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Epilepsy Surveillance Among Adults --- 19 States, Behavioral Risk Factor Surveillance System, 2005

Rosemarie Kobau, MPH1
Hatice Zahran, MD, MPH2
David J. Thurman, MD, MPH1
Matthew M. Zack, MD, MPH1
Thomas R. Henry, MD3
Steven C. Schachter, MD4
Patricia H. Price, DO1
1
Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
2Agency for Toxic Substances and Disease Registry, CDC
3University of Minnesota, Minneapolis, Minnesota
4Beth Israel Deaconess Medical Center, Boston; Harvard Medical School, Boston, Massachusetts

Corresponding author: Rosemarie Kobau, MPH, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, 4770 Buford Hwy, N.E., MS K-51, Atlanta, GA 30347. Telephone: 770-488-6087; Fax: 770-488-5486; E-mail: rkobau@cdc.gov.

Abstract

Problem/Condition: Epilepsy is a brain disorder characterized by brief, recurrent disturbances in the normal electrical functions of the brain that result in seizures. Few population-based studies of epilepsy have been published for the United States, and the prevalence is expected to increase with the aging of the population. This is the first multistate study examining the prevalence of self-reported epilepsy and active epilepsy and includes an examination of socioedemographic and behavioral characteristics and of health-related quality of life among adults with epilepsy.

Reporting Period Covered: Data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS) are presented for 19 states.

Description of System: BRFSS is an ongoing, state-based, random-digit--dialed telephone survey of the noninstitutionalized U.S. population aged >18 years. BRFSS collects information on health risk behaviors and preventive health services related to leading causes of death and morbidity. In 2005, 19 states included questions on epilepsy or seizure disorder.

Results/Interpretation: During 2005, 1.65% of noninstitutionalized adults from 19 states reported that they had ever been told by a doctor that they had epilepsy or seizure disorder (i.e., a history of epilepsy); 0.84% reported having active epilepsy (i.e., a history of epilepsy and currently taking medication or reporting one or more seizures during the past 3 months), and 0.75% were classified as having inactive epilepsy (i.e., a history of epilepsy or seizure disorder but currently not taking medicine to control epilepsy and no seizures in the 3 months preceding the survey). No substantial differences among states in the prevalence of lifetime epilepsy, active epilepsy, or inactive epilepsy were detected. Prevalence estimates for active and inactive epilepsy revealed no significant differences by sex or race/ethnicity.

Adults with a history of epilepsy and with active epilepsy were more likely to report fair or poor health, be unemployed or unable to work, live in households with the lowest annual incomes, and have a history of co-occurring disorders (e.g., stroke or arthritis). Adults with a history of epilepsy and with active epilepsy also reported significantly worse health-related quality of life. Adults with a history of epilepsy were more likely to be obese, physically inactive, and current smokers. Among adults with active epilepsy with recent seizures, 16.1% reported not currently taking their epilepsy medication, and 65.1% reported having had more than one seizure in the past month. Among adults with a history of epilepsy, 23.7% reported cost as a barrier to seeking care from a doctor within the past year. A total of 34.9% of adults with active epilepsy with seizures reported not having seen a neurologist or an epilepsy specialist (i.e., a neurologist who specializes in treating epilepsy) in the previous year.

Public Health Action: Additional descriptive and analytic studies of epilepsy occurrence in diverse U.S. communities and populations are needed to better characterize epilepsy incidence rates, risk factors and etiologies, and types and severity, as well as epilepsy-associated conditions and disabilities. Community-based strategies that link health- care providers with social services such as public transportation, mental health services, and employment services might improve quality of life in persons with epilepsy. Implementing educational programs developed by CDC and the Epilepsy Foundation for schools, emergency responders, employers, providers, and the general public can increase awareness about epilepsy and reduce stigma associated with this disorder.

Introduction

Epilepsy is one of the most common neurological disorders worldwide, affecting 50 million persons (1), including an estimated 2.1 to 2.7 million persons in the United States (2,3). The condition is a brain disorder characterized by recurrent, transient disturbances in the electrical functions of the brain that result in seizures. Signs and symptoms of seizures include sudden and transitory phenomena such as alterations of consciousness, or involuntary motor, sensory, autonomic, or psychic effects (3--5). Many persons with epilepsy also experience certain signs and symptoms immediately after seizures, such as memory impairment, fatigue, depressive symptoms, or anxiety (i.e., the postictal state) (6). Seizures are broadly classified into generalized, partial, and unclassifiable types, with additional subcategories; persons can experience more than one seizure type (4,5).

Seizures and epilepsy result from many causes, including those that are preventable. Causes include traumatic brain injury, stroke, central nervous system (CNS) infections (e.g., meningitis and encephalitis), brain tumor, idiopathic causes presumed to be genetic, and others (5). Not all persons with seizures have epilepsy. Epilepsy is not diagnosed when seizures are provoked by acute and temporary conditions that affect brain function (e.g., fever, acute systemic metabolic disturbance, or alcohol withdrawal). Rather, a person receives a diagnosis of epilepsy only when seizures recur in the absence of such acute conditions and when any underlying pathological conditions, if identifiable, are chronic (4,5). Although persons of all ages can develop epilepsy, incidence rates are higher among young children and older adults because risk factors for epilepsy are more common in these age groups (2,3). Recurrent seizures often result in limitations in activities, depression, anxiety, and impaired quality of life and can increase risk for death (7--9). Misconceptions about epilepsy and its causes and consequences are prevalent, contributing to stigma associated with the condition and increasing challenges for persons living with this disorder (1,8--12).

Texas, Georgia, Tennessee, and South Carolina were among the first states to use the state-based BRFSS to assess state-level epilepsy prevalence using five standardized questions developed by the CDC Epilepsy Program (13--17). In 2003 and 2005, CDC, in partnership with the University of California, Los Angeles, used the California Health Interview Survey (CHIS) to assess epilepsy prevalence in California (16). Although case definitions differed among these state studies depending on the questions used, lifetime prevalence estimates ranged from 1.2% to 2.6%, and prevalence estimates for active epilepsy ranged from 0.7% to 1.6% (13--16).

With CDC financial and technical support, local foundation affiliates of the national Epilepsy Foundation worked with state departments of public health to incorporate at least one of five standardized epilepsy questions into the 2005 Behavioral Risk Factor Surveillance System (BRFSS). Nineteen states accepted one or more questions. This study is the first to examine the prevalence of self-reported epilepsy in these states and the prevalence of active epilepsy in some states. Sociodemographic and behavioral characteristics, health-related quality of life (HRQOL), and life satisfaction of persons by epilepsy status also were examined.

Methods

BRFSS is an ongoing, state-based, random-digit--dialed telephone survey of the civilian, noninstitutionalized population aged >18 years that tracks the prevalence of key health and safety-related behaviors and characteristics (18). The questionnaire consists of three parts: 1) core questions asked in all 50 states, the District of Columbia, and three territories; 2) supplemental modules (i.e., a series of questions on a specific topic such as arthritis, diabetes, or depression); and 3) state-added questions. Each state decides which supplemental modules and state-added questions to include in its BRFSS survey. BRFSS also includes standardized questions on sociodemographic and behavioral characteristics and self-reported chronic diseases. The complete BRFSS survey is available at http://www.cdc.gov/brfss (18). BRFSS data are weighted to reflect the age, sex, and racial/ethnic distribution of the state's estimated population during the survey year.

