الفهرس 
Overview about EpilepsyOnly 14 pages are availabe for public view
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Abstract
Epilepsy is a common neurological disorder in childhood stage and characterized by recurrent unprovoked seizures attack due to excessive and abnormal neuronal discharges. It causes a significant sociocultural and psychological burden to both epileptic children and their families compared with other chronic disorders which has complex implications regarding children’s intellectual, psychological, and social development (Ahmed, 2019).
In other words, epilepsy is characterized by its episodic, unpredictability, and chronic nature which have a negative impact on the children’s psychological, social, and school domains, and lastly can lead to psychological and social stressors and adjustment related problems. Actually, the comprehensive care should be directed to determine and manage the medical and psychosocial problems related to epilepsy for epileptic children and their caregivers (Rani and Thomas, 2019).
Various new researches have described stressors among caregivers of epileptic children. However, none of these researches has focused particularly on the experienced stressors among the epileptic children themselves. So, lack of researches concerning epileptic children’s stressors constitutes a major gap in the literature.
Aim of the study:-
The aim of the study was to assess the psychosocial stressors among epileptic children.
Research Question:-
What are the psychosocial stressors among epileptic children?
Subjects and methods:-
Research design:
A descriptive design was conducted in this study.
Research Setting:
The study was conducted at the neurological clinic of Children’s University Hospital at Ain Shams University.
Subjects:
A convenient sample of 100 epileptic children of both sexes was selected from the neurological clinic of Children’s University Hospital at Ain Shams University who fulfilled these criteria (age range from 8-13 years old, diagnosed with epilepsy within a period of 1 year and more, free from any other psychiatric or chronic medical disorders, able to communicate, and willing to participate and cooperate).
Tools of data collection:
An Arabic questionnaire was developed by the researcher after review of related literature and data were collected after the patient interview using the following tools:
1) Socio-demographic characteristics and medical history:
This tool was designed by the researcher and included:
A. Socio demographic characteristics of the epileptic child and his parents such as child’s age, child’s gender, child’s education, area of residence, father’s education ……etc.
B. Medical history of the epileptic child such as duration of disease, seizure frequency, common seizures attack’s place, ……..etc.
2) The psychosocial stressors inventory for epileptic child:
This tool was designed by the researcher as statements and interviewed the epileptic child to measure the frequency of the psychosocial stressors of the epileptic children. It was classified into two main parts:
A. The first part represents the psychological stressors and contains thirty-eight items; which includes the following subscales of psychological stressors related to: epileptic fits (twelve items), treatment and its side effects (eight items), precautions of illness (six items), school (seven items), and periodic follow-up (five items).
B. The second part represents social stressors and contains twenty-two items; which includes the following subscales of social stressors related to family (twelve items) and school (ten items).
Pilot study
The aim of pilot study was to:
Test the tools of the study and its applicability
Identify the time required to fill the sheet
Ensure the simplicity of the assessment sheet
Determine any unpredicted obstacles and difficulties
The pilot study was conducted on ten epileptic children. They represent 10% of total sample from above mentioned setting to ensure the clarity of questions, applicability of the tools and the time needed to complete them. The necessary modifications were done as a result of pilot study; those patients were excluded from the actual study sample.
Results:
The findings of the current study can be summarized as:
• As regards characteristics about children with epilepsy, it was found that more than two thirds of studied epileptic children were (69%) in primary school, more than half of them were (55%) males and (61%) in age from 11 years to 13 years old, and (37%) of them had two or more of siblings. Regarding child’s order of birth, it showed that one third of them (33%) reported being only child in their family, while half of them (50%) were first and last (25% equally for each one).
• Concerning characteristics about parents had children with epilepsy, it was estimated that more than half of their fathers (55%) had university education and the majority of them (93%) had work and (65%) lived in urban area, while nearly half of their mothers (47%) had pre-university education and more than three fifths of them (62%) had work.
