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77. The transcultural concept of epilepsy in traditional beliefs
Abstracts / Epilepsy & Behavior 17 (2010) 579–620
The patient’s local neurologist recommended carbamazepine. We performed a video/EEG study and recorded several not quite similar nighttime seizures followed by awakening. There was no ictal epileptic activity; an interictal epileptic focus was noted in the right frontotemporal region. Thus, we decided to perform a polysomnography (PSG) study, during which we successfully recorded another four seizures quite similar to the previous ones. The hypnogram was interrupted, and sleep continuity was lost and sleep stages were altered. Neither sleep apnea nor periodic limb movement syndrome was found to be the trigger for awakening. The reason for the wake periods is not clear. Several short periods of somniloquy were recorded. Daytime sleepiness and tiredness were the main problems of the patient. There were no specific findings on brain MRI scans. It is also important that a family member, the patient’s wife, participated in the night seizures as a caregiver. Although she did not undergo PSG, we thoroughly understand the reasons for her sleep interruptions and can explain her daytime tiredness. Both the patient and his wife completed the Quality of Life, Quality of Sleep, and PRIME-MD PHQ-9 questionnaires. Results: The patient was diagnosed with recent nighttime frontal epileptic seizures after a long seizure-free period. Add-on therapy was recommended. The decrease in the number of nighttime seizures was followed by improvements in the quality of life and sleep of both the patient and his wife. The patient’s depression is also improving. No medication was needed. We plan to perform a prospective study of the families of patients with nighttime seizures. Conclusions: The origin of nighttime seizures is not always clear at first. Video/EEG and video/PSG can be successfully combined, and the results help not only the patient but family members as well. Medication and family background help to stabilize the patient’s condition. doi:10.1016/j.yebeh.2010.01.100
Topic 4. Cultural and spiritual aspects 76. Homicidal behavior and patients with epilepsy admitted at Ibin-Al-Haitham High Secure Unit, Al-Rashad Teaching Mental Hospital, Baghdad Naamah Sh. Humaidi, Jameel K. Muslim, Al-Rashad Teaching Mental Hospital, Baghdad, Iraq
Objectives: It is generally thought that epilepsy does not predispose subjects to homicidal behavior. However, many previous studies have suffered from notable methodological weaknesses. In particular, obtaining comprehensive study groups of violent offenders has been difficult. Iraqi police have been able to solve an increasing percentage of homicides during the last few years with the gradual rebuilding of the infrastructure of the police and judicial systems; these bodies totally collapsed after the fall of previous regime. Because most homicidal offenders were subjected to intensive forensic psychiatric examination, we were able to obtain data for 118 homicidal offenders admitted to the Ibin-Al-Hiathim Secure Unit at AL-Rashad Teaching Hospital, Baghdad during the period July 2003 to July 2008. The goals of this study were to (1) determine the percentage of 118 homicides committed by people with epilepsy; (2) study the sociodemographic characteristics of people with epilepsy accused of homicide; and (3) determine the characteristics of the victims of people with epilepsy admitted to the Secure Unit. Methods: In this retrospective study, files were thoroughly examined to determine who had epilepsy and their characteristics, all according to DSM-IV criteria.