Twelve states included all five epilepsy questions as state-added questions in their 2005 BRFSS questionnaire; one state included three questions; four states included two questions; and two states included one question.* The first question was, "Have you ever been told by a doctor that you have a seizure disorder or epilepsy?" (response options: "yes," "no," "don't know," and "refused"). Participants who answered "yes" to this question were asked some or all of the remaining questions: 2) "Are you currently taking any medicine to control your seizure disorder or epilepsy?" (response options: "yes," "no," "don't know," and "refused"); 3) "How many seizures have you had in the last 3 months?" (response options: "none," "one," "more than one," "no longer have epilepsy or seizure disorder," "don't know," and "refused"); 4) "In the past year, have you seen a neurologist or epilepsy specialist for your epilepsy or seizure disorder?" (response options: "yes," "no," "don't know," and "refused"); and 5) "During the past 30 days, to what extent has epilepsy or its treatment interfered with your normal activities like working, school, or socializing with family or friends?" (response options: "not at all," "slightly," "moderately," "quite a bit," "extremely," "don't know," and "refused").

The lifetime prevalence (i.e., cumulative incidence) of self-reported epilepsy was determined by affirmative responses to the first question. Respondents were classified as having active epilepsy if they responded "yes" to ever having been told by a doctor that they had a seizure disorder or epilepsy and also responded that they either were currently taking medication to control it, had one or more seizures in the past 3 months, or both (Figure). Active epilepsy was further categorized by whether the respondent had experienced a seizure in the past 3 months (i.e., active epilepsy with or without recent seizures). Respondents who responded that they had ever been told by a doctor that they had a seizure disorder or epilepsy (i.e., had a history of epilepsy) but were not taking medication for epilepsy and had not had a seizure in the past 3 months were classified as those with inactive epilepsy (Figure).

HRQOL was measured for all respondents, with and without a history of epilepsy, with the following validated CDC Healthy Days questions (19): 1) "Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?" 2) "Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?" and 3) "During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?" CDC methods for calculating HRQOL were used (19). In addition, all respondents were asked to respond to a question on self-rated health: "Would you say that in general your health is excellent, very good, good, fair, or poor?" Responses for self-rated health were classified into two groups for analysis: 1) excellent, very good, or good and 2) fair or poor.

Statistical software was used to account for the complex survey design. Data were weighted to obtain appropriate population estimates, standard errors, and 95% confidence intervals (CIs). Estimates were considered significantly different if CIs did not overlap. The total eligible number of BRFSS respondents among all 50 states was 556,117 adults; the median refusal rate was 14.4% (20). The Council of American Survey Organizations (CASRO) response rates among the 19 states for the 2005 BRFSS survey ranged from 40.0% (New York) to 63.1% (Kansas) (median among 19 states: 51.1%); cooperation rates§ among respondents ranged from 67.6% (New York) to 85.0% (Tennessee) (median among 19 states: 76.9%) (20).

Results

Prevalence

A total of 2,207 adults from 19 states (1.65%, CI = 1.52--1.80) reported ever being told they had epilepsy (i.e., a history of epilepsy) (Table 1). Among 13 states that included three questions sufficient to classify epilepsy status, 919 (0.84%; CI = 0.74--0.96) were classified as having active epilepsy, and 693 (0.75%; CI = 0.65--0.86) were classified as having inactive epilepsy (Table 1). Some significant differences in prevalence were detected between states (e.g., Delaware and Wyoming, New York and Washington).

Characteristics of Adults with a History of Epilepsy

Of persons ever told they had epilepsy (i.e., persons with a history of epilepsy), 55.9% were women, and half were aged 35--44 (22.0%) to 45--54 years (22.7%); in addition, 74.1% were white, 8.8% were black, 11.2% were Hispanic, and 6.0% were of another race/ethnicity (Table 2). Compared with those without the disorder, a greater percentage of adults with a history of epilepsy had lower levels of education and income. A smaller percentage of persons with a history of epilepsy were married or part of an unmarried couple and a greater percentage were formerly married compared with those without the disorder.

A smaller percentage of persons with a history of epilepsy were employed (45.8%) and a greater percentage (23.7%) were unable to work than those without epilepsy (61.6% and 4.8%, respectively) (Table 2). Nearly the same percentages of those with (17.0%) and without (16.3%) a history of epilepsy did not have health-care insurance. However, 23.7% of those with a history of epilepsy reported not being able to see a doctor in the past year because of the cost, compared with 13.4% of those without the disorder. A total of 69.0% of persons with a history of epilepsy reported having a checkup within the past year, a proportion similar to that in the general population.

A significantly greater percentage of persons with a history of epilepsy were classified as obese compared with those with no history of epilepsy (30.1% versus 24.0%, respectively). A greater percentage of persons with a history of epilepsy were current smokers compared with those without the disorder (30.1% versus 20.9%, respectively) (Table 2). A total of 33.5% of persons with a history of epilepsy reported no exercise in the past 30 days compared with 24.5% of those without the disorder, and 37.0% of persons with a history of epilepsy reported fair or poor health, compared with 15.8% of those without the disorder (Table 2). In addition, 13.6% of those with a history the disorder reported rarely or never receiving the emotional support they needed, compared with 8.0% of those without the disorder (Table 2). A total of 16.6% of those with a history of epilepsy reported being dissatisfied or very dissatisfied with their life, compared with 5.4% of those without the disorder (Table 2).

Classification of Active and Inactive Epilepsy

Among adults with a history of epilepsy, 48.8% reported currently taking medication to control their disorder (Table 3). Of those with a history of epilepsy, 15.0% reported having more than one seizure in the past 3 months; 8.1% had one seizure, and 71.0% had no seizures in the past 3 months (Table 3). A total of 5.9% of those with a history of epilepsy reported no longer having the disorder (self-determined) in response to the question on seizure frequency (Figure, Table 3).

Of those classified with active epilepsy, 55.1% reported having had no seizures in the past 3 months, 15.3% reported one seizure, and 28.6% reported more than one seizure; in addition, 6.9% of those classified with active epilepsy reported not taking medication for their seizure disorder but having had recent seizures. Although 1.0% of adults with active epilepsy reported no longer having the disorder, they were classified as having active epilepsy because they also reported currently taking medication (Figure, Table 3). Among adults with active epilepsy and recent seizures, 16.1% reported not taking medication for their disorder, and 34.9% reported having had one seizure in the past 3 months, with 65.1% having had more than one seizure (Table 3). A total of 34.9% of adults with active epilepsy with recent seizures reported not seeing a neurologist or epilepsy specialist in the past year (Table 3). Among adults with active epilepsy and no recent seizures, 40.6% reported not having seen a neurologist or epilepsy specialist in the past year.

Among persons with active epilepsy with recent seizures, 32.9% reported that epilepsy or its treatment limited their abilities in the past month "quite a bit or extremely" compared with 7.6% among those with no recent seizures.

Characteristics of Adults Classified with Active Epilepsy

Prevalence estimates for active and inactive epilepsy reveal no differences by sex or race/ethnicity (Table 4). Differences in prevalence occurred by age (e.g., 35--54 years versus 18--24 years); however, these differences should be interpreted with caution because of the small sample sizes in certain age groups.

Among persons with active epilepsy, 56.4% were women, and half were aged 35--54 years (22.1% aged 35--44 years, 26.1% aged 45--54 years) (Table 5). A total of 80.4% of adults with active epilepsy were white, 11.0% were black, and 5.5% were Hispanic. A significantly greater percentage of those with active epilepsy reported not completing high school, compared with adults without the disorder, and a smaller percentage of adults with active epilepsy reported having some college education (Table 5). Similar percentages with respect to educational attainment occurred among those with inactive epilepsy.

A total of 47.7% of adults with active epilepsy and 40.7% of those with inactive epilepsy reported an annual household income of <$25,000, compared with 26.5% of adults without the disorder. A significantly smaller percentage of persons with active epilepsy were married or part of an unmarried couple than those without the disorder, and a greater percentage of those with active epilepsy were formerly married compared with those without the disorder (Table 5).

Among adults with active epilepsy, 9.8% were unemployed, compared with 5.4% in those without a history of epilepsy. A total of 31.3% of those with active epilepsy and 15.4% of those with inactive epilepsy reported being unable to work, compared with 4.9% of those without the disorder (Table 5).