• More than half of studied epileptic children had (59%) epilepsy one to three years ago, (57%) no seizure episode over the last month, and (52%) the common seizure attack’s place was at home.
• The majority of studied epileptic children were compliant with (74%) the prescribed medications, (68%) regular follow-up visits to the clinics, and (63%) the medical instructions.
• More than three fifths of studied epileptic children were experienced psychological stressors related to epileptic fits such as (65%) being upset from no one answered their questions about epilepsy, (62%) fear from death or occurring epileptic seizures during the sleep, and (61%) fear from having epilepsy forever or hurting themselves during convulsions, as well as more than half of them (56%) had fear from having a serious illness or occurring epileptic seizures in front of strangers.
• The majority of studied epileptic children were experienced psychological stressors related to the treatment and its side effects such as (74%) the fear from the injection, (68%) unknowing the time of medications cessation, (66%) slow speech and oblivion because of the treatment, (64%) family suffering as a result of the treatment cost, and (63%) feeling lazy and sleepy due to the medication.
• The majority of studied epileptic children were experienced psychological stressors related to the precautions of illness such as parents’ refusal about (68%) their watching the television for a long period and sharing in sports activities, (65%) walking alone in the street, and (63%) drinking tea/cola.
• The majority of studied epileptic children were experienced psychological stressors related to school such as (63%) forgetting the studied lessons, (60%) fear from epileptic seizures occurring in the school, frequent absenteeism from school due to (58%) feeling fatigue or (57%) hospital dates, and (57%) lower academic performance.
• The majority of studied epileptic children were experienced psychological stressors related to periodic follow-up such as (70%) several follow-up visits, (61%) hospitalization, and (59%) urgency of doctors and nurses.
• More than three fifths of studied epileptic children (63%) were experienced high psychological stressors, which nearly two thirds of them (64%) were experienced high psychological stressors related to precautions of illness, three fifths of them (60%) were experienced high psychological stressors related to the treatment and its side effects, and more than half of them (51%) were experienced high psychological stressors related to epileptic fits.
• The majority of studied epileptic children were experienced social stressors related to family such as (71%) afraid from knowing anyone about their disease of epilepsy, (70%) upset from their siblings concerning getting away from them because of their fear of getting hurt during epileptic episode, (67%) feeling weakness and dependence, (66%) their siblings’ sufferance because of their assistance and refusal getting out with them, (64%) hospital dates and feeling tired interfered with different social visits, (63%) their families’ sadness and overprotection that cause jealousy of their siblings, and (61%) feeling of difference from their siblings and friends because of having epilepsy.
• The majority of studied epileptic children were experienced social stressors related to school such as (70%) feeling of upset from non-appreciation of their teachers, (69%) their schoolmates’ believes about the epilepsy is an infectious disorder, inability of playing in the school because of (66%) refusal of their colleagues or (60%) fear of epileptic attack happening, (65%) lack of communication with their schoolmates because of getting away from them, (64%) jeering at their illness and the frequent absenteeism, and (63%) sitting alone.
• More than three quarter of studied epileptic children (78%) were experienced high social stressors, which more than two third of them (71%) were experienced high social stressors related to school.
• There were statistically significant relations between the psychological stressors related to epileptic fits among studied epileptic children and their age, educational level, number of siblings, area of residence, common seizures attack’s place, and periodic follow-up regularity with P-value (< 0.05).
• There were very statistical significant relations between the psychological stressors related to the treatment and its side effects among studied epileptic children and their age and number of siblings, area of residence, and common seizures attack’s place with P-value (≤ 0.01).
• There were statistically significant relations between the psychological stressors related to precautions of illness among studied epileptic children and their area of residence and duration of disease with P-value (< 0.05), and also their age and number of siblings, and common seizures attack’s place with P-value (< 0.01)
• There were statistically significant relations between the psychological stressors related to school among studied epileptic children and their age, educational level, and number of siblings, area of residence, and periodic follow-up regularity with P-value (< 0.05).
