and household income. We also assessed whether AEDs are prescribed differently to patients with epilepsy by neuropediatricians as compared to other physicians. KEY FINDINGS: Of 1,788,382 children aged 1-17 years in 2006, living in the country by the end of 2006, 9,935 had a diagnosis of epilepsy (0.56%). Patients with epilepsy on AED treatment (n = 3,631) comprised 0.24% of the total Swedish population aged 1-17 years. Out of 3631 patients with epilepsy on AED treatment, 2301 (63.4%) received prescriptions from a neuropediatrician. Children with epilepsy aged 1-5 years old--as opposed to older children and adolescents--and children with epilepsy residing in large cities--as opposed to children living in smaller cities and rural areas--were more likely to be treated by a neuropediatrician. Children living in large cities received oxcarbazepine to a greater extent than children living in rural areas. Levetiracetam was prescribed more extensively to children whose parents had higher incomes. Of the five most frequently used AEDs, three (lamotrigine, oxcarbazepine, and levetiracetam) were prescribed to a larger extent by a neuropediatrician rather than by other specialists, and one AED (carbamazepine) was prescribed to a lesser extent. SIGNIFICANCE: The results of this nationwide cross-sectional study of children with epilepsy are important because they show that universal coverage for medical care does not eliminate inequalities of access to health care services among children and adolescents. No data are available that can guide us as to whether the density of child neurologists is of importance to access to expert health care, but this seems likely. Prescription patterns of AEDs differ between child neurologists and other specialists.

Meningitis: is a major cause of disability amongst Papua New Guinea children?

PURPOSE: This article is intended to focus on the need for the use of rehabilitation services, for children with meningitis in Papua New Guinea, which is one of largest developing country in The Pacific with diverse culture and landscape. Meningitis is the fifth leading disease that results in disability in the country. The first line of treatment is usually antibiotics, administration of vaccination is also recommended. Currently community based rehabilitation workers and Physiotherapist offer the rehabilitation services. There is a need for the other rehabilitation professionals and appropriate education to the CBR workers, caregivers for providing effective Rehabilitation. METHOD: Articles related to meningitis were recruited through various electronic database such as Ovid SP, MEDLINE, CINHAL, Google Scholar and HINARI and EBSCOhost for full text. The search includes journal articles, editorials, research reports, systematic reviews and books. RESULTS: The neurological sequelae resulting from meningitis are increasing. There is a need for Hib vaccination to reduce the rate of mortality. Physiotherapists are new professionals that emerged since 2006 and are assisting in reducing the motor and neurological disability. CONCLUSIONS: A multidisciplinary approach is required to manage the child with meningitis. Adequate knowledge, resources and assistance about the condition among the health professionals, carers and teachers would enable the children to achieve the quality of life.

[Social support for people with epilepsy].

People with epilepsy (PWEs) find it difficult to join society because of their seizures and because of the many kinds of problems that they face in the interictal periodo. These interictal issues include coexistent disabilities other than epilepsy, comorbidity (depression or anxiety), and psychosocial issues. PWEs show a high rate of impairment of intelligence and of, psychological, verbal, and motor functions; these impairments are classified according to the International Classification of Impairments, Disabilities, and Handicaps (ICIDH; 1980). These impairments lead to disabilities such as those with regard to communication, social functions, personal care, mobility, skillful work, and engaging in an occupation. Social ignorance and discrimination also make it difficult for PWEs to integrate in the society. Therfore, social support for PWEs is important, and doctors should be aware regarding the social resources, social welfare systems, and laws for PWEs. In this study, the current Japanese social support systems for PWEs have been briefly reviewed. For example, since 2002, PWEs can hold a driving license if they are seizure free for more than 2 years, can prove that their seizures occur only during sleep for more than 2 years and can also prove that these seizures do not impair of consciousness (simple partial seizure) nor affect their ability to drive for more than 1 year.