Fair or poor health was reported by 48.5% of adults with active epilepsy and 28.5% of those with inactive epilepsy, both significantly more than the 15.8% of adults without the disorder (Table 6). A significantly greater percentage of adults with inactive epilepsy reported not having health-care insurance (23.9%) compared with those with active epilepsy (10.9%) or those without the disorder (14.1%). From 63.1% to 71.5% of adults in these three groups reported having had a checkup within the past 2 years. However, a significantly greater percentage of adults with active epilepsy reported not being able to see a doctor in the past 12 months because of the cost.

A total of 32.2% of adults with active epilepsy and 31.9% of those inactive epilepsy were classified as obese, compared with 23.3% of adults without the disorder (Table 6). A significantly smaller percentage of adults with active epilepsy (60.7%) reported any exercise in the past 30 days compared with adults without the disorder (75.4%). Among those with active epilepsy or inactive epilepsy, 32.4% and 32.0% were current smokers, respectively, compared with 21.6% of those without the disorder. A smaller percentage of adults with active epilepsy (30.4%) reported drinking any alcohol in the past month than those without the disorder (53.4%).

A greater percentage of adults with active epilepsy (15.7%) and inactive epilepsy (7.3%) reported having had a stroke than those with no history of the disorder (2.4%). Eight percent of adults with active epilepsy reported having heart disease, compared with 4.8% of those with inactive epilepsy. Twenty percent of adults with active epilepsy reported having asthma, approximately twice the proportion among those with inactive epilepsy or without the disorder. A greater percentage of adults with active epilepsy (13.0%) and inactive epilepsy (14.9%) reported being told they had diabetes compared with those with no history of the disorder (7.7%). A significantly greater percentage of adults with active epilepsy or inactive epilepsy reported being told they had arthritis and reported current joint pain than those without the disorder (Table 6).

A total of 21.6% of adults with active epilepsy reported getting the recommended 5 servings of fruits and vegetables a day, similar to those with inactive epilepsy (27.4%) and those without the disorder (26.4%). Approximately the same percentages of adults with and without the disorder reported receiving a flu shot in the past year.

A significantly greater percentage of adults with active epilepsy reported rarely or never getting the emotional support they needed (19.1%) than those without the disorder (7.6%). In addition, a greater percentage of those with active epilepsy were dissatisfied or very dissatisfied with their life (18.8%) than those without the disorder (5.7%) (Table 6).

Sex and age were not associated with increased or decreased risk for active epilepsy with recent seizures (Table 7). However, a significantly greater percentage of Hispanics (79.2%) reported recent seizures than did whites (40.0%), and a greater percentage of persons with active epilepsy at the lowest annual household income level (57.3%) reported recent seizures than persons with epilepsy at the highest annual household income level (20.9%). Similarly, a greater percentage of adults with active epilepsy who were unemployed or unable to work (59.2%) reported recent seizures than adults with epilepsy who were employed (33.2%) or other groups (33.5%).

Health-Related Quality of Life

Compared with adults with no history of the disorder, adults with a history of epilepsy reported significantly more mentally unhealthy days (7.3 versus 3.2), physically unhealthy days (9.1 versus 3.5), overall unhealthy days (13.0 versus 5.9), and activity-limitation days (6.8 versus 2.1) (Table 8). Compared with those with no history of epilepsy, adults with active epilepsy reported significantly more mentally unhealthy days (9.3 versus 3.4), physically unhealthy days (10.7 versus 3.6), overall unhealthy days (15.1 versus 6.1), and activity-limitation days (8.4 versus 2.2) (Table 8). Similarly, adults with inactive epilepsy reported more mentally unhealthy days, physically unhealthy days, overall unhealthy days, and activity-limitation days than those with no history of the disorder (Table 8). Adults with active epilepsy with recent seizures reported significantly more physically unhealthy days than those with no recent seizures (13.1 versus 8.8) and more activity-limitation days (11.1 versus 6.4) than those with no recent seizures.

Discussion

Population-based epidemiological studies of epilepsy are important for policymakers and health-care providers to plan and provide prevention programs and appropriate care and services for those affected (1,10). Adults with a history of epilepsy and with active epilepsy were more likely to report negative health outcomes, and they face substantial socioeconomic disadvantages such as unemployment and low household income. In addition, these findings highlight the substantial adverse effects of recurring seizures on daily activities and HRQOL in adults with epilepsy. However, because of the cross-sectional nature of BRFSS, no causality among the associations found can be inferred.

Although prevalence estimates differed among certain states, these differences might have been a result of random error associated with response rates, response bias, or multiple comparisons. The estimates of persons who were ever told they had epilepsy (i.e., lifetime prevalence) and active epilepsy are comparable to previous estimates from the 1998 Texas BRFSS (lifetime prevalence, 1.8%), 2002 Georgia BRFSS (lifetime prevalence, 1.7%), and 2003 and 2004 South Carolina BRFSS surveys (lifetime prevalence, 2.2%; active epilepsy, 1.1%) and with estimates from the 2003 CHIS (lifetime prevalence, 1.2%; active epilepsy, 0.7%) (13--16). The active epilepsy estimate of 0.8% also is comparable to results from a recent study of a managed care population (0.7%); a 1978 door-to-door survey of all household and institutionalized residents in Copiah County, Mississippi (1%); and a community-based study of diagnostic records for 5 decennial census years in Minnesota (0.7%) (21--23)

Despite methodologies that differed from those used in other studies, self-reports of medication use and seizure frequency from this study were comparable to findings from the 2003 CHIS (16), the 2003 and 2004 South Carolina BRFSS surveys (14), the 2004 HealthStyles Survey (17), and Copiah County, Mississippi (22). For example, in California, 10% of adults with active epilepsy reported not taking any medication for their seizure disorder, and 29% reported having had more than one seizure during the past 3 months (16).

The finding in this report that epilepsy prevalence was lower among older adults differs from findings in other studies that have shown an increased prevalence with increased age (23); however, this study excluded institutionalized older adults from BRFSS, which might have resulted in the lower estimate. Like this study, other U.S. studies have not found consistent differences in the prevalence of epilepsy by sex or by race (15--17,22--26).

Findings from this study regarding educational attainment, employment, marital status, and household income among persons with a history of epilepsy are comparable to those from other U.S. studies based on convenience samples of persons with epilepsy and with longitudinal studies in Canada and Europe (27--29). Researchers who conducted cohort studies of children with epilepsy found a higher prevalence of psychosocial problems, unemployment, and financial dependency and lower levels of education at adulthood compared with controls and suggested that ongoing psychosocial support is needed for children with epilepsy as they transition into adulthood (27). The higher percentages of adults with epilepsy at lower levels of education and income in this study are consistent with findings from the 2002 Georgia BRFSS and 2002 Tennessee BRFSS, which found that 22% of adults with a history of epilepsy did not complete high school and 44% had an annual household income of <$25,000; in addition, in the 2003 CHIS, 45% of Californians with epilepsy reported an annual household income <$25,000 (15,16). However, the results of this study indicate that although nearly half of adults with active epilepsy in 2005 had completed some college or more, many of these adults remained at lower household income levels. For example, 32% (CI = 22.7--42.7) of adults with active epilepsy who either had some college experience or completed college reported an annual household income of <$25,000, although only 15% (CI = 14.5--15.9) of adults with no history of the disorder and comparable education reported an income of <$25,000. Epilepsy and its treatment can impair cognition, limiting academic achievement in some students with epilepsy (30,31), which might contribute to the lower educational attainment among adults with epilepsy. Lower levels of household income might be associated with periods of unemployment, disability status, or other factors unaccounted for in this study. Because these data are cross-sectional, no causal associations between epilepsy and lower levels of education and income can be inferred. The finding of lower rates of marriage and partnership in this analysis among adults with a history epilepsy is similar to findings from the 2003 CHIS, in which only 45% of adults with epilepsy were married, compared with 55% of adults without the disorder (16). This might result from decreased social opportunities among some persons with epilepsy (e.g., from limited access to transportation or to certain educational or occupational opportunities) or from stigma associated with the disorder (11,32). In addition, a higher percentage of adults with a history of epilepsy reported being formerly married compared with those without the disorder, which might be a result of the challenges of living with a chronic condition and the strain it might have on close relationships (33,34). Higher rates of divorce were found among persons with a history of epilepsy who did not disclose their epilepsy before marriage (35,36) and among those whose seizures had remitted (37).

