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Fulltext Epilepsy stigma in Asia: the meaning and impact of stigma

Lim, Kheng-Seang, Tan, Chong-Tin

Neurology Asia, 2014;19(1):1-10.
MyJurnal

Stigma is conceptually broad and culturally variable. Understanding stigma from the conceptual theories, culturally application based on the word stigma in other languages, the definition of stigma and its synonyms, as well as the medical implications in other stigmatized disease such as AIDS, will help us to understand the complexity of stigma in epilepsy. This review investigated the meaning and types of stigma from different perspectives, leading to staging stigma into 5 levels, i.e. social identity, stereotype, prejudice, discrimination and social disability. In addition to the conventional categorization of stigma into social, felt, self-perceived or internalized stigma, new categories of stigma i.e. personal and general attitudes towards epilepsy based on a newly developed Public Attitudes Toward Epilepsy (PATE) scale was introduced. Courtesy stigma was further elaborated in related to Asian culture. Based on well-established and recently developed theories, the causation and impact of epilepsy stigma was discussed in an Asian context, especially from the aspects of language and society values which are culturally specific. Integrating these theories of causation, illness and stereotype perceptions were proposed to be the mediating mechanism of stigma, which led to the development of a practical and multi-dimensional stigmatization model, aiming to guide, widen and deepen the scope of future stigma research in epilepsy. Using the established model, together with review of related studies, research priorities in epilepsy stigma research especially in Asia focusing on five aspects, i.e. expanding population studies especially on significant others, understanding stigma from personal attitude perspective, investigating the cultural and social causation of stigma, and the impacts of stigma on patients as well as the family members, were proposed.
Fulltext Malaysian society of neurosciences (MSN) –Asian and Oceanian myology centre (AOMC) annual scientific meeting 2018

Lim, Kheng-Seang, Goh, Khean-Jin, Tan, Ai-Huey, Low, Soon-Chai, Mustapha Muzaimi

Neuroscience Research Notes, 2018;1(2):6-11.
MyJurnal

The conjoint 17thAsian and Oceanian Myology Centre (AOMC) and 28thMalaysian Society of Neurosciences (MSN) Annual Scientific Meeting, held in Hotel Istana, Kuala Lumpur, Malaysia from 27 to 29 July 2018, was a great success to gather all neurosciences professionals locally and in the Asian-Oceanian region to share the latest updates in Neurology and specifically Myology. This congress attracted 516 local participants and 167 international delegates from 14 countries
Fulltext Epilepsy and comorbidities: towards unravelling the common underlying mechanisms

Paudel, Yam Nath, Lisgaras, Christos Panagiotis, Lim, Kheng Seang, Shaikh, Mohd. Farooq

Neuroscience Research Notes, 2018;1(3):1-4.
MyJurnal

Epilepsy is a chronic neurological disorder characterized by the rapid occurrence of epileptic seizures affecting approximately 70 million people worldwide[1,2]. The quality of life of people with epilepsy (PWE) is challenged by a series of comorbidities that might include neurologic and neuropsychiatric disorders (cognitive decline, depression, anxiety, schizophrenia, and autism) as well as metabolic, cardiovascular and respiratory diseases[3]. Neurobehavioral and other comorbidities might share a reciprocal and complex relationship with epileptogenesis and ictogenesis thus biomarkers of the former might be useful for the prediction of the latter and vice versa[4].
Fulltext Spontaneous remission without progression to limbic encephalitis in a patient with LGi1 seropositive faciobrachial dystonic seizure

Sherrini Bazir Ahmad, Suhailah Abdullah, Chong, Tin Tan, Lim, Kheng Seang, Goh, Khean Jin

Neurology Asia, 2016;21(2):191-193.
MyJurnal

Faciobrachial dystonic seizures are pathognomonic of leucine-rich glioma inactivated-1 (LGi1) antibody, non-paraneoplastic limbic encephalitis. Faciobrachial dystonic seizures usually precede limbic encephalitis by about a month. It is unknown whether, if untreated, faciobrachial dystonic seizures inevitably progress to limbic encephalitis. We present an LGi1 seropositive patient with a year’s history of faciobrachial dystonic seizures, who achieved remission spontaneously without immunotherapy or antiepileptic drug treatment, and did not develop evidence of limbic encephalitis over a three-year follow-up.
Fulltext Efficacy of repetitive transcranial magnetic stimulation on refractory epilepsy in Malaysia