601
Conclusions: Forty-four percent of the subjects had abnormal EEGs. Six percent of the subjects had epilepsy. Fifty-seven percent of those with epilepsy were in the age range 20–40. There were more males than females, probably because males are more liable to break the law. Most of the offenders were urban dwellers, probably because there is greater access to psychiatric institutions and services in urban environments. The victims were mostly first-degree relatives of the offenders. doi:10.1016/j.yebeh.2010.01.101
77. The transcultural concept of epilepsy in traditional beliefs M. Darghal, Medical Center Diour Jemaa, Rabat, Morocco(P)
The prevalence of epilepsy is 1.1%. But despite the high number of patients, epilepsy is still unknown and care is lacking. The truth about this disease has too long remained mysterious. Traditional beliefs reinforce the public on the idea that epilepsy is a disease caused by evil spirits. In addition, the Moroccan words used to describe this evil are revealing: jnoun, maskoun, krina, msalmin, ladam, riah. Unfortunately these beliefs are behind the delay in diagnosing the disease and hence the greater debilitation and poor social integration of the patient. This is very expensive. The stigmas associated with epilepsy are very numerous. Sometimes patients suffer much more than their disease. Sometimes it is claimed that epilepsy is contagious, that patients with epilepsy are abnormal, dangerous, mentally retarded, or even doors misfortune. All these ideas are false and exacerbate the isolation of patients with epilepsy. Epilepsy affects people of all ages but especially children and adolescents, and because of the weight of prejudice and delay in diagnosis, these patients remain out of the cycle of school, vocational training, and social life (marriage. . .) and are completely marginalized. The scientific advances in recent years have made it possible to improve the plight of persons with epilepsy. The anxiety generated by the onset of the crisis can lead to emotionally dependent relationships with parents and inhibit the acquisition of emotional or intellectual autonomy of a child or young person. These difficulties in autonomy may themselves be a source of pain or symptoms (emotional immaturity, self disorders, disturbances, aggressiveness) The loss of selfcontrol during the crisis and dependence on others cause an injury that, in turn, affects self-confidence. Thus, the real trauma of the disease in addition to the psychological trauma deserves to be considered. doi:10.1016/j.yebeh.2010.01.102
78. The work of a free epilepsy clinic in the community Ayesha Maqbool, Khalid Mufti, Haroon R. Chaudhry
FLAME (First Liberated Action Movement Against Epilepsy) has run an epilepsy clinic for the last 25 years at Ahabab Hospital, Ravi Road, Lahore. This unit deals with a wide range of issues faced by people with epilepsy, for instance, in education, employment, transport, childcare and psychosocial factors affecting the family with a member or members suffering from epilepsy. Each week 300 patients receive pharmacological and psychological treatment by attending this facility. As an important component of FLAME’S objectives the community education program rapidly creates an awareness of epilepsy, its consequences and treatment among the people. The information
The patient’s local neurologist recommended carbamazepine. We performed a video/EEG study and recorded several not quite similar nighttime seizures followed by awakening. There was no ictal epileptic activity; an interictal epileptic focus was noted in the right frontotemporal region. Thus, we decided to perform a polysomnography (PSG) study, during which we successfully recorded another four seizures quite similar to the previous ones. The hypnogram was interrupted, and sleep continuity was lost and sleep stages were altered. Neither sleep apnea nor periodic limb movement syndrome was found to be the trigger for awakening. The reason for the wake periods is not clear. Several short periods of somniloquy were recorded. Daytime sleepiness and tiredness were the main problems of the patient. There were no specific findings on brain MRI scans. It is also important that a family member, the patient’s wife, participated in the night seizures as a caregiver. Although she did not undergo PSG, we thoroughly understand the reasons for her sleep interruptions and can explain her daytime tiredness. Both the patient and his wife completed the Quality of Life, Quality of Sleep, and PRIME-MD PHQ-9 questionnaires. Results: The patient was diagnosed with recent nighttime frontal epileptic seizures after a long seizure-free period. Add-on therapy was recommended. The decrease in the number of nighttime seizures was followed by improvements in the quality of life and sleep of both the patient and his wife. The patient’s depression is also improving. No medication was needed. We plan to perform a prospective study of the families of patients with nighttime seizures. Conclusions: The origin of nighttime seizures is not always clear at first. Video/EEG and video/PSG can be successfully combined, and the results help not only the patient but family members as well. Medication and family background help to stabilize the patient’s condition. doi:10.1016/j.yebeh.2010.01.100
Topic 4. Cultural and spiritual aspects 76. Homicidal behavior and patients with epilepsy admitted at Ibin-Al-Haitham High Secure Unit, Al-Rashad Teaching Mental Hospital, Baghdad Naamah Sh. Humaidi, Jameel K. Muslim, Al-Rashad Teaching Mental Hospital, Baghdad, Iraq
Objectives: It is generally thought that epilepsy does not predispose subjects to homicidal behavior. However, many previous studies have suffered from notable methodological weaknesses. In particular, obtaining comprehensive study groups of violent offenders has been difficult. Iraqi police have been able to solve an increasing percentage of homicides during the last few years with the gradual rebuilding of the infrastructure of the police and judicial systems; these bodies totally collapsed after the fall of previous regime. Because most homicidal offenders were subjected to intensive forensic psychiatric examination, we were able to obtain data for 118 homicidal offenders admitted to the Ibin-Al-Hiathim Secure Unit at AL-Rashad Teaching Hospital, Baghdad during the period July 2003 to July 2008. The goals of this study were to (1) determine the percentage of 118 homicides committed by people with epilepsy; (2) study the sociodemographic characteristics of people with epilepsy accused of homicide; and (3) determine the characteristics of the victims of people with epilepsy admitted to the Secure Unit. Methods: In this retrospective study, files were thoroughly examined to determine who had epilepsy and their characteristics, all according to DSM-IV criteria.
