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Original Research (Original Article) 


Tahani Alharshan et al, 2020;4(2):395–402.

International Journal of Medicine in Developing Countries

Awareness and attitudes toward epilepsy in Al-Ahsa, Eastern Region, Saudi Arabia

Tahani Alharshan1, Fathia Omer Mohamed2, Reem Al Harshan3*

Correspondence to: Reem Al Harshan

*College of Medicine, King Faisal University, Al Ahsaa, Saudi Arabia.

Email: reemkhalid95 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 10 December 2019 | Accepted: 22 December 2019


ABSTRACT

Background:

Epilepsy is known to be a common disorder frequently encountered in the Department of Paediatric Neurology. Lack of awareness and inadequate knowledge toward epilepsy among the general population may affect epileptic children’s life. The current study was aimed to assess the level of awareness and attitude regarding epilepsy in Al-Ahsa, Saudi Arabia.


Methodology:

A descriptive observational study was conducted randomly among 421 participants in Al-Ahsa, Saudi Arabia, for a period from August 2017 to May 2018.


Results:

Most of the participants disagreed (60.05%) that epilepsy could be a cause of Jinn. However, 25.24 (7.35% completely and 17.89% partially) agreed it could be caused due to Jinn. Also, the majority of the participant 49.75% disagreed that epilepsy could be caused due to evil eye and envy, but 12.25% of participants agreed and 23.28% partially agreed to it. The participants who believed that epilepsy is linked with Jinn or evil eye and envy were significantly dependent on the education level with a p-value of 0.005 and 0.001, respectively.


Conclusion:

The level of awareness and attitude regarding epilepsy in the Saudi population living in Al-Ahsa was high, but still needs improvement as few misconceptions regarding its etiology has been noticed in the studied population. To raise the level of epilepsy awareness and education among the public, the authors recommend adopting public health programs and campaigns. Those programs and campaigns should include etiology, manifestations, complications, and awareness on how to deal with an epileptic attack, proper management strategies, and the social impact on individuals living with epilepsy.


Keywords:

Epilepsy, awareness; attitudes, neurology, Al Ahsaa.


Introduction

Epilepsy is a common chronic neurologic disorder in the world affecting people of all ages, race, and social classes [1]. The episode of epilepsy is characterized by recurrent unprovoked seizures attacks [2]. It has multiple causes, each cause reflecting underlying brain dysfunction [3]. A provoked seizure by a reversible event for example due to fever does not fall under the definition of epilepsy because it is not a chronic state [2]. Epilepsy associated with stigma, psychiatric comorbidity, and high economic costs [4]. The stigma of epilepsy can lead to education, employment, and marriage problems [5,6]. Sixty-five million people worldwide are diagnosed with epilepsy, and approximately 80% of them live in the developing countries [7,8]. The prevalence of epilepsy is between 5 to 8 per 1,000 population in the developed countries and 10 per 1,000 population in the developing countries [9]. Prevalence in the Arab area ranged between 0.9 per 1,000 in Sudan and 6.5 per 1,000 in Saudi Arabia, with a median of 2.3 per 1,000. Approximately 724,500 people with epilepsy live in the Arab world [10]. Seizures are classified according to a new classification which contains both a basic and expanded version; it applies to all the age groups. After classification of seizure type, the physician should aim to identify the patient’s epilepsy type and if it is possible to be epilepsy syndrome or not [11,12]. A basic version is a limited form of the expanded version. The basic version will be more useful for doctors in general practice, pediatricians, internists, family physicians, nurses, and healthcare workers. The expanded version will support epileptologists, neurophysiologists, and researchers [13]. The basic classification depends on the onset of the seizure as focal, generalized, unknown, or unclassifiable. Focal is synonymous with partial. It classified as seizures with awareness or impaired awareness. A generalized onset seizure happened when both hemispheres activated during the attack, according to behavior and electroencephalography. Most of the time the perception is impaired during generalized seizures. It classified as tonic-clonic or other motor seizures. Unknown onset refers to when the time is unknown, but other manifestations are known. Unclassified remains as a category, although usage may decrease given the addition of additional seizure types and the unknown onset category. The seizures treatment depends on the diagnosis and the specific seizure type [13]. There is no single antiepileptic drug (AED) that is ideal for first-line treatment in all patients (7). Treatment choices should take into account seizure type, syndrome, and other characteristics, such as age, sex, and comorbidities as recommended by the United Kingdom National Institute for Health and Care Excellence guidelines [14]. The common AEDs such as carbamazepine and valproic acid still valuable as first-line options, some latest AEDs increasingly used as initial treatment, mainly because of their perceived improved tolerability and reduced propensity to cause drug interactions [7]. Besides comorbidities add to the weight of epilepsy and have suggestions for drug selection and prognosis. For example, psychiatric comorbidity gives a worse response to the initial treatment with AEDs [15]. Also, it associated with an increased risk of death [16]. People’s engagement in pediatric epilepsy care is needed to be highlighted cause the people who contact the affected child daily can profoundly affect him [17]. The poor awareness regarding epilepsy in the general population has identified in multiple studies [1821]. One study showed Jinn possession is still believed to be the cause of epilepsy in Saudi Arabia even in somewhat well-educated people [22]. On the other hand, some studies showed an excellent mothers’ level of knowledge of epilepsy and their attitudes towards epilepsy were mainly positive [23]. Other research found that schoolteachers were generally knowledgeable about epilepsy [1].


