Dental Students’ Knowledge and Attitudes towards Patients with Epilepsy

Noura A. AL-Essa1                         BDS

INTRODUCTION

Epilepsy is a chronic disorder of the brain that affects people worldwide. It is characterized by recurrent seizures, which are brief episodes of involuntary movements that may involve a part of the body or the entire body, sometimes accompanied by loss of consciousness and controlof bowel or bladder function. This condition considered as one of the most common neurological disorders effecting humans, but full understanding of development of this disease is still incomplete1-4.

Worldwide, About 50 million people are lived with epilepsy1 which affects 4 -10 per 1000 people. Unfortunately, there is deficiency in epidemiologic data from Arab countries. In Saudi Arabia, the prevalence rate of epilepsy had been  reported to be 6.54 per 1000 persons5 . The prevalence of epilepsy is different if compared from country to country, but it found to be higher in rural areas and poor countries.6 Low- and middle-income countries showed between 7-14 per 1000 people had epilepsy1 .

In many parts of the world, people with epilepsy and their families suffer from stigma and discrimination. This stigma in many countries can impact on the quality of life for people with this disorder and their families.1 Less understanding of this condition and the cultural influences can affect people’s perceptions and attitudes toward this disease. Several studies had reported that educated individuals had better knowledge and less negative attitudes regarding epilepsy.7-10 University students especially health care students probably considered as an educated people in the society. Thus, it is important to have enough knowledge for the future health care professionals about epilepsy and to improve their attitude toward people with this disease.

Several studies were conducted about the knowledge and attitude toward epilepsy among different groups of society, but there are no published studies that were conducted among university dental students in related to epilepsy knowledge in Saudi Arabia. The aim of this study is to investigate the knowledge and attitudes toward epilepsy among university dental students at King Saud University in Riyadh, Saudi Arabia and to evaluate the degree to which university dental students were aware of the nature, causes, and some of the treatment options for common and important diseases such as epilepsy.

METHODS

The study was conducted at King Saud university dental college. Approval was obtained from the College of Dentistry Research Center at King Saud University.

Attending the clinics and treating patients are started from the third year studying at this college, so only third, fourth and fifth (final year) year students who were dealing with patients were included. Informed consents were obtained from all the students and only who were willing to participate were included in this survey. The total number of the students was three hundred sixty three representing the three levels, one hundred thirty two students in the third year, one hundred thirty two students in the fourth year and ninety nine students in the fifth year. A self-administered two-page questionnaire was in English language and consisted of questions on awareness, knowledge about the causes and treatment options, attitudes toward persons with epilepsy and the students’ information sources regarding this disease. Students were required to answer ‘‘Yes’’, ‘‘No’’ or ‘‘Don’t know’’.

The questions were utilized and modified from questionnaires used in other published surveys4,11,12. The dental students were given the questionnaires in the classrooms and asked to fill it out without discussing it with any colleague. Answering the questionnaire took between 5 to 10 minutes. No private information were requested as names or contact numbers.

A pilot questionnaire was conducted for twenty students to evaluate the ease of reading clarity of the wording and understanding of the questions as it was necessary to check the students’ perception and interpretation of the questions, few modifications were introduced accordingly. The students who participated in the pilot study were not included in the final sample.

All returned questionnaires were entered and analyzed using SPSS 20.0. Frequencies and percentages were obtained and the Chi-square test was applied to assess the associations between variables. The level of statistical significance was set at P<0.05.

RESULTS

A total of three hundred and three (303) students were answered the questionnaires with a response rate of 83.4%. 156 (51.5%) were males and 147 (48.5%) were females, from third (103), fourth (106) and fifth (94) dental students at King Saud university.

Majority of the students98.3 % had heard or read about epilepsy and 9.2% of the students had a history of epileptic seizures. In addition 32.7% of the participants knew people who are suffering from epilepsy with no significant difference in different academic level or gender P>0.05. It was found that 37.3% of the study group had seen people having epileptic seizures in front of them with significantly males more than females P=0.000 (Table 1).

Table (2) reflects the knowledge of the students regarding the causes of epilepsy. Majority of the students 72.6% believed that Accidents or head trauma can cause epilepsy followed by brain tumors 70.6% with significant difference in different academic level P= 0.000, while 55.1%, 53.8% of the students reported that it is caused by genetic and certain drugs respectively.

The most reported treatment option was the use of medications 84.5% with statistically significant different between the students’ level and gender (P=0.014, 0.023 respectively). Approximately two-third of the students thought that it can be treated by Holy Quran 64% (statistically significant between males and females P=0.015). About 46.9% of the students believed that the drug therapy is seldom effective in controlling seizures with significant difference in different academic level and gender P<0.05. In the other hand only 32.3% knew that antiepileptic drugs can produce babies malformations of epileptic mothers and 46.2% of the students were recognized about the fact of epilepsy drugs had advanced over the last 10 years (Table 3).