Inter-rater agreement in the assessment of response to motor and cognitive rehabilitation of children and adolescents with epilepsy.

INTRODUCTION: To assess inter-rater agreement among child neurologists and psychiatrists on evaluation of response to physical and cognitive rehabilitation of children and adolescents with epilepsy. MATERIALS AND METHODS: Five child neurologists/psychiatrists ("raters") were invited to draw 2-3 short case reports among those most commonly seen. 14 case histories were presented and raters used a structured questionnaire to report changes after selected rehabilitation programs. Response was coded as "Yes", "No", or "Uncertain" in different functional domains (Motor, Social, Alimentary, Communication, Personal Autonomy). Inter-rater agreement was measured using the kappa statistic. Raters where then asked to discuss any reason for disagreement. The test was repeated with different cases (16 case histories) adding a sixth rater, who had participated to the discussion. RESULTS: Even with this small number of cases, the agreement mostly ranged from poor to good in the first test (worse for Social, Personal Autonomy and Communication). Training improved agreement in almost all domains. There were no frank outliers. The agreement was lower with a specific approach (i.e. grouping "Uncertain" to "No") than with sensitive approach (i.e. grouping "Uncertain" to "Yes"). DISCUSSION: The interpretation of patients' response to physical and cognitive rehabilitation tends to vary among Italian child neurologists/psychiatrists depending on measures and training procedures. Discussion and training improves agreement, although this is only a pilot study conducted using a non standardized questionnaire.

Quality of life in people with epilepsy and their family caregivers. An Arab experience using the short version of the World Health Organization quality of life instrument.

OBJECTIVE: To assess the subjective quality of life (QOL) of Sudanese epilepsy patients with generalized tonic clonic seizures and their family caregivers, compared with the general population, and previous Sudanese data for chronic conditions, and to examine the predictors of QOL. METHODS: This cross-sectional study using the World Health Organization's 26-item QOL instrument, was carried out from December 2005 to December 2006, on consecutive government hospital Neurology Clinic attendees and their family caregivers, who fulfilled the study's inclusion criteria, in the cities of Khartoum, Wad Medani, and Atbara, Sudan. RESULTS: There were 276 patients (56.5% male; mean age 29.5 years). Patients' QOL scores were significantly lower (physical health domain [57.1%], psychological [60.1%], social relations [58.4%], environment [50.6%], and general facet [60.8%]), than the control group. They scored lower than the WHO 23-country patients for social relations and environment domains, and had lower environment domain scores than Sudanese diabetes patients. Caregivers had significantly higher scores (57.4 -73.7%) than patients and control group. Patients' higher QOL was associated with marriage, education, employment, no side effects and caregiver occupation. Caregivers had lower QOL if they were female, patients' own children, and less educated. The predictors of QOL included caregiver's proxy rating of the patient's QOL and drug side effects. CONCLUSION: Poor QOL in epilepsy reflects social underachievement, and calls for programs to remedy their psychosocial circumstance, and improve service provisions. Vulnerable caregivers need to be identified for assistance, to enhance their role.

Depressive symptoms among mothers of children with epilepsy: a review of prevalence, associated factors, and impact on children.

The impact of epilepsy is not limited to the child experiencing seizures, but affects all members of the family. As primary caregivers, mothers are particularly at risk for experiencing increased depressive symptoms and risk for clinical depression. The objective of this systematic review was to critically assess available evidence regarding the prevalence, associated factors, and impact of maternal depressive symptoms on child outcomes in epilepsy. Using a modified version of the Quality Index, studies were rigorously evaluated in terms of reporting, external validity, and internal validity. Limitations in the study designs and analytic techniques of previous research are discussed, and study methods to overcome these barriers are presented in order to advance this research area. Up to 50% of mothers of children with epilepsy are at risk for clinical depression. Correlates of maternal depressive symptoms include a number of modifiable risk factors such as role ambiguity, worry, and satisfaction with relationships. In addition, studies suggest that depressive symptoms in mothers have a negative impact on child outcomes in epilepsy including behavior problems and health-related quality of life. The overall mean score on the Quality Index was 9.7, indicating a midrange quality score, suggesting a need for more methodologically robust studies.

