Summary:Purpose: To study the stigma of epilepsy in a European sample.Methods: Clinical and demographic details and information about patient-perceived stigma was collected by using selfcompleted questionnaires mailed to members of epilepsy support groups.

Summary:Purpose: Epilepsy is a common neurological condition, with significant resource implications for the health services, but few studies to date have examined the uptake and costs of care for this condition. As part of a large prevalence study of epilepsy conducted in one U.K. Health Region, we investigated both direct and indirect costs of epilepsy care and measured and valued the direct costs.Methods: Data about service use were obtained from primary physician records and patient questionnaires. Unit costs for each item of resource use were generated from several sources.Results: The greatest direct health care cost is that of hospital-based care. Pharmaceutical services also represent a significant element of the cost of epilepsy, the financial costs of prescribing newly developed antiepileptic drugs (AEDs) being large relative to those of the older drugs; therefore, the benefits derived from their use must be carefully assessed. The importance of good seizure control is amply illustrated by the findings about the differential costs associated with epilepsy of varying severity. The direct costs of caring for people with poorly controlled epilepsy are significant, with more than half the total cost of epilepsy care accounted for by patients with frequent seizures even though this group represented only a quarter of all patients in the present study.Conclusions: Our data emphasize the importance of optimizing seizure control as a means of reducing the costs of epilepsy, not only to the person with the condition, but also to society.

The impact of epilepsy on the quality of life of older people with epilepsy has rarely been investigated. As part of a large prevalence study of epilepsy conducted in one UK Health Region, we investigated the burden of their condition in older compared with younger people. A second analysis compared quality of life in those men and women diagnosed after the age of retirement from the workforce compared with those diagnosed before that age. Data were collected from men and women with epilepsy and from their primary and secondary care physicians. There were few differences between older and younger people with regard to their reported quality of life, though younger people were more likely to report feeling stigmatized by their condition. Older people with epilepsy diagnosed in later life were more anxious and depressed than those diagnosed earlier and their overall perception of quality of life was more likely to be negative. Our data emphasize that older people do not necessarily experience poorer quality of life than younger people, but those first diagnosed in later life do appear to have a quality of life which is more impaired. Consideration should be paid to the important psychosocial consequences of epilepsy in the older person.

Future increases in the population aged 65 years or over lead to rising formal care costs. However, the magnitude of cost changes depends on assumptions over dementia prevalence and levels of mental and physical functioning.

The financial, opportunity and social costs and benefits of providing informal support to frail older people are described within an economic framework. Mentally and/or physically frail older people were identified through screening interviews with random community samples of people aged 65 and over in four UK areas: 884 frail older people living in private households nominated key informal supporters and 650 of these supporters were interviewed. Around half the supporters reported financial costs (43 per cent) or lost social opportunities (45 per cent). A minority of supporters had reduced their working hours or withdrawn from employment because of caregiving. Nearly all supporters reported at least one social cost (92 per cent) and identified at least one positive aspect of caregiving (95 per cent). Co-resident supporters were more likely to report opportunity costs and loss of health and well-being. Daughters supporting a frail parent were generally most likely, and friends or neighbours least likely, to report each type of cost. Supporters of older people who were both mentally and physically frail reported significantly greater opportunity and social costs. The benefits of caregiving were not consistently related to co-residency, relationship of supporter or frailty type. Possible strategies for decreasing the costs and increasing the benefits of caregiving are discussed.