Most of the students 92.4%defined epilepsy as convulsion or a shaking while the others defined it as loss of consciousness 72.9%, episode of behavioral change 63.4% or period of memory disturbance 57.4% all of these definitions had significant difference between 3rd,4th and 5th year students (Table 4). The most reported source of students’ information was university teaching 88.8% followed by internet 66.7% and the least sources of information were books or magazines 33.7% and newspaper 17.8%, Figure 1. Table (5) shows the Students’ knowledge and perception of children and adult with epilepsy. From the total sample, 7.3%

thought that the children with epilepsy should be isolated from other children and these children should be restricted from participation in sports 17.8%,only 10.9% of the students thought that these children should not eat candies with significant difference P<0.05between the previous thoughts of the students and different academic level. 13.9% of the study sample reported that the children with epilepsy should attend schools for people with disabilities.

Few students believed that people with epilepsy should not get married 7.6% or having children 5.9%. Approximately half of the participants 42.9% agreed that people with epilepsy can drive with statically significant more males agreed on that than females P=0.000 (Table 5).

Students’ attitudes toward people with epilepsy are shown in Table (6). Of the study group 88.8% will allow their children to play with a child with epilepsy and 89.1% are willing to go to a public place with a person with epilepsy. Approximately half of the study group is willing to employ a person with epilepsy in a clerical job 56.8%. Only one-third of the students 33.7% agreed to marry a person with epilepsy it was noticed that more males had better attitude to marry person with epilepsy than females p=0.000.

DISCUSSION

As the importance of the dentists in the community and dealing with different kinds of patients who may have different kinds of diseases one of them could be epilepsy which considered as the most common chronic neurological disorder1 and it had a high prevalence in Saudi Arabia.5 Previously published study approved dissimilarities in providing dental care for different patients with epilepsy 13 this is could be attributed to less understanding of this condition, so knowledge, attitude and perception about this disease were investigated among dental students.

First and second year dental students are classified as preclinical years and had no contacts with patients, so they were not included in this survey. The college’s curriculum includes topics about pathophysiology of epilepsy and managements of medically compromised patients including epilepsy started from third year in this college based on that only 3rd, 4th and 5th dental students were included in this study.

The results of this study reflect a favorable awareness and knowledge about epilepsy among dental students. The university teaching was the main source for the students’ knowledge 88.8%. More than two-third of the students recognized that brain tumors, accidents or head trauma can cause epilepsy. It was reported that traumatic brain injuries considered as the most common cause of acquired epilepsy.14About half of the students knew that the inherited diseases and Stroke can lead to epilepsy. The most reported treatment option was the use of medications 84.5%. It was reported that 70% of epileptic patients were controlled by antiepileptic drugs.14Majority of the students 92.4% were able to define epilepsy as convulsion or a shaking as a sign of the disease. In the present study 32.7% of the participants knew people suffering from epilepsy which considered to be high if compared to what was reported in Malaysia (6.3%).15 also it was reported that in a study conducted for Saudi university students 60% knew people with epilepsy.16 The explanation for that is the high prevalence of epilepsy in Saudi Arabia 6.54 per 1000 persons.5 Majority of dental students had positive attitudes toward people with epilepsy only 7.3% of the students thought that the children with epilepsy should be isolated from other children and 13.9% of the study sample agreed on the children with epilepsy should attend schools for people with disability. 88.8% of the students will allow their children to play with a child with epilepsy which means they had better attitudes if compared to dental student of Jordan (61.4%)17 or dentist in Pakistan (76.7%)18In the present study few students believed that people with epilepsy should not get married 7.6% or having children 5.9% while 44.4%, 89.9% of Jordanian dental students and dentists from Pakistan respectively believed that people with epilepsy should not have children.17,18 A study from Korea reported that knowledge was the important factor affecting the attitude toward epilepsy.19 In the present study 98.3% had knew about epilepsy that will rise to better attitude toward the children with epilepsy. About half of the study group are willing to employ a person with epilepsy in a clerical job 56.8% this result reflects the low level of knowledge in Saudi Arabia. That percentage could be attributed to the concerns of dental students about safety for these people rather than the work itself. Only onethird of the students 33.7% agreed to marry a person with epilepsy, this attitude was comparable with what was observed in Saudi Arabia 24% 16, United Arab Emirates 32% 20 Greece 34% 21 and Kuwait 28.3%. 22 These findings reflect the believes of the people that epilepsy is an inherited disease, in the present study about half of the students reported epilepsy as inherited disease 51.2%. Although the results of the present survey provided information about dental students’ knowledge and attitudes in case of epilepsy; increasing the sample number by including students in private sectors and other governmental sectors could help to have valuable knowledge among Saudi dental students.

CONCLUSION

The findings of this study indicate a favorable awareness and knowledge about epilepsy among dental students. They had some negative attitude toward people with epilepsy. Based on that education about the disease needs to be improved through enhancing more information about the disease at school and university teaching, so people will understand more about epilepsy and will have better attitude toward people having this disease.

ACKNOWLEDGEMENT

The author would like to thank the students for their participation to complete the research process. The research was registered at the college of Dentistry Research Center (FR 0268), King Saud University, Riyadh, Saudi Arabia.

CONFLICT OF INTEREST

None declared.

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Department of Pediatric Dentistry and Orthodontics, Dental College, King Saud University, Riyadh 11362, KSA
Corresponding author: “Dr. Noura A. AL-Essa” < Dr.nnn@hotmail.com >