Sherrini Bazir Ahmad, Lim, Kheng Seang, Goh, Hui Ting, Wo, Chen Mun, Low, Siew Yong, Tan, Chong Tin

Neurology Asia, 2016;21(3):225-233.
MyJurnal

Background & Objective: Modulation of cortical excitability by low frequency repetitive transcranial
magnetic stimulation (rTMS) has demonstrated therapeutic use in epilepsy. This study aimed to evaluate
the efficacy of low-frequency rTMS on refractory epilepsy in a group of Malaysian subjects. Methods:
Nine patients with refractory epilepsy completed the study. All patients received 10 sessions of 1Hz
rTMS (1000 pulses per session) at 90% of resting motor threshold. Outcome measures included seizure
frequency, Symptom Checklist-90 (SCL-90), Beck Depression Inventory II (BDI II) and Quality of
Life in Epilepsy-31 (QOLIE-31). Responders were defined as having ≥ 50% seizure reduction. Results:
The mean age was 33.8 years (SD 11.7), with 4 male. Three patients had mesial temporal sclerosis
(MTS); 4 with focal cortical dysplasia (FCD) and two lesion-negative. Three patients achieved >50%
seizure reduction at 8 weeks post-treatment, with 2 of them had improvement in the number of IED.
All of the responders had FCD. The responders were younger (mean 24.7 vs. 38.3 years old), had
shorter duration of illness (mean 15.7 vs. 30.5 years) and had less frequent seizure frequency prior to
treatment (mean 5.5 vs. 10.8 attacks per week), as compared to the non-responders. Six patients had
improvement in BDI-II scores, two in QOLIE-31 and four in SCL-90 post treatment, irrespective of
seizure control. The mean scores in BDI-II improved significantly with treatment (p
Fulltext Association between HLA-B* 15:02 and carbamazepine induced severe cutaneous adverse drug reactions in Myanmar

Amy Hui-Ping Khor, Lim, Kheng-Seang, Tan, Chong-Tin, Seinn Mya Mya Aye, Yan Lynn Aung, Yin Minn Aye, et al.

Neurology Asia, 2017;22(3):283-285.
MyJurnal

Genetic predisposition to carbamazepine (CBZ)-induced Stevens-Johnson syndrome (SJS) and toxic
epidermal necrolysis (TEN) had been reported in several Southeast Asian populations, but not in
Myanmar. Previous studies had so far reported more than 70% of CBZ-induced SJS/TEN cases
positive for HLA-B*15:02 allele.1-4 Myanmar, as the second largest country in Southeast Asia with a
population of 54.5 million, has high HLA-B*15:02 carrier frequency in its general population (27.3-
49.1%).5,6 We investigated the association of HLA-B alleles and CBZ-induced SJS/TEN in Myanmar
population. HLA-B*15:02 was detected in 3/3 (100%) of cases and 6/53 (11.3%) of tolerant controls,
and HLA-B*15:02 is significantly associated with CBZ-SJS/TEN in Myanmar population (OR 51.2,
95% CI 2.36-1106.95, p=0.003). (Copied from article)
Fulltext Level 4 comprehensive epilepsy program in Malaysia, a resource-limited country

Lim, Kheng-Seang, Sherrini Ahmad Bazir Ahmad, Vairavan Narayanan, Kartini Rahmat, Norlisah Mohd Ramli, Mun, Kein-Seong, et al.

Neurology Asia, 2017;22(4):299-305.
MyJurnal

Background and Objective: There is a great challenge to establish a level 4 epilepsy care offering
complete evaluation for epilepsy surgery including invasive monitoring in a resource-limited country.
This study aimed to report the setup of a level 4 comprehensive epilepsy program in Malaysia and the
outcome of epilepsy surgery over the past 4 years.

Methods: This is a retrospective study analyzing
cases with intractable epilepsy in a comprehensive epilepsy program in University Malaya Medical
Center (UMMC), Kuala Lumpur, from January 2012 to August 2016.

Results: A total of 92 cases
had comprehensive epilepsy evaluation from January 2012 till August 2016. The mean age was 35.57
years old (range 15-59) and 54 (58.7%) were male. There were 17 cases having epilepsy surgery
after stage-1 evaluation. Eleven cases had mesial temporal sclerosis and 81% achieved Engel class
I surgical outcome. Six cases had lesionectomy and 60% had Engel class I outcome. A total of 16
surgeries were performed after stage-2 evaluation, including invasive EEG monitoring in 9 cases.
Among those with surgery performed more than 12 months from the time of data collection, 5/10
(50%) achieved Engel I outcome, whereas 2 (20%) had worthwhile improvement (Engel class III)
with 75% and 90% seizure reduction.