• Moreover, there were highly statistical significant relation between the psychological stressors related to school among studied epileptic children and their common seizures attack’s place with P-value (≤ 0.001).
• There were statistically significant relations between the psychological stressors related to periodic follow-up among studied epileptic children and their age, educational level, number of siblings, area of residence, and periodic follow-up regularity with P-value (≤ 0.05), as well as their common seizures attack’s place with P-value (= 0.001).
• There were statistically significant relations between the total psychological stressors among studied epileptic children and their common seizures attack’s place with P-value (< 0.05), in addition to their age, number of siblings, and area of residence with P-value (< 0.01).
• There were statistically significant relations between the social stressors related to family among studied epileptic children and their number of siblings, father’s education, and duration of disease with P-value (≤ 0.05).
• There were statistically significant relations between the social stressors related to school among studied epileptic children and their age, number of siblings, order of birth, and medications compliance with P-value (< 0.05), also their educational level with P-value (= 0.001). Meanwhile, there was no statistically significant relation between the social stressors related to school among studied epileptic children and their parents’ socio-demographic characteristics with P-value (> 0.05).
• There were statistically significant relations between the total social stressors among studied epileptic children and their father’s education and compliance with medications and medical instructions with P-value (< 0.05), and also their age with P-value (= 0.001).
Conclusion:
\In the light of this study results, it can be concluded that:
• The epileptic children have high psychosocial stressors in relation to their socio-demographic features and medical history such as their age, number of siblings, residence area, fathers’ education, common seizures attack’s place, and medications compliance, additionally the majority of these stressors are due to illness precautions, side effects of medications, epileptic fits, and the school.
• The most commonly psychological stressors among epileptic children are parents’ overprotection, cost and long duration of treatment, medications side effects, lack of information about epilepsy, and fear from the injection, death, chronicity of epilepsy, seizure-related injuries, and epileptic fits.
• The most commonly social stressors among epileptic children are communication barriers with their teachers and schoolmates related to their illness, frequent absenteeism, and aloneness.
Recommendations:
According to the findings, it is recommended that:
For Children:
• Provide pamphlets and flyers having the basic information for children about epilepsy in a simple and clear manner.
• Develop a routine screening of stressors for epileptic children by health professionals during their visits at outpatient clinics.
• Apply nursing intervention programs for epileptic children at outpatient clinics about effective coping strategies and management of their stressors.
• Conduct health educational programs for epileptic children about epilepsy to provide them the essential information and answer their questions about their illness.
• Establish regular support groups with epileptic children to talk about their fears and stressors related to epilepsy and how to manage it.
For Parents:
• Provide brochures and booklet involving the basic data for parents about epilepsy.
• Apply nursing intervention programs for parents of epileptic children at outpatient clinics about positive coping strategies and management of their children’s stressors.
• Provide counseling sessions for parents of epileptic children during their visits at outpatient clinics about effective coping strategies that contribute to reduce their children’s stressors.
• Apply workshops for parents about giving age-appropriate opportunities and duties to their epileptic children to enhance their psychosocial adjustment.
• Conduct regular support groups with parents of epileptic children to talk about stressors facing them and their children and its management.
• Apply regular and continuous health educational programs for parents about epilepsy, care of their children, their community resources, management of their children’s psychosocial stressors, and how to guard against overprotection of their children.
For Teachers:
• Arrange periodically workshops for teachers about social stressors sources facing epileptic children in the school and how to manage it to enhance children’s adjustment, academic performance, and psychosocial development.
For Future Researchers:
• It is recommended to apply a qualitative research about stressors in epileptic children and identify effectiveness of nursing intervention to manage it.
• There is a need to assess other variables that may contribute to epileptic children’s stressors.
• Further researches should be conducted to develop educational programs for epileptic children, their parents, and their teachers to improve their knowledge, awareness, and attitudes towards epilepsy.
• Further studies should be applied to determine the coping patterns of epileptic children towards their stressors and develop appropriate educational programs about learning positive coping strategies.