Subjects and Methods

A descriptive observational study was conducted randomly among 421 participants in Al-Ahsa, Saudi Arabia, for a period from August 2017 to May 2018. The study was approved by the higher authorities of King Faisal University in Al-Ahsa, Saudi Arabia. This study included any individual from Al-Ahsa excluding individuals younger than 20-year old. The sample size should be not less than 385 according to the computer software (EPI-INFO) sample size calculator with the confidence level of 95%. Sample Size = Z 2 * (p) * (1−p) / c 2. The data collected using electronic and hard-copy self-administered questionnaire which included questions designed to fulfill the study objectives. The questionnaire survey was taken from the previous study which was valid and well-designed. The questionnaire was judged by experts from the field of awareness and attitudes. The Arabic version of the questionnaire was shown to be valid and reliable [19]. The Statistical Package for the Social Sciences (SPSS) software version 24 was done to analyze the data. The results were presented as the mean±SD. Unpaired T-test, Chi-squared, or Fisher’s exact test used to determine the significant differences among different groups. The result considered significant when p ≤ 0.05.

Participation in this research was voluntary. All participants acquired written informed consent to join this study, and they had the right to withdraw at any time. All information in this study was confidential, and the privacy of the participant data protected with no access to data other than who authorized. The survey was legally permitted and socially accepted.


Results

A total of 421 questionnaires were distributed randomly during the study period. Thirteen questionnaires were excluded due to incomplete data, so 408 were prepared for data analysis. Our study included 107 (26.2%) male and 301 (73.8%) were female subjects (Table 1). The majority of the participants were married (62%), the single participants were 36.3%, widowed were 1.2% and, divorced participants were (0.5%). Most of the precipitants 315 (77.2%) were obtained from families of healthy children, whereas 93 (22.8%) were obtained from families of epileptic children. The sociodemographic data of all of the studied families are shown in (Table 1).

The socio-demographic data showed no significant difference between families who have epileptic children and families who did not have epileptic children regarding the age group, gender, marital status, education level, or employment. However, families of epileptic children tended to be living in rural areas (Table 2).

Awareness about the etiology of epilepsy

Most of the participants disagreed (60.05%) epilepsy could be a cause due to Jinn. However, there was 7.35% who agreed and 17.89% who partially agreed, which means (25.24%) of participants believe Jinn as the cause for epilepsy. Also, the majority of the participant (49.75%) disagreed epilepsy could be caused due to evil eye and envy, but there was (12.25%) of participants who agreed and (23.28%) who partially agreed to it. The idea that epilepsy is related to Jinn or evil eye and envy is significantly dependent on the education level p-value = 0.005 and 0.001, respectively.

In this study, only 34 (8.3%) thought epilepsy is contagious, but the majority of the participant 374 (91.7%) disagreed and partially disagreed with it. The level of education has strongly affected this thinking with a p-value equal to 0.001. There were variable opinions regarding epilepsy is a heritable disease (21.32%) agreed, (36.03%) partially agreed, (16.67%) partially disagreed and finally (25.97%) disagreed. Experience has a significant correlation p: 0.024. Finally, 34.56% of participants disagreed with epilepsy is a mental disease, while (24.8%) are agreed. There is a significant association between gender and this thought, p-value = 0.013 (Graph 1).

Table 1. Socio-demographic data of the studied patients (n = 408).

