Should we stop saying "epileptic"? A comparison of the effect of the terms "epileptic" and "person with epilepsy"

AbstractObjectiveThe advantages and disadvantages of using “epileptic” as a noun to describe someone with epilepsy have long been debated. Recent high-profile recommendations have stated that the term should not be used, including in English, as it perpetuates stigma. This decision was largely informed by a Brazilian Global Campaign Against Epilepsy study that reported experimental evidence indicating that, with students, the label evokes more negative attitudes than “person with epilepsy”. The generalizability of this effect to different countries/cultures, and thus the justification for the recommendations, has never been tested.MethodsWe replicated the Brazilian study in the UK, in English, while also addressing methodological limitations. It was powered to detect the effects reported by the Brazilian study, with 234 students completing a survey regarding epilepsy attitudes. Half were randomized to Group 1 and half to Group 2. In Group 1, patients were referred to as “people/person with epilepsy” within the attitudinal measures, while in Group 2 they were referred to as “epileptic/s”. Measures included translations of the questions used in the Brazilian study and the Attitudes and Beliefs about Living with Epilepsy scale. Participants' epilepsy familiarity and knowledge were also assessed.ResultsThe two groups were comparable in characteristics. A comparison of their responses to the attitude measures revealed no statistically significant or meaningful differences.ConclusionsIn this English replication, the word “epileptic” did not provoke more negative attitudes. This suggests that the effect reported by the Brazilian study might be culturally dependent. Methodological limitations to that study might also be relevant. Our results have implications for the global debate about how negative attitudes towards epilepsy might be addressed. Simply not saying “epileptic” may not promote the positive attitudes towards epilepsy that had been expected. To know how to best refer to those with epilepsy, evidence on the preferences of those actually living with epilepsy is needed

Withholding the choice of sodium valproate to young women with generalised epilepsy: Are we causing more harm than good?

PURPOSE: Although sodium valproate (VPA) remains the most effective antiepileptic for generalised and unclassified epilepsies, clinicians may be failing to discuss this treatment option because of guideline misinterpretation. Current guidelines recommend caution regarding teratogenic risks but do not advocate absolute avoidance. METHOD: We assessed VPA prescribing in young people attending a transition epilepsy clinic. We present six patients with idiopathic generalised epilepsy (IGE) in whom VPA had been initially avoided. RESULTS: Overall, the results were consistent with VPA's superior antiepileptic efficacy and ability to reduce harmful seizure-related complications. Young people denied of VPA showed prolonged periods of poor seizure control with medical, social and psychological complications. Following contraceptive counselling and VPA introduction, all six patients showed improved seizure control including seizure-freedom during follow-up of up to twenty-four months. There was also evidence of reduced seizure-related morbidity and improved educational and occupational functioning. Prior to referral, documentation revealed no discussion of VPA treatment options. CONCLUSION: Failure to prescribe valproate for IGE, particularly when another first-line treatment has failed, may not be in a young woman's best interests-particularly when they are most vulnerable to sequelae from uncontrolled seizures. Indiscriminate avoidance of valproate needs to be recognised as a misinterpretation of current epilepsy guidelines as it may harm young people. Although the use of valproate demands careful consideration, there remains a strong case to always discuss this medication because of its efficacy and potential to reduce seizure-related harm. Patients must be allowed to make their own informed decisions about effective epilepsy treatments.NoneThis is the author's accepted manuscript. The final version is available from Elsevier at: http://www.sciencedirect.com/science/article/pii/S1059131114002349

Identifying new antiepileptic drugs through genomics-based drug repurposing

Currently available antiepileptic drugs (AEDs) fail to control seizures in 30% of patients. Genomics-based drug repurposing (GBR) offers the potential of savings in the time and cost of developing new AEDs. In the current study, we used published data and software to identify the transcriptomic signature of chornic temporal lobe epilepsy and the drugs that reverse it. After filtering out compounds based on exclusion criteria, such as toxicity, 36 drugs were retained. 11 of the 36 drugs identified (>30%) have published evidence of the antiepileptic efficacy (for example, curcumin) or antiepileptogenic affect (for example, atorvastatin) in recognised rodent models or patients. By objectively annotating all ∼20,000 compounds in the LINCS database as either having published evidence of antiepileptic efficacy or lacking such evidence, we demonstrated that our set of repurposable drugs is ∼6-fold more enriched with drugs having published evidence of antiepileptic efficacy in animal models than expected by chance (P-value <0.006). Further, we showed that another of our GBR-identified drugs, the commonly-used well-tolerated antihyperglycemic sitagliptin, produces a dose-dependent reduction in seizures in a mouse model of pharmacoresistant epilepsy. In conclusion, GBR successfully identifies compounds with antiepileptic efficacy in animal models and, hence, it is an appealing methodology for the discovery of potential AEDs

Interfirm supply chains: The contribution of management accounting

It has been argued that 'traditional' management accounting systems do not readily support supply- chain management perspectives. Our study of the implications of supply-chain management initiatives for management accounting and for management accountants both supports that criticism and shows how management accounting is changing in response to the challenges

Quantitative Analysis of EEG Signal in Drug-Resistant Juvenile Myoclonic Epilepsy

Juvenile Myoclonic Epilepsy (JME) is a genetic generalised epilepsy syndromes characterized by myoclonic jerks mostly in the morning, tonic-clonic seizures and absence seizures. About 30% of people with JME continue to have seizures despite treatment with antiepileptic drugs. Quantitative EEG (qEEG) is a computer analysis of the electroencephalography. The aim of this study was to compare qualitative vs quantitative EEG, quantitatively analyse background EEG activity in two different physiological states and the correlation with cognitive performances in patients with refractory JME. Inclusion criteria were: drug-resistant JME and aged between 14 and 65 years. The recorded ambulatory EEG data was subjected to visual and quantitative analysis and chosed two samples of 20-60 second duration per patient, morning sample (MS) and evening sample (ES). Our study cohort consisted of 19 patients with refractory JME, 6 females and 13 males, with a mean age of 29.8 years. EEG visual analysis of background activity revealed inter-ictal abnormalities in all patients localized to left frontal region. When we compared dominant rhythm in standard EEG with dominant rhythm in qEEG we have found that is 1.50 is associated with a decrease in cognitive IQ scores