Abstracts

Treatments for and perceptions of epilepsy have been found to vary across cultures. The objective of this study was to compare social perceptions of epilepsy as well as attitudes and practices surrounding conventional and alternative treatments in a developed Western and a developing Eastern society.
Interviews were conducted with 25 Kashmiri and 25 American epileptic patients and their families. Patients were interviewed about perceptions of epilepsy they held or had encountered, alternative treatment they had considered or sought, and the ways in which the disease had affected their quality of life. Alternative and conventional healthcare providers were also interviewed.
The use of alternative therapies, particularly spiritual ones, in conjunction with conventional therapies was more prevalent in Kashmiri than in American society. Although Kashmiris utilized conventional medicine as a primary treatment, spiritual remedies were often concurrently sought, and herbal therapies were frequently used as adjunctive therapy. Psychiatrists, general practioners, and neurologists were primarily responsible for providing conventional treatment for Kashmiri epilepsy patients. American patients, however, tended to rely predominantly on conventional treatments by neurologists; reliance on alternative therapies was found to be comparatively minimal.
Although Kashmiri physicians prescribed a similar regimen of traditional antiepileptic drugs as their American counterparts, including phenytoin, valproic acid, carbamazepine, and phenobarbital, a wider range of drugs and treatments, such as the Vagus Nerve Stimulator and the Ketogenic Diet, were available and used by the latter. And although patients in both societies tended to defer to their physicians to determine the cause of their illness, Kashmiri patients were more likely to attribute it, at least in part, to spiritual causes.
Quality of life for Kashmiri patients was found to be poorer in many respects, including greater absence of educational and occupational opportunities, higher prevalence of feelings of stigmatization, and lesser tendency for openness with others about their illness. Additionally, psychosocial support, while limited in both societies, was less readily available in Kashmir.
The results of this study affirm the need for sensitivity and understanding of the cultural, social, and spiritual aspects of the commonly-held views and practices of patients. Such cross-cultural understanding can help to ensure optimal patient treatment and care within and across individual societies.