Demographic Characteristics Count (n = 408) Relative Frequency (%)
Age
20–30 years 218 53.4
31–40 years 95 23.3
41–50 years 66 16.2
50 years and above 29 7.1
Gender
Male 107 26.2
Female 301 73.8
Marital status
Single 148 36.3
Married 253 62.0
Widow 5 1.2
Divorced 2 0.5
Education level
Elementary 1 0.2
Intermediate 15 3.7
Secondary 69 16.9
Higher education and above 323 79.2
Work
Worker 168 41.2
Non-worker 240 58.8
Residency
Urban 348 85.3
Rural 60 14.7
Experience
One of my relative diagnosed with epilepsy 93 22.8
No one of my relative diagnosed with epilepsy 315 77.2

Table 2. The sociodemographic characteristics among families of epileptic children and families of normal children.

Variable Family of an epileptic child Family of non-epileptic child p values
Age 0.69
20–30 years 40 178
31–40 years 28 67
41–50 years 15 51
50 years and above 10 19
Gender 0.879
Male 25 82
Female 68 233
Marital status 0.313
Single 27 121
Married 65 188
Widow 1 4
Divorced 0 2
Education level 0.138
Elementary 0 1
Intermediate 5 10
Secondary 22 47
Higher education and above 66 257
Work 0.303
Worker 34 134
Non-worker 59 181
Residency 0.000
Urban 68 280
Rural 25 35

Awareness about the outcome and the treatment of epilepsy

Overall (44.85%) participants’ believed epilepsy is a curable disease. However, (31.37%) of participants agreed and (35.54%) partially agreed epilepsy could cause death. The majority of the participants (47.79%) agreed and (36.8%) partly agreed that medications are the only choice of treatment for epilepsy, while (10%) of participants thought traditional therapies such as cupping and cautery should consider as a treatment option for epilepsy. Although there were variable opinions regarding that surgical management is the treatment choice for epileptic patients, only 11.3% agreed for it, and the majority (37.01%) disagreed. Among them, 48.28% of participants thought an epileptic child needs specialized treatment while 7.1% disagreed.

A statistical difference existed between the different levels of educations and the belief of the traditional treatment with a p-value of 0.003. Also, a statistically significant difference existed between urban and rural people regarding their belief that the outcome of epilepsy as a curable disease, p-value = 0.024 (Graph 2).

Caring and awareness about performing first aid during the attack

Variable opinions detected regarding how to perform first aid for convulsing patients, 115 (28.2%) agreed that they knew how to do first aid during the epileptic attack, but 125 (30.64%) thought that they do not know it. There is a statically significant difference between knowing how to do the first aid and the people who have previous experience with a relative who has been diagnosed with epilepsy and people who do not, p-value = 0.001 (Graph 3).

Graph 1. Awareness about the etiology of epilepsy.

Graph 2. Awareness about the outcome and the treatment of epilepsy.

The epileptic patient should be treated differently

Of the responding participants, 197 (48.3%) agreed, and 135 (33.1%) partially agreed that epileptic children should be treated differently with no significant differences between gender, residency, education level, and previous experience (Graph 4, Table 3).

Epileptic have ordinary school achievement

Most of the participant 294 (72.06%) thought that epileptic child has a capability for school achievement whereas only (0.98%) thought that they could not. With no statistically significant differences between gender, residency, education level, and previous experience (Graph 4, Table 3).

Graph 3. Caring and awareness about performing first aid during an epileptic attack.

Graph 4. Attitudes toward epilepsy among participants.

Table 3. Attitudes towards epilepsy among participants.

Variable Agree Partially Agree Partially Disagree Disagree
I think an epileptic child needs to be treated differently 197 (48.3%) 135 (33.1%) 47 (11.5%) 29 (7.1%)
I think an epileptic child has the capability for school achievement 294 (72.1%) 103 (25.2%) 7 (1.7%). 4 (1%)
I think an epileptic child can participate in any type of sport 164 (40.2%) 157 (38.5%) 60 (14.7%) 27 (6.6%)
I think epileptic drugs affect a patient’s life 114 (27.9%) 150 (36.8%) 84 (20.6%) 60 (14.7%)
I think epileptic drugs affect an epileptic child’s activity 95 (23.3%) 162 (39.7%) 87 (21.3%) 64 (15.7%)
I think epileptic drugs affect patient’s school achievement 71 (17.4%) 149 (36.5%) 101 (24.8%) 87 (21.3%)
I think this disease will affect an epileptic child’s life 170 (41.7%) 157 (38.5%) 41 (10%) 40 (9.8%)

Epileptic can play sports

Of overall participants, 164 (40.2%) agreed, and 157 (38.5%) partially agreed that the epileptic child could perform any sports. There are no statistically significant differences between gender, residency, education level, and previous experience groups (Graph 4, Table 3).