Conclusion: Level 4 epilepsy care has an important role and is possible with joint multidisciplinary
effort in a middle-income country like Malaysia despite resource limitation.
Fulltext HLA-B*1502 and carbamazepine induced Stevens-Johnson syndrome/toxic epidermal necrolysis in Indonesia

Herlyani Khosama, Astri Budikayanti, Amy Hui Ping Khor, Lim, Kheng Seang, Ng, Ching-Ching, Indra G. Mansyur, et al.

Neurology Asia, 2017;22(2):113-116.
MyJurnal

Background & Objective: Association between HLA-B*1502 and carbamazepine-induced StevenJohnson
syndrome/toxic epidermal necrolysis (CBZ-SJS/TEN) was reported in many Southeast Asian
populations but not in Indonesian. The purpose of this study was to evaluate the association between
HLA-B*1502 andCBZ-SJS/TEN in an Indonesian population.

Methods: Patients with history of
CBZ-SJS/TEN are recruited as cases and those who tolerated CBZ as controls. HLA-B typing was
performed.

Results: We recruited 14 cases with CBZ-SJS/TEN and 53 controls. Positive HLA-B*1502
was found in 8 (57.1%) cases and 14 (26.4%) controls (OR 3.7, 95% CI 1.09-12.61, p=0.035).

Conclusion: HLA-B*1502 is associated with CBZ-SJS/TEN patients in Indonesian.
Fulltext Validity and reliability of the Chinese parent proxy and child self-report health related quality of life measure for children with epilepsy (CHEQOL-25) in Malaysia

Wo, Su Woan, Lai, Pauline Siew Mei, Ong, Lai Choo, Low, Wah Yun, Lim, Kheng Seang, Tay, Chee Geap, et al.

Neurology Asia, 2016;21(3):235-245.
MyJurnal

Objective: To determine the validity and reliability of the Chinese parent proxy and child self-report
health related quality of life measure for children with epilepsy (CHEQOL-25) in Malaysia. Methods:
Face and content validity of the Chinese parent proxy and child self-report CHEQOL-25 was verified
by an expert panel, and piloted in five children with epilepsy (CWE). The Chinese CHEQOL-25 was
then administered to 40 parent proxies and their CWE (aged 8-18 years), from two tertiary hospitals,
at baseline and 2 weeks later. Results: Forty parents and their CWE were recruited. Cronbach’s alpha
for each subscale ranged from 0.56-0.83. At test-retest, the interclass correlation for all items ranged
from 0.68-0.97. Items 8 and 25 were removed as their corrected item-total correlation values were
Fulltext Bilateral thalamic internal medullary lamina involvement in a case of dengue encephalitis

Sherrini Bazir Ahmad, Chin, Sum Cheong, Lim, Shen-Yang, Kartini Rahmat, FaizatulIzza Rozalli, Sekaran, Shamala Devi, et al.

Neurology Asia, 2016;21(4):374-379.
MyJurnal

There are 50-100 million dengue infections each year, but dengue encephalitis is relatively
uncommon. The aetiology of neuronal injury is proposed to be due to direct viral neurotropism or
host immune response-mediated inflammation causing neuronal damage. We report a case of severe
dengue encephalitis, presenting during the acute viraemic phase of the disease. This was associated
with inflammation and haemorrhage of the internal medullary lamina of both thalami which, to our
knowledge, has not yet been reported in other infections of the central nervous system.
Periodic lateralized epileptiform discharges in neuropsychiatric lupus: association with cerebritis in magnetic resonance imaging and resolution after intravenous immunoglobulin

Lim KS, Cheong KL, Tan CT

Lupus, 2010 May;19(6):748-52.
PMID: 20133346 DOI: 10.1177/0961203309351539

A 13-year-old girl with a known diagnosis of systemic lupus erythematosus presented with seizures and psychosis. An electroencephalogram (EEG) revealed continuous, non-evolving periodic lateralized epileptiform discharges (PLEDs) in the left temporal region, which did not resolve with benzodiazepine. A magnetic resonance imaging (MRI) brain scan demonstrated a focal hyperintensity in the left medial temporal and left occipital lobes, left thalamus and bilateral cerebellar white matter, with evidence of vasculitis in the magnetic resonance angiography. Intravenous immunoglobulin was given because of failed steroid therapy, which resulted in a full resolution of clinical, EEG and MRI abnormalities. Lupus cerebritis should be considered as a possible aetiology in PLEDs, and immunoglobulin can be effective in neuropsychiatric lupus.
Focal epilepsy recruiting a generalised network of juvenile myoclonic epilepsy: a case report

