Needs Assessment for Information and Support of Parents of Children with Epilepsy / 기본간호학회지

PURPOSE: This study investigated the need for information and social support in parents of children with epilepsy. METHODS: A total of 119 parents of children with epilepsy were recruited and asked to fill out questionnaires. RESULTS: Of 119 parents, two-third reported that they received full and sufficient information about their child's disease and its management but one-third felt the information was insufficient and incomplete. Most parents (62.2%) felt at loss when their child had a seizure, either at home or at school. They wanted information on the causes of seizures, adequate steps deal with seizure and steps they should take to become adequate and supportive parents for their children. However, most parents were reluctant to disclose the disease or to receive support from outsiders. CONCLUSION: Regardless of the fact that most parents received sufficient information about the management of epilepsy, they felt at a loss when their child had a seizure attack. Therefore nurses should give specific instruction on seizure management and assess the needs of parents on a regular basis.

A Comparative Study of Parental Stress in Families with Epileptic Children

PURPOSE: The purpose of this study is to assess and compare the stress of mothers and fathers in families with epileptic children, and to assess contributing factors to their stress. METHODS: We used a family stress survey with 35 questionnaires to obtain data concerning the parents' perceived stress. Data were analyzed with SPSS 8.0 program using Pearson correlation coefficient, oneway ANOVA, and multiple range test. RESULTS: The parents' stress level seemed not so high and there was no significant difference in stress level between mothers and fathers. There was no significant correlation between most demographic variables of the parents and parents' stress level. But the time of bringing epileptic children correlates positively with the stress level. Oneway ANOVA showed the differences of parents' stress level according to the education institution, seizure type, number of antiepileptic drugs, and the combined disabilities of the sufferer. CONCLUSION: The results of present study indicate that the stress level in the families with epileptic children may be influenced by some treatment-related characteristics of epileptic children such as seizure type, number of antiepileptic drugs, combined disabilities and the raising method of hospital expenses.

Family Functioning of Families with Epileptic Children / 대한소아신경학회지

PURPOSE: Epilepsy, a typical chronic disease, may cause a high level of psychosocial difficulties for all family members, including stigmatization, stress, marital problems, poor self esteem and restriction of social activities. The present study focuses on how children with epilepsy affect their families' functioning. METHODS: The subjects were 30 parents of epileptic children. The Feetham Family Function Survey(FFFS) was used to obtain data concerning the parents' perceived family functioning. Data were analyzed with SPSS 8.0 program using Pearson correlation coefficient, Oneway ANOVA, and multiple range test(Scheffe test). RESULTS: The results of analysis showed slightly low score of the amount of the activity, high importance score and discrepant score, which mean a low satisfaction level. There was no significant correlation between most demographic variables of the family and the family functioning. Oneway ANOVA showed the differences of the discrepant score according to the number of the antiepileptic drugs, the frequency of the seizure, the combined disabilities, and the ways in which families with epileptic children raised money for hospital expenses. CONCLUSION: The results of this study indicate that the expected level and the important score might be higher than the achieved level of the family functioning, which indicates the low satisfaction in the families with epileptic children. The results also suggest that the discrepant score in the families with epileptic children may be influenced by some treatment-related characteristics of the epileptic children such as the frequency of the seizure, the number of the antiepileptic drugs, the combined disabilities and the ways in which families with epileptic children raised money for hospital expenses.

Comparison of Attitude toward Pediatric Idiopathic Convulsive Disorder Between Parents with Epilepic Children and Parents with Healthy Children / 신경정신의학

OBJECTIVES: We conducted this study to investigate the parental attitude toward their children wiht idiopathic convulsive disorder and to compare it with that of parents with healthy children. METHODS: The parents of children with convulsive disorder were recruited from the outpatient department of pediatric neurology in Seoul National University Hospital in Korea. We excluded patients with mental retardation, pervasive developmental disorder and overt organic brain pathology. The parents of normal students were chosen as control group. Children's sex, age, achievement and socioeconomic status were matched. The author interviewed all the children and their parents and obtained the developmental history and family information. 'Questionnaire for adult's attitude toward children with convulsive disorder' was used to obtain the data about the ideas about epileptic children and their family members from both parents of epileptic and normal children. RESULTS: First, parents of epileptic children worried too much about the possibility that convulsion made serious damage on physical status of patients. 25% of them believed that even single convulsion could lead to sudden death. Second, as the causes of convulsive disorder, the parents chose brain damage brain pathology worries of children mode of parenting worries of family genetic origin in order of frequency. 40% of them had false concepts that the way of rearing and childen's psychological problems might cause the convulsive disorder. Third, according to the answers of parents of epileptic children, more than 60% of children with convulsive disorder had cognitive, emotional, behavioral and learning problems. Fourth, parents of epileptic children reported behavioral change, emotional disturbance and attentional problems as result of adverse effect of medication. Fifth, Many parents of epileptic children had difficulties in explaining the disease and reasons of taking medication to patients. Sixth, Many parents of epileptic children worried about marriage and employment and reported the several limitations of social lives of parents and patients. The parents of healthy children had more tendency to believe that the convulsive disorder could be one of genetic diseases than parents of epileptic children. They chose the brain pathology-genetic originmode of parenting-brain damage-worries of children-worries of family as the causes of convulsive disorder in order of frequency. The parents of healthy children had overcare about the limitations of children's social activity and difficulties of parents and family members of epileptic children. CONCLUSION: This study revealed the parents of epileptic children had some overcares and misbelieves about their children's disorder. Also, the parents of healthy children had more distorted ideas about the causes of the convulsive disorder and its impact on epileptic children and their family members. So the mental health professionals should prepare and conduct the comprehensive and effective educational programs for the parents and public members.