Persons with a history of epilepsy and active epilepsy are more likely than those without such histories to be obese, physically inactive, and current smokers (15,16). The stress of living with a chronic disorder such as epilepsy, including its social limitations, might encourage unhealthy coping behaviors (e.g., smoking and poor diet) and discourage healthy behaviors (e.g., physical activity). Persons with a history of epilepsy experience more depression and anxiety than those without the disorder; these common comorbid conditions are associated with unhealthy coping behaviors (38--40). In addition, certain anticonvulsant medications can cause sedation and lethargy, which might impede physical activity, whereas others can stimulate appetite, resulting in weight gain (41,42). Although persons with epilepsy historically have been discouraged from participating in physical activity because of concerns about inducing seizures or sustaining injuries associated with seizures, physical activity can improve seizure control, mood, and quality of life (43,44). Although persons with epilepsy should avoid physical injuries, many can benefit from daily physical activity such as walking (44--46).

The higher reported prevalence of obesity, physical inactivity, and current smoking among persons with a history of epilepsy might be a factor in the higher reported prevalence of self-reported heart disease, stroke, diabetes, and arthritis among these persons. In addition, certain underlying brain disorders can lead to decreased mobility and epilepsy. Other studies have found higher prevalence of comorbid illnesses in persons with epilepsy compared with the general population (47,48). Epilepsy and its treatment have been associated with co-occurring disorders and disease risk factors (e.g, cerebrovascular and cardiovascular disorders, obstructive sleep apnea, and depression) (47--58). Because certain comorbid conditions might occur before epilepsy onset, occur simultaneously with epilepsy onset, or result from the condition or its treatment, additional studies are required to identify causal associations and shared disease pathways (47--58). Physicians treating persons with epilepsy should screen for and treat these chronic disease comorbidities and their risk factors (58,59). When recommending treatment options, health-care providers also should consider the effects of antiepileptic drugs on risk factors (e.g., weight gain, mood disorders, and sleep problems) and health status (41,42,57,60,61). In addition, general health-promotion information (e.g., smoking cessation, physical activity and healthy diet, and heart disease prevention) might be useful for providers and Epilepsy Foundation affiliates to distribute to patients with epilepsy.

The findings in this study regarding inadequate seizure control by medications might partly be a result of limited knowledge of current diagnostic and treatment standards for the care of epilepsy among certain groups of health care professionals (62,63). Clinical tools and guidelines recommended for epilepsy care are available to improve clinical evaluation and services for patients with epilepsy (59,64,65). Inadequate seizure control might also arise, in part, from the difficulties with maintaining therapy regimens. Epilepsy medication regimens typically require multiple daily doses (and sometimes multiple drugs) that must be taken consistently; patients can have difficulty strictly adhering to these requirements, resulting in seizure recurrence. Lapses in treatment adherence also might arise among patients with discontinuous or inadequate health insurance coverage when such patients are unable to afford medication. Finally, nearly 40% of epilepsy cases with partial seizures are considered refractory (i.e., resistant to medical therapy), resulting in occasional or frequent seizure recurrences despite optimal treatment with antiepileptic drugs (64).

Persons with epilepsy might have difficulties finding and navigating through health-care and public services that could be helpful. Collaborative care models such as the chronic care model (66--69) also might improve health outcomes for persons with epilepsy. For example, the Awareness and Access to Care for Children and Youth with Epilepsy (AACYE) initiative focuses on timely clinical follow-up care with medical specialists, including screening and referral for behavioral and mental health needs, and an individualized patient- and family-centered care plan (70). Community-based strategies (e.g., that include public transportation or telemedicine) that provide hard-to-reach persons with epilepsy with access to social services might also be helpful; these strategies have been effective for persons with complex chronic conditions (71--73).

Adults with a history of epilepsy reported substantially worse self-rated health and HRQOL, more dissatisfaction with emotional support received, and more overall dissatisfaction with life than adults without the disorder. Depression has been shown to be one of the strongest predictors of quality of life in persons with epilepsy (64). Although this analysis could not control for confounding effects of depression on HRQOL, a recent similar study found that adjusting for covariates such as race/ethnicity and income and chronic disease comorbidity made no difference in HRQOL estimates in persons with self-reported epilepsy or active epilepsy (16).

Adults with inactive epilepsy also reported worse HRQOL than those without the disorder, consistent with previous findings (14,16). A diagnosis of epilepsy earlier in life, despite its resolution or remission, can still interfere with later life opportunities and alter perceptions of health status (27,74--76). In addition, some persons with epilepsy who achieve a reduction in number of seizures or complete seizure remission continue to experience psychosocial distress associated with unmet or unrealistic life expectations (76).

The results of this study are subject to at least seven limitations. First, the data are self-reported and subject to recall bias and response bias. However, the estimates collected for several years are in general agreement, indicating these types of bias might be minimal (13--17). Second, because the survey is cross-sectional, no causal associations among variables can be inferred. Third, the reported cases of epilepsy are not classified by seizure type, severity, or etiology, and certain acute symptomatic seizures or nonepileptic seizures (NESs) might have been misclassified as epilepsy. However, given the small percentages of adults with NESs, significant skewing of results because of these cases is unlikely (77). In addition, many adults with NESs also have epileptic seizures, making such distinctions less likely to substantially skew results (78,79). Fourth, the higher number of days of impaired HRQOL in persons with inactive epilepsy compared with those without the disorder might also have resulted from the case definition, which was based on a 3-month recall period for seizure frequency and is more conservative than the 5-year recall period recommended by the International League Against Epilepsy (ILAE) (4). Thus, some inactive cases in this study would have been classified as active cases using the ILAE definition. The case definition in this study was used to minimize difficulties in respondent recall of potentially numerous seizures over a lengthy interval, whereas the ILAE approach is designed for epidemiologic studies based on record review. Fifth, the analysis was unable to control for the possible effects of mood disorder on HRQOL in this study. Investigators might be able to do so in future BRFSS studies using data from states that included the Patient Health Questionnaire Survey or the Kessler-6 Psychological Distress scale along with the epilepsy questions (18). Sixth, epilepsy prevalence might be underestimated because of underreporting resulting from the stigma associated with disclosing epilepsy and because BRFSS methodology excludes institutionalized adults. Finally, BRFSS excludes households without landline telephones. However, the National Center for Health Statistics found that the percentage of households without landline phones is still low, and bias for persons who used cellular telephones exclusively was associated with select sociodemographic factors (80).

CDC-supported Prevention Research Centers (PRCs) are conducting community-based research on self-management and depression prevention to improve health outcomes in persons with epilepsy (81--83). Pilot testing of WebEase (Web Epilepsy Awareness, Support, and Education), an Internet-based program that is focused on behavioral change theory and tailored communication strategies, found significant improvements in overall self-management and other health outcomes among adults with epilepsy (84,85).

Although this study identified effects of epilepsy on persons in several states, additional descriptive and analytic studies of epilepsy occurrence in various U.S. communities and populations are needed. CDC is supporting the development of international standards for studies of epilepsy incidence and prevalence. Such research will better characterize epilepsy incidence rates, risk factors and etiologies, types, severity, associated conditions, and disability (1,10).