Khaing M, Lim KS, Tan CT

Epileptic Disord, 2014 Sep;16(3):370-4.
PMID: 25166001 DOI: 10.1684/epd.2014.0672

We report a patient with juvenile myoclonic epilepsy who subsequently developed temporal lobe epilepsy, which gradually became clinically dominant. Video telemetry revealed both myoclonic seizures and temporal lobe seizures. The temporal lobe seizures were accompanied by a focal recruiting rhythm with rapid generalisation on EEG, in which the ictal EEG pattern during the secondary generalised phase was morphologically similar to the ictal pattern during myoclonic seizures. The secondary generalised seizures of the focal epilepsy responded to sodium valproate, similar to the myoclonic epilepsy. In this rare case of coexistent Juvenile Myoclonic Epilepsy and Temporal lobe epilepsy, the possibility of focal epilepsy recruiting a generalised epileptic network was proposed and discussed.
Positive psychological interventions for people with epilepsy: An assessment on factors related to intervention participation

Lai ST, Lim KS, Tang V, Low WY

Epilepsy Behav, 2018 03;80:90-97.
PMID: 29414564 DOI: 10.1016/j.yebeh.2017.12.019

BACKGROUND: Positive psychological interventions (PPI) are increasingly employed as a coping strategy with physical and mental conditions, including neurological diseases. Its effectiveness on improving wellbeing in people with epilepsy (PWE) has been shown in a few studies. This study aimed to explore factors related to participants' willingness to engage in psychological interventions from the perspective of patients with epilepsy.
METHODS: Participants answered a needs assessment questionnaire eliciting information about their illness perception (Brief Illness Perception Questionnaire (Brief-IPQ)), emotions (Hospital Anxiety and Depression Scale (HADS)), willingness to participate in psychological interventions, preferences in types of PPI and intervention designs, as well as barriers in seeking mental health services.
RESULTS: A total of 154 patients with epilepsy participated, with a mean age of 37.3years (range 16-86years). Most patients had focal epilepsy (68.2%), and drug-resistant (59.1%). Majority (71.4%) of them indicated a strong willingness to participate in PPI. Out of nine types of PPI, character strengths, mindfulness-based and expressive-based interventions were highly preferred. Those with negative illness perception (p=0.001), anxiety (p=0.004), and being unemployed (p=0.048) were more willing to participate in PPI. Most participants preferred group rather than individual session, and a shorter duration (30min) was favored by most.
CONCLUSION: This study captured the self-report willingness to participate in psychological interventions. Findings suggested that psychological interventions delivered in short-group session were highly preferred. Future study is required to determine the feasibility of such design for patients with epilepsy.
Positive psychological interventions for neurological disorders: A systematic review

Lai ST, Lim KS, Low WY, Tang V

Clin Neuropsychol, 2019 04;33(3):490-518.
PMID: 29938575 DOI: 10.1080/13854046.2018.1489562

OBJECTIVES: Psychological well-being in people with neurological diseases can be compromised due to brain damage or psychological reactions towards chronic disabilities. This systematic review evaluated the efficacy of positive psychological intervention (PPI) in neurological populations.
METHODS: Previous studies relevant to this topic were identified by searches in PUBMED, EMBASE, MEDLINE, and PSYCINFO databases from Jan 1980 to August 2017.
RESULTS: Of 1361 articles identified, 31 studies were included. Nineteen studies were randomized controlled trials. Sixteen studies had sample sizes of less than 30. Twelve studies were rated as high quality using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools. Six therapies were found: mindfulness-based approaches, positive savoring, life summary, expressive-based, hope-based interventions, and character strengths. These interventions were shown to improve quality of life, reduce symptomatic distress, and depressive symptoms.
CONCLUSION: PPIs promote well-being among patients with neurological deficits. For PPIs to be considered as an evidence-based practice, more trials with adequate statistical power are required.
Validity and reliability of the Turkish version of Public Attitudes Toward Epilepsy scale

Aktürk T, Tanık N, Saçmacı H, Chia ZJ, Lim KS

Epilepsy Behav, 2020 10;111:107245.
PMID: 32693372 DOI: 10.1016/j.yebeh.2020.107245