601
Conclusions: Forty-four percent of the subjects had abnormal EEGs. Six percent of the subjects had epilepsy. Fifty-seven percent of those with epilepsy were in the age range 20–40. There were more males than females, probably because males are more liable to break the law. Most of the offenders were urban dwellers, probably because there is greater access to psychiatric institutions and services in urban environments. The victims were mostly first-degree relatives of the offenders. doi:10.1016/j.yebeh.2010.01.101
77. The transcultural concept of epilepsy in traditional beliefs M. Darghal, Medical Center Diour Jemaa, Rabat, Morocco(P)
The prevalence of epilepsy is 1.1%. But despite the high number of patients, epilepsy is still unknown and care is lacking. The truth about this disease has too long remained mysterious. Traditional beliefs reinforce the public on the idea that epilepsy is a disease caused by evil spirits. In addition, the Moroccan words used to describe this evil are revealing: jnoun, maskoun, krina, msalmin, ladam, riah. Unfortunately these beliefs are behind the delay in diagnosing the disease and hence the greater debilitation and poor social integration of the patient. This is very expensive. The stigmas associated with epilepsy are very numerous. Sometimes patients suffer much more than their disease. Sometimes it is claimed that epilepsy is contagious, that patients with epilepsy are abnormal, dangerous, mentally retarded, or even doors misfortune. All these ideas are false and exacerbate the isolation of patients with epilepsy. Epilepsy affects people of all ages but especially children and adolescents, and because of the weight of prejudice and delay in diagnosis, these patients remain out of the cycle of school, vocational training, and social life (marriage. . .) and are completely marginalized. The scientific advances in recent years have made it possible to improve the plight of persons with epilepsy. The anxiety generated by the onset of the crisis can lead to emotionally dependent relationships with parents and inhibit the acquisition of emotional or intellectual autonomy of a child or young person. These difficulties in autonomy may themselves be a source of pain or symptoms (emotional immaturity, self disorders, disturbances, aggressiveness) The loss of selfcontrol during the crisis and dependence on others cause an injury that, in turn, affects self-confidence. Thus, the real trauma of the disease in addition to the psychological trauma deserves to be considered. doi:10.1016/j.yebeh.2010.01.102
78. The work of a free epilepsy clinic in the community Ayesha Maqbool, Khalid Mufti, Haroon R. Chaudhry
FLAME (First Liberated Action Movement Against Epilepsy) has run an epilepsy clinic for the last 25 years at Ahabab Hospital, Ravi Road, Lahore. This unit deals with a wide range of issues faced by people with epilepsy, for instance, in education, employment, transport, childcare and psychosocial factors affecting the family with a member or members suffering from epilepsy. Each week 300 patients receive pharmacological and psychological treatment by attending this facility. As an important component of FLAME’S objectives the community education program rapidly creates an awareness of epilepsy, its consequences and treatment among the people. The information