The Association of State and Territorial Chronic Disease Directors endorsed a role for state public health departments in developing epilepsy surveillance capacity and establishing strong working relationships with other government agencies and with nongovernmental lay and professional groups (86). State and local public health agencies can work with their local Epilepsy Foundation affiliates, other groups such as the Epilepsy Therapy Project (available at http://www.epilepsy.com) that support persons with epilepsy and their families, and social service agencies to promote awareness and reduce social stigma, provide community and professional education about epilepsy, address employment and transportation needs, and provide referral and support for health promotion and disease prevention for persons with epilepsy (86--91).

References

  1. World Health Organization. Neurological disorders: public health challenges. Available at http://www.who.int/mental_health/neurology/neurodiso/en/index.html.
  2. Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohammed M, Chaudhuri AR, Zalutsky R. How common are the "common" neurological disorders? Neurology 2007;68:326--37.
  3. National Epilepsy Foundation. Epilepsy and seizure statistics. Available at http://www.epilepsyfoundation.org/about/statistics.cfm.
  4. International League Against Epilepsy, Commission on Epidemiology and Prognosis. Guidelines for epidemiologic studies on epilepsy. Epilepsia 1993;34:59--96.
  5. Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935--1984. Epilepsia 1993;34:453--68.
  6. Fisher RS, Schachter SC. The postictal state: a neglected entity in the management of epilepsy. Epilepsy Behav 2000;1:52--9.
  7. Johnston A, Smith P. Sudden unexpected death in epilepsy. Expert Rev Neurother 2007;7:1751--61.
  8. Baker GA. The psychosocial burden of epilepsy. Epilepsia 2002;43: 26--30.
  9. Morrell MJ. Stigma and epilepsy. Epilepsy Behav 2002;3(Suppl 2): S21--S25.
  10. Theodore WH, Spencer SS, Wiebe S, et al. Epilepsy in North America: a report prepared under the auspices of the Global Campaign Against Epilepsy, the International Bureau for Epilepsy, the International League Against Epilepsy, and the World Health Organization. Epilepsia 2006;1--23.
  11. Jacoby A. Stigma, epilepsy, and quality of life. Epilepsy Behav 2002;3 (Suppl 2):S10--S20.
  12. Sirven JI, Lopez RA, Vazquez B, Van Haverbeke P. Que es la epilepsia? Attitudes and knowledge of epilepsy by Spanish-speaking adults in the United States. Epilepsy Behav 2005;7:259--65.
  13. CDC. Health-related quality of life among persons with epilepsy---Texas, 1998. MMWR 2001;50:24--6.
  14. CDC. Prevalence of epilepsy and health-related quality of life and disability among adults with epilepsy---South Carolina, 2003 and 2004. MMWR 2005;54:1080--2.
  15. Kobau R, DiIorio CA, Price PH, et al. Prevalence of epilepsy and health status of adults with epilepsy in Georgia and Tennessee: Behavioral Risk Factor Surveillance System, 2002. Epilepsy Behav 2004;5:358--66.
  16. Kobau R, Zahran H, Grant D, Thurman DJ, Price PH, Zack MM. Prevalence of active epilepsy and health-related quality of life among adults with self-reported epilepsy in California: California Health Interview Survey, 2003. Epilepsia 2007;48:1904--13.
  17. Kobau R, Gilliam F, Thurman DJ. Prevalence of self-reported epilepsy or seizure disorder and its associations with self-reported depression and anxiety: results from the 2004 HealthStyles Survey. Epilepsia 2006;47:1915--21.
  18. CDC. Behavioral Risk Factor Surveillance System. Available at http://www.cdc.gov/brfss.
  19. Moriarty DG, Zack MM, Kobau R. The Centers for Disease Control and Prevention's Healthy Days measures---population tracking of perceived physical and mental health over time. Health Qual Life Outcomes 2003;1:1--8.
  20. CDC. 2005 Behavioral Risk Factor Surveillance System summary data quality report. Available at http://www.cdc.gov/brfss/technical_infodata/quality.htm.
  21. Holden EW, Nguyen HT, Grossman E, et al. Estimating prevalence, incidence, and disease-related mortality for patients with epilepsy in managed care organizations. Epilepsia 2005;46:311--9.
  22. Haerer AF, Anderson DW, Schoenberg BS. Prevalence and clinical features of epilepsy in a biracial United States population. Epilepsia 1986;1:66--75.
  23. Hauser WA, Annegers JF, Kurland LT. Prevalence of epilepsy in Rochester, Minnesota: 1940--1980. Epilepsia 1991;32:429--45.
  24. CDC. Prevalence of self-reported epilepsy. MMWR 1994;43:810--2.
  25. Annegers JF, Dubinsky S, Coan SP, Newmark ME, Roht L. The incidence of epilepsy and unprovoked seizures in multiethnic, urban health maintenance organizations. Epilepsia 1999;40:502--6.
  26. Kelvin EA, Hesdorffer DC, Bagiella E, et al. Prevalence of self-reported epilepsy in a multiracial and multiethnic community in New York City. Epilepsy Res 2007;77:141--50.
  27. Camfield CS, Camfield PR. Long-term social outcomes for children with epilepsy. Epilepsia 2007;48:3--5.
  28. Fisher RS, Vickrey BG, Gibson P, et al. The impact of epilepsy from the patient's perspective I. Descriptions and subjective perceptions. Epilepsy Res 2000;41:39--51.
  29. Fisher RS. Epilepsy from the patient's perspective: review of results from a community-based survey. Epilepsy Behav 2000;1:S9--S14.
  30. Aldenkamp AP, Alpherts WC, Dekker MJ, Overweg J. Neuropsychological aspects of learning disabilities in epilepsy. Epilepsia 1990;31 (Suppl 4):S9--S20.
  31. Tromp SC, Weber JW, Aldenkamp AP, Arends J, vander Linden I, Diepman L. Relative influence of epileptic seizures and epilepsy syndrome on cognitive function. J Child Neurol 2003;18:407--12.
  32. Jones EE, Farina A, Hastorf AH, Markus H, Miller DT, Scott RA. The dimensions of stigma. In: Atkinson RC, Lindzey G, Thompson RF, eds. Social stigma: the psychology of marked relationships. New York, NY: WH Freeman and Company; 1984.
  33. Thompson PJ, Upton D. The impact of epilepsy on the family. Seizure 1992;1:43--8.
  34. Tyerman AD, Hobbs L, Measures AC. Quality of life in family members of persons with chronic neurological disability. In: Epilepsy and quality of life. Trimble MR, Dodson WE, eds. New York, NY: Raven Press; 1994:33--48.
  35. Satosh D, Kumar TS, Sarma PS, Radhakrishnan K. Women with onset of epilepsy prior to marriage: disclosure or conceal? Epilepsia 2007;48:1007--10.
  36. Wada K, Iwasa H, Okada M, et al. Marital status of patients with epilepsy with special reference to the influence of epileptic seizures on the patient's married life. Epilepsia 2004;45(Suppl 8):33--6.
  37. Carran MA, Kohler CG, O'Connor MJ, Cloud B, Sperling MR. Marital status after epilepsy surgery. Epilepsia 1999;40:1755--60.
  38. Bandura AS. Depression. In: Self-efficacy: the exercise of control. New York, NY: WH Freeman and Company; 1997:319--57.
  39. Linde JA, Jeffery RW, Levey RL, et al. Binge eating disorder, weight control self-efficacy, and depression in overweight men and women. Int J Obes Relat Metab Disord 2004;28:418--25.
  40. Murphy JM, Horton NJ, Monson RR, Laird NN, Sobol AM, Leighton AH. Cigarette smoking in relation to depression: historical trends from the Stirling County Study. Am J Psychiatry 2003;160:1663--9.
  41. El-Khatibe F, Rauchenzauner M, Lechleitner M, et al. Valproate, weight gain and carbohydrate craving: a gender study. Seizure 2007;16:226--32.