OBJECTIVE: This study was conducted to test the validity and reliability of the Turkish version of the Public Attitudes Toward Epilepsy (PATE) scale, which aims to understand public perceptions of seizures and epilepsy.
METHODS: The scale was translated following the standard procedures. For psychometric validation, the Turkish version of the PATE scale was administered to 201 native Turkish speakers above the age of 18 who had no history of seizures or epilepsy. It was found that the respondents were able to fill out the scale quickly and without difficulty in understanding the translated items on the scale.
RESULTS: Cronbach's alpha coefficient was found to be 0.843 for the overall scale and above 0.7 for each individual item. Cronbach's alpha was 0.78 for the general domain and 0.792 for the personal domain. Exploratory and confirmatory factor analyses were carried out and showed that the scale had a structure similar to that of the original scale, with the 14 items grouped under two dimensions, similar to the original scale.
CONCLUSION: The Turkish version of the PATE scale was a valid and reliable tool to measure the attitudes toward epilepsy in Turkish society.
Fulltext Genotypic and phenotypic variation of CADASIL among Chinese, Indians and Rungus in Malaysia

Toh, Tsun-Haw, Lim, Kheng-Seang, Ng, Ching-Ching, Imran Idris, Sherrini Bazir Ahmad, Lim, Thien-Thien, et al.

Neuroscience Research Notes, 2019;2(3):1-11.
MyJurnal

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary disease of small cerebral arteries. This case series aims to describe the mutations in NOTCH3and their phenotypes in Malaysia. We includedpatients who were genetically confirmed to have CADASIL, diagnosed at the University of Malaya Medical Centre, Malaysia. Family members who fulfilled clinical or imaging criteria, and patients from two previous published Malaysian families were also included. Six families (eleven cases) were included in this series. Genetic testing revealed NOTCH3 mutations in c.328C>T (p.Arg110Cys, R110C), c.553T>G (p.Cys185Gly, C185G), c.1630C>T (p.Arg544Cys, R544C) and c.160C>T (p.Arg54Cys, R54C). Two out of four Chinese families had R544C mutation in exon 11, with a later age of onset, absence of migraine and lack of anterior temporal pole involvement on MRI. One family with mixed Indian and Chinese ancestry had a mutation in exon 3 with R110C and another Indian family exon 4 with C185G mutation. This case series highlights the genotypic and phenotypic variability of CADASIL in a multi-ethniccountry. The finding of p.Arg544Cys mutation among the older Chinese families, similar to those reported in Jeju Island and Taiwan, suggest the need to screen the older Chinese stroke patients with typical MRI changes.
Fulltext Efficacy and safety of retigabine/ezogabine as adjunctive therapy in adult Asian patients with drug-resistant partial-onset seizures: A randomized, placebo-controlled Phase III study

Lim KS, Lotay N, White R, Kwan P

Epilepsy Behav, 2016 Jul 1;61:224-230.
PMID: 27376872 DOI: 10.1016/j.yebeh.2016.05.018

The purpose of this study was to evaluate the efficacy and safety of adjunctive retigabine/ezogabine (RTG/EZG) therapy in Asian adults with partial-onset seizures.
Factors affecting the employability in people with epilepsy

Wo MC, Lim KS, Choo WY, Tan CT

Epilepsy Res, 2016 Dec;128:6-11.
PMID: 27792885 DOI: 10.1016/j.eplepsyres.2016.10.003

PURPOSE: People with epilepsy (PWE) are negatively prejudiced in their ability to work. This study aimed to examine demographic, clinical and psychological factors associated with employability in PWE.

METHODS: This study recruited epilepsy patients from a neurology clinic in Malaysia. Employability was measured using employment ratio, with a ratio ≥90% (ER90) classified as high employability. Basic demographic data such as age, gender, marital status, religion, education level and household income was collected. Clinical measures consisted of age of seizure onset, seizure frequency, type of epilepsy, aura, polytherapy, nocturnal seizures and seizure control. Psychological measures included Work Self-Determination Index (WSDI), Rosenberg Self-Esteem Scale (SES), and Multidimensional Scale of Perceived Social Support (MSPSS).

