title: The socioeconomic, cultural, and emotional implications of starting or withholding treatment in a patient with a first seizure.
abstract: The decision to treat or not treat individuals who have suffered a single epileptic seizure is based on clinical factors, which are considered within the individual's social, cultural, and emotional environment. Even if optimally communicated, individuals and their carers will make different decisions about first seizures and their treatment, as they will judge the risks and benefits of treatment (or its deferment) in this wider context. There is a significant body of literature that describes the impact of established epilepsy on aspects of an individual's overall quality of life (QoL), and more recently evidence is emerging about the factors that may be important in 2 years after a single seizure on and off treatment. Little research, however, has considered the importance of nonclinical factors in individual's choices at the time of a first seizure, and in particular in an individual's decision to use or not use treatment. Understanding these issues may improve communication of risks and benefits to individuals, and may offer insight into the mechanisms by which social and socioeconomic disadvantage occur in epilepsy.
authors.affiliation: Institute of Neurology, University College London, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Dominic C
authors.initials: DC
authors.lastname: Heaney
authors.forename: Gail S
authors.initials: GS
authors.lastname: Bell
authors.forename: Josemir W
authors.initials: JW
authors.lastname: Sander
mesh_terms: D002755:Choice Behavior; D003469:Culture; D004644:Emotions; D004651:Employment; D004827:Epilepsy / Q000188:drug therapy* / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011788:Quality of Life; D018570:Risk Assessment; D055502:Secondary Prevention; D012931:Social Environment; D012959:Socioeconomic Factors