  42. Ben-Menachem E. Weight issues for people with epilepsy---a review. Epilepsia 2007;48:42--5.
  43. Howard GM, Radloff M, Sevier TL. Epilepsy and sports participation. Curr Sports Med Rep 2004;3:15--9.
  44. Dubow JS, Kelly JP. Epilepsy in sports and recreation (review). Sports Med 2003;33:499--516.
  45. Fountain NB, May AC. Epilepsy and athletics. Clin Sports Med 2003;22:605--16.
  46. US Department of Health and Human Services. Healthy people 2010 (conference ed, in 2 vols). Washington, DC: US Department of Health and Human Services; 2000. Available at http://www.healthypeople.gov.
  47. Weibe S, Hesdorffer DC. Epilepsy: being ill in more ways than one. Epilepsy Curr 7;145--8.
  48. Gaitatzis A, Carroll K, Majeed A, Sander J. The epidemiology of the comorbidity of epilepsy in the general population. Epilepsia 2004;45:1613--22.
  49. Malow BA. The interaction between sleep and epilepsy. Epilepsia 2007;48(Suppl 9):36--8.
  50. Hollinger P, Khatami R, Gugger M, Hess CW, Bassetti CL. Epilepsy and obstructive sleep apnea. Eur Neurol 2006;55:74--9.
  51. Chihorek AM, Abou-Khalil B, Malow BA. Obstructive sleep apnea is associated with seizure occurrence in older adults with epilepsy. Neurology 2007;69:1823--7.
  52. Camilo O, Goldstein LB. Seizures and epilepsy after ischemic stroke. Stroke 2004;35:1769--75.
  53. Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C. Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project. BMJ 1997;315:1582--7.
  54. Bladin CF, Alexandrov AV, Bellavance A, et al. Seizures after stroke: a prospective multicenter study. Arch Neurol 2000;57:1617--22.
  55. Kanner AM, Balabanov A. Depression and epilepsy: how closely related are they? Neurology 2002;58:S27--S39.
  56. Kanner AM. Depression in epilepsy: a neurobiologic perspective. Epilepsy Curr 2005;5:21--7.
  57. Herman ST. Epilepsy and sleep. Curr Treat Options Neurol 2006; 4:271--9.
  58. Gilliam FG, Mediratta A, Pack Am, Bazil CW. Epilepsy and common comorbidities: improving the outpatient epilepsy encounter. Epileptic Disord 2005;7:S27--S33.
  59. Pugh MJV, Berlowitz DR, Montouris G, et al. What constitutes high quality of care for adults with epilepsy? Neurology 2007;69:2020--7.
  60. Reijs R, Aldenkamp AP, DeKrom M. Mood effects of antiepileptic drugs. Epilepsy Behav 2004;5(Suppl 5):S66--S76.
  61. Ketter TA, Post RM, Theodore WH. Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders. Neurology 1999;53:S53--S67.
  62. Morrell MJ, Sarto GE, Shafer PO, Borda EA, Herzog A, Callanan M. Health issues for women with epilepsy: a descriptive survey to assess knowledge and awareness among healthcare providers. J Womens Health Gend Based Med 2000;9:959--65.
  63. Sirven, JI. Acute and chronic seizures in patients older than 60 years. Mayo Clin Proc 2002;175--83.
  64. Gilliam F. Optimizing health outcomes in active epilepsy. Neurology 2002;58(Suppl 8):S9--S19.
  65. Agency for Healthcare Research and Quality. Management of newly diagnosed patients with epilepsy: a systematic review of the literature summary. Evidence report/technology assessment: number 39. Available at http:www.ahrq.gov/clinic/epcsums/epilepsum.
  66. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, part 2. JAMA 2002;288:1909--14.
  67. von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic disease. Ann Intern Med 1997;127: 1097--102.
  68. Gruman J, von Korff M, Reynolds J, Wagner EH. Organizing health care for people with seizures and epilepsy. J Ambul Care Manage 1998;21:1--17.
  69. Roumie CL, Elasy TA, Greevy R, et al. Improving blood pressure control through provider education, provider alerts, and patient education: a cluster randomized trial. Ann Intern Med 2006;145:165--75.
  70. National Initiative for Children's Healthcare Quality. Awareness and access to care for children with epilepsy. Available at http://www.nichq.org/nichq/programs/collaborativelearning/epilepsy2005.htm.
  71. Holman H, Lorig K. Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public Health Rep 2004; 119:239--43.
  72. Rasmusson KA, Hartshorn JC. A comparison of epilepsy patients in a traditional ambulatory clinic and a telemedicine clinic. Epilepsia 2005;46:767--70.
  73. Woods K, Kutiar A, Grigsby RK, Adams L, Stachura ME. Primary-care delivery for sickle cell patients in rural Georgia using telemedicine. Telemed J 1998;4:353--61.
  74. Bailis DB, Segall A, Chipperfield JG. Two views of self-rated general health status. Soc Sci Med 2003;56:203--17.
  75. Shackleton DP, Kasteleijn-Nolst Trenite DG, de Craen AJ, Vandenbroucke JP, Westendorp RG. Living with epilepsy: long-term prognosis and psychosocial outcomes. Neurology 2003;61:64--70.
  76. Wilson SJ, Bladin PF, Saling MM. Paradoxical results in the cure of chronic illness: the "burden of normality" as exemplified following seizure surgery. Epilepsy Behav 2004;5:13--21.
  77. Alsaadi TM, Marquez AV. Psychogenic nonepileptic seizures. Am Fam Phys 2005;72:851--5.
  78. Devinsky O, Sanchez-Villasenor F, Vazquez B, Kothari M, Alper K, Luciano D. Clinical profile of patients with epileptic and nonepileptic seizures. Neurology 1996;46:1530--3.
  79. Henry TR, Drury I. Non-epileptic seizures in temporal lobectomy candidates with medically refractory seizures. Neurology 1997;48: 1374--82.
  80. Blumberg S, Luke JV, Cynamon ML. Telephone coverage and health survey estimates: evaluating the need for concern about wireless substitution. Am J Public Health 2006;96:926--31.
  81. CDC. Epilepsy. Available at http://www.cdc.gov/epilepsy.
  82. Pramuka M, Hendrickson R, Zinski A, Van Cott AC. A psychosocial self-management program for epilepsy: A randomized pilot study in adults. Epilepsy Behav 2007;11:533--45.
  83. DiIorio C, Escoffery, C, Yeager KA, et al. WebEase: using theory to develop a web-based epilepsy self-management intervention. Prev Chronic Dis. In press 2008.
  84. Escoffery C, DiIorio C, Yeager KA, et al. Use of computers and the Internet for health information by patients with epilepsy. Epilepsy Behav 2007;12:109--14.
  85. DiIorio C, Escoffery C, McCarty F, et al. Evaluation of WebEase: an epilepsy self-management website. Health Educ Res. In press 2008.
  86. Association of State and Territorial Chronic Disease Directors. The role of public health in addressing lower prevalence chronic conditions: the example of epilepsy. Association of State and Territorial Chronic Disease Directors; 2003. Available at http://www.chronicdisease.org/files/public/epilepsy_report.pdf.
  87. Epilepsy.com. Epilepsy therapy project. Available at http://www.epilepsy.com.
  88. Epilepsy Foundation. Children and teens: education. Available at http://www.epilepsyfoundation.org/living/children/education.
  89. Varekemp I, Verbeek JH, van Dijk FJ. How can we help employees with chronic diseases to stay at work? A review of interventions aimed at job retention and based on an empowerment perspective. Int Arch Occup Environ Health 2006;80:87--97.
  90. US Department of Labor. Job accommodations for people with epilepsy. Job Accommodation Network. Available at http://www.jan.wvu.edu.
  91. Epilepsy Foundation. NoLimits TeleMentoring: people helping people achieve career goals. Available at http://www.epilepsyfoundation.org/living/wellness/employment/telementoring/telementoring.cfm.