Epilepsy and epileptic drugs affect a child’s life

Most participants 170 (41.7%) agreed, and 157 (38.5%) partially agreed that the diagnosis of epilepsy could affect a child’s life while only 40 (9.8%) do not think that epilepsy could affect child’s life. A significant statistical difference was shown between the educational levels and believing that epilepsy could affect a child’s life. Besides, 114 (27.9%) agreed, and 150 (36.8%) agreed to some extent that epileptic drugs can affect a child’s life. There are significant differences between the previous experience with an epileptic child and the belief that epileptic medications could affect a child’s life. There is (23%) of the participants thought the epileptic drug could affect a child’s activity and (17.4%) thought epileptic drugs affect a child’s school performance (Graph 4, Table 3).


Discussion

Epilepsy is the most common pediatric neurologic disorders worldwide [1]. Awareness and attitudes towards epilepsy studies are widespread to obtain reliable data in our community and determine their attitude toward epileptic patients [24,25]. Epilepsy is more common in the developing countries, and within these countries, there are many false beliefs and misconceptions towards epilepsy due to lack of information in the media accessible which has been leading to stigma perpetuation [9,19]. This study is the first paper that focused on measuring the awareness and attitude toward epilepsy in Al-Ahsa, eastern region, Saudi Arabia. It includes 408 participants who represent the target population, the preponderance of respondents aged 18–30 years old, married and having a high educational degree. The present study shows that the percentages of those who held the belief that Jinn is the cause of epilepsy were (7.35%) of the participant, and (17.89%) of the respondents agreed to some extent which gave us a total of a quarter of the participant believed on that. Also, there are participants (35.53%) who believed that epilepsy might cause due to evil eye and envy. This value is lower than those studies which have reported in different regions of Saudi Arabia. For example, in the Neyaz study which held in Almadinah Almunawwarah, 44.7% of the respondent believed that epilepsy is related to Jinn [19]. Obeid et al. [22] study in Jeddah reported that 40.3% of school teachers and 50.4% of students in their sample believed that epilepsy might cause by Jinn. Also, a similar study conducted in the Al Kharj governorate reported that 46.5% of their sample believed the primary cause of epilepsy is a supernatural linked with a demonic attack or evil spirits and 51.25% believed it is due to envy or evil eye [26]. Moreover, Zainy et al. [27] study conducted at the pediatric neurology out-patient clinic of King Abdul-Aziz University Hospital, Jeddah, found that 44% of epileptic parents believed that epilepsy associated with evil. This thought also conducted in multiple countries. In Egyptian, for instance, Thabit et al. [28] showed that 74.5% of non-epileptic respondents think the cause of epilepsy is by evil spirits and evil eyes or due to psychiatric disorders. On the other hand, in Pakistan and Malaysia, only 0.6% and 5%, respectively, of responders believed epilepsy related to supernatural or evil eye [29,30]. In this report, we found the misconception of the cause of epilepsy depended on the level of education and the residency urban or rural. Our findings are very close to what reported from the previous study done in Al Madinah in which high educational levels responders have higher awareness and attitude levels [19]. Also, in Iran study stated that responding with higher education levels give higher awareness and attitude level [31]. Another study in Kuwait shows both knowledge and attitude were significantly higher in senior teachers with more extensive teaching experience p =0.048 [32]. In this present study, a high percentage of respondents (84.58%) believed that epilepsy should be treated medically and more than half (57.35%) stated that it is curable. On the other hand, 33% believed in traditional medicine in treating epilepsy. We observed that our finding was similar to previously studied that done in Saudi Arabia. For example, in Neyaz et al. [19] research conducted in Al Madinah Al Monowah reported 86.7% of their sample to appreciate the medical treatment and 15.3% considered traditional medicine in treating epilepsy. The participant who knows how to perform first aid for a convulsive child is variable regarding that the majority (30.64%) thought that they do not know. The people who know how to perform first aid is correlated with the experience because it is more with people who have an epileptic family member. In overall, most of the studies show a positive attitude towards epilepsy; 72.06% of participant thought that epileptic child has a capability for school achievement whereas only 0.98% thought that they could not. 78% agreed that epileptic children could participate in a different type of sports. Neyaz et al. [19] study showed a similar response 88% believed that epileptic children could have ordinary school achievement and 76.7% believed that epileptic children could participate in sports. These differences also may be affected by religion, cultural thinking, and educations level. The limitations of this study include that there was an unknown prevalence of epileptic cases in Al Ahsaa. So, this would possibly lead to the prompt of the median awareness and attitude level regarding epilepsy. Also, in this investigation, we tried a structured closed question, as a reason it did not give us the actual attitudes of the target population.