A general practice-based prevalence study of epilepsy among adults with intellectual disabilities and of its association with psychiatric disorder, behaviour disturbance and carer stress.

BACKGROUND: Although the elevated occurrence of epilepsy in people with intellectual disabilities (ID) is well recognized, the nature of seizures and their association with psychopathology and carer strain are less clearly understood. The aims were to determine the prevalence and features of epilepsy in a community-based population of adults with ID, and to explore whether the presence of epilepsy was associated with greater psychopathology or carer strain. METHODS: Data were collected on the age, gender, place of residence, adaptive and challenging behaviour, social abilities and psychiatric status of 318 adults from 40 general practices, together with the degree of malaise and strain of family carers. For participants with epilepsy, a nurse collected information on seizures, investigations, treatment and carer concerns by interview. Association between epilepsy and psychiatric morbidity, challenging behaviour and caregiver malaise or strain, was explored by comparing those with epilepsy with a comparison group matched on adaptive behaviour. RESULTS: Fifty-eight participants (18%) had epilepsy: 26% were seizure free, but 34% had extremely poorly controlled seizures. Earlier onset and seizure frequency were associated with adaptive behaviour. Carer concerns were related to seizure frequency and a history of injury. There were no significant differences in psychopathology, carer malaise or caregiver strain between the matched epilepsy and non-epilepsy groups. CONCLUSIONS: This study supports the high occurrence and chronicity of epilepsy among people with ID. While psychopathology and carer strain is common within this population, underlying disability-related factors appear to be more important than the presence of epilepsy per se.

The burden of normality: a framework for rehabilitation after epilepsy surgery.

This paper describes a conceptual framework that generates a modus operandi for rehabilitation after epilepsy surgery derived from regular longitudinal and prospective follow-up of patients and families. The framework focuses on patient experiences of undergoing surgery placed within the context of the family and broader community. It adopts a holistic view of patient care to understand the complex interactions between neurobiological and psychosocial factors that determine surgical outcome in the eyes of the patient, family, and clinical team. It emphasises the importance of anticipating postoperative adjustment issues using a preventive treatment approach.

[Epilepsy--inability to work and drive]. / Epilepsie--Arbeitsunfähigkeit und Fahruntauglichkeit.

Epilepsy presents a diverse clinical picture and thus skill and expertise are required when evaluating a patient's inability to work. The assessment must be based on the individual's unique medical history (type of attack, triggering mechanisms, frequency of attacks, presence of an underlying primary disease or other sequelae, possible neuropsychological deficits). It is often the causal diseases or subsequent sequelae that are the actual restricting factors for the inability to work and not the fact, per se, that the patient suffers from epileptic attacks. Rare or occasional attacks seldom interfere with the ability to work. Adverse drug reactions occasionally evoke a restriction in activities. In order to be able to correctly evaluate the inability to work, an accurate understanding of the workplace is indispensable--a general description is by no means adequate. Only when this understanding has been gleaned can a possible danger to the patient or his co-workers be correctly evaluated. Likewise, an epilepsy-related inability to drive can be a significant restriction for certain jobs. When the inability to drive results in an inability to work likely to last for a prolonged period, plans for alternative employment should be made as soon as possible and include the parties responsible (employers, Social Insurance). Vocational training is another option that can be considered in these cases. However, before such anticipated new employment or retraining is undertaken, one must always ensure that possible epilepsy-related neuropsychological deficits do not pose concerns or restrict a particular rehabilitation option. This article presents a tabular summary of the Swiss Guidelines (2006 revision) concerning driving and epilepsy.

Vocational assessment and intervention for people with epilepsy.