Acknowledgments

The findings in this report are based, in part, on contributions by the following BRFSS state system coordinators: Brian A. Bender, MBA, Arizona; Fred Breukelman, Delaware; Melissa Murray, MS, Florida; Leah Bryan, MPH, Georgia; Farooq Ghouri, MBBS, MPH, Ghazala Perveen, PhD, Kansas; Tracy Sparks, Kentucky; Ann Rafferty, PhD, Michigan; Janet S. Wilson, MEd, MPA, Missouri; Susan Knight, MPH, New Hampshire; Colleen Baker, New York; Kathryn E. Pickle, Renee K. Boyd, Oregon; Robert F. Dewar, Pennsylvania; Jennifer Chiprich, PhD, South Carolina; David Ridings, Tennessee; Michelle Cook, MPH, Texas; Susan K. Spain, Virginia; Katrina Wynkoop Simmons, PhD, Washington; Anne Ziege, PhD, Wisconsin; and Menlo Futa, Wyoming; and by Laurie Elam-Evans, PhD, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

* All five questions: Arizona, Delaware, Georgia, Michigan, Missouri, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Washington, and Wyoming; three questions: Kentucky; two questions: Florida, Texas, Virginia, and Wisconsin; one question: Kansas and New Hampshire.

Including those who responded "no longer have epilepsy" to the seizure frequency question.

§ The percentage of persons who completed interviews among all eligible persons contacted.

Table 1

TABLE 1. Prevalence of adults with a history of epilepsy* and estimated prevalence of active and inactive epilepsy,† by state — 19 states, Behavioral Risk Factor Surveillance System, 2005 Total with history of epilepsy Active epilepsy Inactive epilepsy
Total State sample size No. % (95 % CI§) No. % (95% CI) No. % (95% CI)
Total 120,845 2,207 1.65 (1.52–1.80) 919 0.84 (0.74–0.96) 693 0.75 (0.65–0.86)
Arizona 4,407 61 1.35 (0.84–2.16) 36 0.46Ά (0.27–0.80) 24 0.89Ά (0.46–1.71) Delaware 4,129 54 1.15 (0.81–1.62) 20 0.43Ά (0.25–0.75) 33 0.69Ά (0.44–1.09) Florida 7,753 136 1.61 (1.25–2.06) — — — — — — Georgia 5,783 104 1.71 (1.29–2.27) 59 0.77 (0.55–1.08) 45 0.94 (0.61–1.46) Kansas 4,211 70 1.75 (1.31–2.34) — — — — — — Kentucky 6,164 165 2.17 (1.75–2.69) 88 1.14 (0.87–1.50) 74 0.98 (0.69–1.39) Michigan 11,798 219 1.79 (1.53–2.09) 127 0.96 (0.78–1.18) 90 0.81 (0.63–1.04) Missouri 4,873 88 1.77 (1.28–2.45) 45 0.71 (0.47–1.07) 41 1.00Ά (0.61–1.63) New Hampshire 5,731 98 1.61 (1.27–2.05) — — — — — — New York 3,571 53 1.29 (0.9–1.76) 33 0.87 (0.59–1.28) 20 0.42Ά (0.25–0.70) Oregon 9,602 183 1.84 (1.55–2.18) 115 1.03 (0.83–1.27) 65 0.78 (0.58–1.05) Pennsylvania 12,474 207 1.58 (1.28–1.94) 130 0.93 (0.71–1.22) 74 0.64 (0.45–0.89) South Carolina 7,992 151 1.69 (1.40–2.04) 85 0.88 (0.69–1.12) 66 0.81 (0.61–1.09) Tennessee 4,427 93 2.07 (1.57–2.73) 54 1.02 (0.74–1.40) 35 0.93Ά (0.58–1.48) Texas 5,901 102 1.73 (1.29–2.33) — — — — — — Virginia 5,064 88 1.96 (1.51–2.56) — — — — — — Washington 7,848 148 1.65 (1.34–2.03) 67 0.69 (0.51–0.94) 79 0.94 (0.71–1.24) Wisconsin 4,294 80 1.64 (1.26–2.13) — — — — — — Wyoming 4,823 107 2.20 (1.77–2.73) 60 1.24 (0.93–1.65) 47 0.96 (0.68–1.34)
* Self-reported epilepsy as determined by affirmative response to the question “Have you ever been told by a doctor that you have a seizure disorder or epilepsy?”
†Respondents were classified as having active epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or epilepsy and also responded that they either were currently taking medication for epilepsy, had one or more seizures in the preceding 3 months, or both. Respondents were classified as having inactive epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or epilepsy but were not taking medication for epilepsy and had not had a seizure in the preceding 3 months. Dashes indicate that the states did not include the questions on epilepsy medication and seizure frequency.
§Confidence interval.
ΆRelative standard error of the estimate is >30%; estimate is unreliable.
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Table 2

TABLE 2. Number and percentage of adults with and without a history of epilepsy,* by selected characteristics — 19 states,† Behavioral Risk Factor Surveillance System, 2005
With history of epilepsy
Without history of epilepsy
Total
(n = 2,207)
(n = 118,638)
Characteristic sample size
No.
%
(95% CI§)
No.
%
(95% CI)
Sex
Male
45,701
805
44.1
(40.0–48.2)
44,896
48.3
(47.7–48.9)
Female
75,144
1,402
55.9
(51.8–60.0)
73,742
51.7
(51.1–52.3)
Age (yrs) 18–24
6,134
90
12.3
(8.8–17.0)
6,044
12.8
(12.3–13.4)
25–34
15,225
277
18.9
(15.6–22.8)
14,948
17.7
(17.3–18.2)
35–44
21,071
446
22.0
(19.0–25.4)
20,625
19.8
(19.3–20.2)
45–54
24,894
594
22.7
(19.8–26.0)
24,300
18.5
(18.1–18.9)
55–64
22,397
417
12.1
(10.1–14.4)
21,980
13.9
(13.5–14.2)
65–74
17,023
239
7.7
(6.2–9.5)
16,784
9.1
(8.9–9.4)
>75
13,371
134
4.3
(3.2–5.7)
13,237
8.1
(7.9–8.4)
Race/Ethnicity White
99,349
1,786
74.1
(69.4–78.3)
97,563
74.2
(73.7–74.8)
Black
9,451
176
8.8
(6.6–11.5)
9,275
9.4
(9.0–9.7)
Hispanic
6,534
106
11.2
(8.2–15.0)
6,428
11.6
(11.1–12.0)
Other
4,393
107
6.0
(3.5–10.0)
4,286
4.8
(4.6–5.1)
Education
Less than high school
12,588
323
16.1
(13.2–19.5)
12,265
11.3
(10.9–11.7)
High school graduate
38,475
771
35.7
(31.7–40.0)
37,704
30.1
(29.6–30.6)
Some college or college graduate
69,544
1,112
48.2
(44.1–52.3)
68,432
58.6
(58.1–59.2)
Income
<$25,000
31,431
905
40.9
(36.7–45.2)
30,526
26.3
(25.8–26.9)
$25,000–$49,999
32,847
511
30.0
(25.6–34.5)
32,336
29.7
(29.2–30.2)
>$50,000
39,943
457
29.2
(25.4–33.4)
39,486
43.9
(43.3–44.5)
Marital status
Married or unmarried couple
70,335
1,083
55.5
(51.3–59.7)
69,252
64.1
(63.6–64.7)
Formerly married
35,015
752
22.9
(20.0–26.2)
34,263
18.0
(17.6–18.3)
Never married
15,115
361
21.5
(17.7–26.0)
14,754
17.9
(17.4–18.4)
Employment status
Employed
66,323
891
45.8
(41.6–50.0)
65,432
61.6
(61.1–62.1)
Unemployed
4,953
127
6.8
(5.0–9.0)
4,826
5.0
(4.8–5.3)
Unable to work
7,443
593
23.7
(20.5–27.2)
6,850
4.8
(4.6–5.0)
Other (homemaker, student, or retired)
41,808
590
23.7
(20.5–27.3)
41,218
28.6
(28.1–29.0)
Health-care insurance
Yes
105,833
1,891
83.0
(79.5–86.1)
103,942
83.7
(83.2–84.1)
No
14,697
313
17.0
(13.9–20.5)
14,384
16.3
(15.9–16.8)
Could not visit doctor because of cost
Yes
15,076
491
23.7
(20.2–27.5)
14,585
13.4
(13.0–13.8)
No
105,510
1,708
76.3
(72.5–79.8)
103,802
86.6
(86.2–87.0)
* Self-reported epilepsy as determined by response to the question “Have you ever been told by a doctor that you have a seizure disorder or epilepsy?”
† Arizona, Delaware, Florida, Georgia, Kansas, Kentucky, Michigan, Missouri, New Hampshire, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Texas,
Virginia, Washington, Wisconsin, and Wyoming.§ Confidence interval. Ά Relative standard error of the estimate is >30%; estimate is unreliable.