The Psychopathology in Chronic Epileptic Children / 신경정신의학

OBJECTIVES: We conducted this study to investigate the extent of psychopathology in chronic epileptic children compared to normal controls. METHODS: The participating patients were recruited from the patients attending the epilepsy clinic of department of pediatric neurology in Seoul National University Hospital in Korea. We excluded seizure disorders associated with mental retardation, pervasive developmental disorder or brain organic pathology. As the control group, normal students whose sex, age, IQ, achievement and socioeconomic status were matched to patients were sellected. The authors interviewed the children and their family members and obtained the developmental history and family infor-mation. We used the following 5 scales to assess psychological and behavioral problems Each scale was standardized and its validity and reliability were confirmed in previous study. Parent rating scales: Yale children's inventory, Disruptive behavior disorder scale, Children's self rating scales: Children's depression inventory, Spielberger's state-trait anxiety anxiety. Piers-Harris self-concept inventory. RESULTS: Compared to normal controls, depression and anxiety scores were increased and self-concept score was decreased in patient group. The prevalence of ADHD, conduct disorder and ODD estimated by parental report was higher in patient group than control group. CONCLUSION: According to this study, chronic epileptic children showed diverse emotional and behavioral problems and needed urgent professional psychiatric help.

Effects of Arbiturary Acute Anticonvulsnat Withdrawal in Epileptic Children / 대한소아신경학회지

PURPOSE: The effects of arbiturary acute anticonvulsants withdrawal in epileptic children were studied and relationship between status epilepticus and anticonvulsant withdrawal was analysed. METHODS: Medical records of 88 withdrawal episodes in 72 active epileptic children were analysed retrospectively according to the types of epilepsies, anticonvulsants. RESULTS: 1) When followed up after withdrawal, 42 cases (47.7%) had a recurrence of habitual seizure, 18 cases (20.5%) had no seizure and increased seizure frequency were found in 14 cases (16.0%). Three cases (3.4%) had no change in seizure frequency or severity and in 2 cases (2.3%) the frequency or severity of seizure were decreased after withdrawal. 2) Recurrence of habitual seizure, increased seizure frequency, more intense seizure or status epilepticus were noted in 55 of 71 withdrawal episodes in focal epilepsies (77.5%), in 9 of 17 withdrawal episodes (52.9%) in generalized epilepsies (P=0.041). These changes occurred in 36 of 55 cases (65.5%) in focal epilepsies, 3 of 9 cases (30.0%) in generalized epilepsies within 4 weeks after withdrawal (P=0.137). 3) Recurrence of habitual seizure, increased seizure frequency, development of more intense seizure or status epilepticus were found in 18 of 26 cases (69.2%) in carbamazepine monotherapy, 15 of 16 cases (93.8%) in phenobarbital monotherapy, 24 of 34 cases (70.6%) in polypharmacy (P=0.143). These changes occurred in 14 of 18 cases (77.8%) in carbamazepine monotherapy, 7 of 15 cases (46.7%) in phenobarbital monotherapy and 18 of 24 cases (75.0%) in polypharmacy within 4 weeks after withdrawal (P=0.122). 4) Four cases (4.5%) of status epilepticus occurred in 4 patients with focal epilepsies at 4 months (2 cases), 5 months, 23 months later after acute anticonvulsant withdrawal. CONCLUSION: Arbiturary acute anticonvulsants withdrawal in epileptic children were more common than expectation and councelling to avoid arbiturary anticonvulsant withdrawal must be entensified. Approximately half of the cases with anticonvulsant withdrawal showed a recurrence of habitual seizure and status epilepticus occurred in 4.5% of cases only. Other factors besides acute anticonvulsant withdrawal must be investigated to clarify the underlying mechanism of status epilepticus. A quarter of cases showed no seizure and even decrease in seizure frequency or severity after anticonvulsant withdrawal. These results suggest more considerated prescription of anticonvulsant is needed in practice.

Compliance with Anticonvulsant Therapy in Epileptic Children

PURPOSE: Good compliance with an anticonvulsant medication regimen is essential for the successful management of epilepsy. However, pediatric compliance with anticonvulsant therapy did not well be studied. The aim of this study was to identify the following key in noncompliance in pediatric out patients receiving anticonvulsant therapy determining factors. METHODS: Eighty-one epileptic outpatients under fifteen years of age with anticonvulsant therapy from the pediatric department of Kang-Dong Sacred Heart Hospital was enrolled for the study. Variables such as age, sex ratio, the reason of poor compliance, medication regimen and seizure frequency were extracted from each patients'medical record. RESULTS: Up to 37% of the patients was labeled as a poor compliant group. Compliance was low at the under 6 year and over 13 year-old patient group, and was also low for those who hadn't had a seizure in a while and for those who had a low seizure rate since last year. The mean plasma level of anticonvulsants was higher in the good compliant group than in the poor compliant group. The most reported obstacle to good compliance was forgetfulness. Side effect and drug rejection were also reported. CONCLUSION: To the high risk group of poor compliance, reminding, decreasing side effects, making simple administration adjustments have been reported to be useful in promoting compliance with medication regimens.