RESULTS: Of 146 PWE, 64.4% had high employability. The participants were predominantly female (52%), Chinese (50.7%), single (50%), having tertiary education (55.5%) and focal epilepsy (72.6%). Clinically, only type of epilepsy was significantly correlated to employability of PWE. Employability of PWE was associated with ability to work (indicated by education level, work performance affected by seizures, ability to travel independently and ability to cope with stress at work) and family overprotection. The high employability group was found to have lower self-perceived stigma (ESS), higher self-determined motivation (WSDI), self-esteem (SES) and perceived social support (MSPSS), than the low employability group. Logistic regression analysis showed that tertiary education level (AOR 3.42, CI: 1.46-8.00), higher self-determination (WSDI, AOR 1.09, CI: 1.012-1.17), lower family overprotection (AOR 0.76, CI: 0.61-0.95), and generalised epilepsy (AOR 4.17, CI: 1.37-12.70) were significant predictors for higher employability in PWE.

CONCLUSION: Ability to work (education level), clinical factor (type of epilepsy) and psychological factor (self-determined motivation and family overprotection) were important factors affecting employability in PWE.

Study site: neurology clinic Universiti Malaya Medical Centre (UMMC)
Mindfulness-based intervention to promote psychological wellbeing in people with epilepsy: A randomized controlled trial

Lai ST, Lim KS, Tang V, Low WY

Epilepsy Behav, 2021 05;118:107916.
PMID: 33743343 DOI: 10.1016/j.yebeh.2021.107916

BACKGROUND: We investigated the efficacy of mindfulness-based intervention (MBI) in promoting psychological wellbeing in people with epilepsy (PWE) using an assessor-blinded randomized controlled design.
METHODS: A total of 28 PWE were randomly assigned to either intervention (n = 14 cases) or control group (n = 14 controls). The intervention group received a six 2.5-hour weekly MBI, while the control group did not receive any intervention. They were assessed at three timepoints (T0: before intervention, T1: immediately after intervention, and T2: 6 weeks after intervention). Repeated measures of analyses of variance (RM-ANOVAs) were used for inter-group comparisons to determine intervention effect from baseline -to T1 and -to T2 for all outcome measures. The individual changes were calculated using the reliable change index (RCI). Key outcomes included depression (BDI-II), anxiety (BAI), epilepsy-related quality of life (QOLIE-31), satisfaction with life (SWLS), and level of mindfulness (MAAS).
RESULTS: Participants who participated in the MBI showed significant reduction in BDI-II (p = 0.001), significant increases in MAAS (p = 0.027) and QOLIE-31 (p = 0.001) at T1 when compared with the control group. However, BAI and SWLS were not significant. The trend was similar at 6-week follow-up, all outcome measures of MBI remained significant (p 
Fulltext Self-Management Apps for People With Epilepsy: Systematic Analysis

Alzamanan MZ, Lim KS, Akmar Ismail M, Abdul Ghani N

JMIR Mhealth Uhealth, 2021 May 28;9(5):e22489.
PMID: 34047709 DOI: 10.2196/22489

BACKGROUND: Patients with epilepsy (PWEs) are motivated to manage and cope with their disorder themselves (ie, self-management [SM] is encouraged). Mobile health (mHealth) apps have multiple features that have a huge potential to improve SM of individuals with chronic disorders such as epilepsy.
OBJECTIVE: This study aimed to review all freely available apps related to the SM of PWEs and to determine the SM domains covered in these apps.
METHODS: We performed a search of apps on Google Play and App Store using the keywords "epilepsy" or "seizures" from May to August 2018. Apps were included if they were free and in English language. We excluded apps with installation-related issues and not related to epilepsy self-management (eSM).
RESULTS: A total of 22 eSM apps were identified in our search: 6 of these run only on iOS, 7 only on Android, and 9 run on both operating systems. Of the 11 domains of SM, seizure tracking and seizure response features were covered by most apps (n=22 and n=19, respectively), followed by treatment management (n=17) and medication adherence (n=15). Three apps (Epilepsy Journal, Epilepsy Tool Kit, and EpiDiary) were installed more than 10,000 times, with features focused specifically on a few domains (treatment management, medication adherence, health care communication, and seizure tracking). Two apps (Young Epilepsy and E-Epilepsy Inclusion) covered more than 6 SM domains but both had lower installation rates (5000+ and 100+, respectively).
CONCLUSIONS: Both Android and iOS mHealth apps are available to improve SM in epilepsy, but the installation rate of most apps remains low. The SM features of these apps were different from one another, making it difficult to recommend a single app that completely fulfills the needs of PWEs. The common features of the apps evaluated included seizure tracking and seizure response. To improve the efficacy and availability of these apps, we propose the following: (1) involve the stakeholders, such as physicians, pharmacists, and PWEs, during the development of mHealth apps; (2) assess the efficacy and acceptance of the apps objectively by performing a usability analysis; and (3) promote the apps so that they benefit more PWEs.

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