Employment restrictions have been experienced by many people with epilepsy. In many cases, the restrictions are unjustified and based on stigma or a stereotypical image of the person with epilepsy. Unjustifiable restrictions are a form of discrimination and lead to unemployment and underemployment. Unfortunately, much of the research in this area has been difficult to interpret because of differences in the definition of "people with epilepsy" and differences in the definition of "employment restrictions or problems." I report on an attempt to develop a classification structure and examine some survey results collected by the IBE Employment Commission from professionals and people with epilepsy concerning the sources of employment restrictions and possible methods to overcome these restrictions.

The sociodemographic findings, beliefs and behaviours of the patients admitted to Kocaeli University, Faculty of Medicine, Epilepsy Section.

Using a standard questionnaire, 121 consequent epileptic patients have been evaluated sociodemographically and according to their beliefs and behaviours about their illness. Monthly income per person was between 26 and 62.5 U.S. dollars (USD) for 3/4 of the patients. About half of the patients were concealing their illness. About one third of the patients' education was hindered because of their illness. When the patients who concealed their illness were compared with the ones who did not, it became clear that the education of the ones who did not conceal the illness was far more hindered. "Carrying an amulet" ratio was greater among the patients who had no social security when compared to the patients with social security. We concluded that prejudice against epileptic patients and superstitions in Turkish population are still valid. Physician should consider the expense of antiepileptics for both patients and the country when prescribing them. All parts of the society should be informed about epilepsy but this again depends on the country's budget.

Cost of epilepsy in patients attending a secondary-level hospital in India.

The study objective was out to provide an estimate of cost of epilepsy in a secondary level hospital in northern India where a once a week epilepsy clinic is run. Cost data were based on existing information on costs of the hospital and market rates for drugs and investigations. Other necessary information was extracted from patient records for the year 2001. Both direct (consultation fees, cost of investigation, drugs and facility costs) and indirect (traveling and loss of productivity) were estimated. A 25% loss of productivity was assumed based on interviews with the epilepsy patients attending the clinic. There were a total of 184 patients attending the epilepsy clinic during the year 2001. The annual drug cost of epilepsy treatment using phenobarbitone was 11 US dollars. The cost of drugs was in the ratio 1:2:3:4 for phenobarbitone, phenytoin, carbamazepine and sodium valproate. The average annual cost of outpatient treatment of epilepsy was found to be 47 US dollars per patient. The annual cost incurred in emergency and inpatient management was estimated at 810.50 US dollars and 168.30 US dollars for all the patients attending the secondary hospital during the year 2001. The total annual treatment cost for patients attending the hospital was 11,470 US dollars. The annual productivity loss for the same patients was estimated at 20,475 US dollars. Applying these to the estimated 5 million epilepsy patients in India, it comes to about 0.2% of the GNP of the country. As disease cost is much lower than productivity loss, epilepsy treatment is a worthwhile investment for the society. Treating epilepsy patients at primary level using phenobarbitone will increase the treatment coverage and reduce treatment costs. Simultaneous efforts must be made to bring the epilepsy patients on mainstream so as to reduce the productivity loss.

The dos and don'ts of neuropsychological assessment in epilepsy.

Neuropsychologists have a significant role in the assessment, treatment, and rehabilitation of people with epilepsy. This includes providing an assessment of an individual's cognitive strengths and weaknesses with respect to being a candidate for the surgery program, detailing intellectual and memory impairments as part of a rehabilitation service, and documenting specific antiepileptic drug effects as part of routine clinical management. Each of these specific roles requires careful consideration with respect to the potential pitfalls they can present to the neuropsychologist. In this article, we have attempted to identify the most obvious "dos and don'ts" in the neuropsychological assessment of people with epilepsy. These range from issues relating to the reliance of measures, to the failure to document patients' backgrounds, to the importance of considering the psychometric tests that we use. We have attempted to emphasize the importance or value of a well-conducted neuropsychological assessment to the management of the person with epilepsy.