Conclusion

The level of awareness and attitude regarding epilepsy in the Saudi population living in Al-Ahsa was found good but it still needs improvement due to some misconceptions regarding the etiology, and it needs correction. To raise the level of epilepsy awareness and education among the public, the authors recommend adopting public health programs and campaigns, including awareness on etiology, manifestations, complications, how to deal with an epileptic attack, proper management strategies, and the social impact on individuals living with epilepsy.


List of Abbreviations

SPSS Statistical Package for the Social Sciences

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The study was approved by the higher authorities of King Faisal University in Al-Ahsa, Saudi Arabia. The study was done after approval of King Faisal University during the educational year 2017/2018.


Author details

Tahani Alharshan1, Fathia Omer Mohamed2, Reem Al Harshan3

  1. Department of Pediatrics, King Abdulaziz Hospital, Al Ahsaa, Saudi Arabia
  2. King Faisal University, Al Ahsaa, Saudi Arabia
  3. College of Medicine, King Faisal University, Al Ahsaa, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alharshan T, Mohamed FO, Harshan RA. Awareness and attitudes toward epilepsy in Al-Ahsa, Eastern Region, Saudi Arabia. IJMDC. 2020; 4(2): 395-402. doi:10.24911/IJMDC.51-1576009677


Web Style

Alharshan T, Mohamed FO, Harshan RA. Awareness and attitudes toward epilepsy in Al-Ahsa, Eastern Region, Saudi Arabia. https://www.ijmdc.com/?mno=77514 [Access: January 28, 2022]. doi:10.24911/IJMDC.51-1576009677


AMA (American Medical Association) Style

Alharshan T, Mohamed FO, Harshan RA. Awareness and attitudes toward epilepsy in Al-Ahsa, Eastern Region, Saudi Arabia. IJMDC. 2020; 4(2): 395-402. doi:10.24911/IJMDC.51-1576009677



Vancouver/ICMJE Style

Alharshan T, Mohamed FO, Harshan RA. Awareness and attitudes toward epilepsy in Al-Ahsa, Eastern Region, Saudi Arabia. IJMDC. (2020), [cited January 28, 2022]; 4(2): 395-402. doi:10.24911/IJMDC.51-1576009677



Harvard Style

Alharshan, T., Mohamed, . F. O. & Harshan, . R. A. (2020) Awareness and attitudes toward epilepsy in Al-Ahsa, Eastern Region, Saudi Arabia. IJMDC, 4 (2), 395-402. doi:10.24911/IJMDC.51-1576009677



Turabian Style

Alharshan, Tahani, Fathia Omer Mohamed, and Reem Al Harshan. 2020. Awareness and attitudes toward epilepsy in Al-Ahsa, Eastern Region, Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (2), 395-402. doi:10.24911/IJMDC.51-1576009677



Chicago Style

Alharshan, Tahani, Fathia Omer Mohamed, and Reem Al Harshan. "Awareness and attitudes toward epilepsy in Al-Ahsa, Eastern Region, Saudi Arabia." International Journal of Medicine in Developing Countries 4 (2020), 395-402. doi:10.24911/IJMDC.51-1576009677



MLA (The Modern Language Association) Style

Alharshan, Tahani, Fathia Omer Mohamed, and Reem Al Harshan. "Awareness and attitudes toward epilepsy in Al-Ahsa, Eastern Region, Saudi Arabia." International Journal of Medicine in Developing Countries 4.2 (2020), 395-402. Print. doi:10.24911/IJMDC.51-1576009677



APA (American Psychological Association) Style

Alharshan, T., Mohamed, . F. O. & Harshan, . R. A. (2020) Awareness and attitudes toward epilepsy in Al-Ahsa, Eastern Region, Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (2), 395-402. doi:10.24911/IJMDC.51-1576009677