TABLE 2. (Continued ) Number and percentage of adults with and without a history of epilepsy,* by selected characteristics — 19 states,† Behavioral Risk Factor Surveillance System, 2005
With history of epilepsy
Without history of epilepsy
Total
(n = 2,207)
(n = 118,638)
Characteristic sample size
No.
%
(95% CI§)
No.
%
(95% CI)
Length of time since last checkup Within past year
84,938
1,569
69.0
(65.0–72.7)
83,369
67.9
(67.4–68.5)
Within past 2 years
15,095
253
11.9
(9.4–14.9)
14,842
14.1
(13.7–14.5)
Within past 5 years
8,813
174
9.7
(7.4–12.5)
8,639
8.6
(8.3–9.0)
>5 years Never
8,946 1,320
155 18
8.2 1.2Ά
(6.2–10.7) (0.5–3.0)Ά
8,791 1,302
7.9 1.5
(7.6–8.2) (1.3–1.6)
Body mass index Underweight (<18.5 kg/m2) Normal weight (18.5–24.9 kg/m2) Overweight (25.0–29.9 kg/m2) Obese (>30 kg/m2)
10,909 37,195 38,642 28,069
221 649 636 613
5.9 35.2 28.8 30.1
(4.6–7.7) (36.0–39.7) (25.2–32.5) (26.5–34.0)
10,688 36,546 38,006 27,456
4.6 35.5 35.9 24.0
(4.5–4.8) (35.0–36.1) (35.3–36.4) (23.5–24.5)
Smoking status Current smoker
24,372
682
30.1
(26.5–33.9)
23,690
20.9
(20.4–21.4)
Former smoker
34,566
596
23.3
(20.3–26.6)
33,970
25.2
(24.7–25.6)
Never smoked
61,389
925
46.6
(42.4–50.8)
60,464
53.9
(53.4–54.5)
Exercise in last 30 days
Yes
89,383
1,382
66.5
(62.8–70.0)
88,001
75.5
(75.0–76.0)
No
31,341
818
33.5
(30.0–37.2)
30,523
24.5
(24.0–25.0)
Alcohol consumption in past month Yes
60,455
809
41.2
(37.1–45.5)
59,646
54.2
(53.6–54.7)
No
60,180
1,396
58.8
(54.5–62.9)
58,784
45.8
(45.3–46.4)
Self-rated health.
Good, very good, or excellent
97,852
1,257
63.0
(59.0–66.8)
96,595
84.2
(83.8–84.6)
Fair or poor
22,609
932
37.0
(33.2–41.0)
21,677
15.8
(15.4–16.2)
Receipt of emotional support Always or usually
93,308
1,440
65.6
(61.5–69.5)
91,868
78.9
(78.4–79.4)
Sometimes
15,897
405
20.7
(17.5–24.4)
15,492
13.1
(12.7–13.5)
Rarely or never
9,492
321
13.6
(11.0–16.8)
9,171
8.0
(7.7–8.3)
Life satisfaction
Very satisfied or satisfied
112,554
1,793
83.4
(80.0–86.2)
110,761
94.6
(94.3–94.8)
Dissatisfied or very dissatisfied
7,408
381
16.6
(13.8–20.0)
7,027
5.4
(5.2–5.7)
* Self-reported epilepsy as determined by response to the question “Have you ever been told by a doctor that you have a seizure disorder or epilepsy?”
† Arizona, Delaware, Florida, Georgia, Kansas, Kentucky, Michigan, Missouri, New Hampshire, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Texas,
Virginia, Washington, Wisconsin, and Wyoming.§ Confidence interval. Ά Relative standard error of the estimate is >30%; estimate is unreliable.
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Table 3

TABLE 3. Percentage of adults taking medication to control seizure disorder or epilepsy, having seizures in past 3 months, visiting a neurologist in the past year, and having activity limitations among adults with a history of epilepsy* and active epilepsy — 13 states,† Behavioral Risk Factor Surveillance System, 2005
Active epilepsyΆ Total with Total with Any seizures No seizures history of epilepsy Inactive epilepsyΆ active epilepsy in past 3 months in past 3 months (n = 1,626) (n = 693) (n = 919) (n = 377) (n = 515) Characteristic % (95% CI§) % (95% CI) % (95% CI) % (95% CI) % (95% CI)
Currently taking medication to control seizure disorder or epilepsy
Yes 48.8 (44.1–53.6) — — 93.1 (90.3–95.1) 83.9 (77.6–88.7) 100.0 —
No 51.2 (46.4–55.9) — — 6.9 (4.9–9.7) 16.1 (11.3–22.4) 0 —
Number of seizures in last
3 months None 71.0 (66.5–75.2) 88.7 (83.3–92.5) 55.1 (48.6–61.5) 0 — 98.2 (95.1–99.4) One 8.1 (5.8–11.1) 0 — 15.3 (11.1–20.7) 34.9 (26.0–45.0) 0 — More than one 15.0 (11.9–18.9) 0 — 28.6 (23.0–34.9) 65.1 (55.0–74.0) 0 — No longer have 5.9 (4.0–8.6) 11.3 (7.5–16.7) 1.0 (0.3–2.8)** — — 1.8 (0.6–4.9)**
Visited neurologist in past year Yes 40.5 (35.4–45.8) 14.9 (9.3–23.0) 62.0 (55.3–68.2) 65.1 (53.8–74.8) 59.4 (50.7–67.5) No 59.5 (54.2–64.6) 85.1 (77.0–90.7) 38.0 (31.8–44.7) 34.9 (25.2–46.2) 40.6 (32.5–49.3)
Extent that epilepsy or its treatment limited activities in past month
No limitations 74.7 (69.8–79.1) 95.0 (90.5–97.4) 57.9 (50.9-64.7) 34.9 (25.3–45.9) 76.5 (66.7–84.0) Slightly or moderately 13.8 (10.9–17.5) 2.5 (1.0–5.7) 23.2 (18.1-29.2) 32.2 (23.9–41.8) 16.0 (9.8–24.9) Quite a bit or extremely 11.4 (8.1–15.9) 2.5 (0.9–6.8) 18.9 (13.3-26.0) 32.9 (22.7–45.0) 7.6 (3.5–15.8)
* Self-reported epilepsy as determined by an affirmative response to the question “Have you ever been told by a doctor that you have a seizure disorder or epilepsy?”
† Arizona, Delaware, Georgia, Kentucky, Michigan, Missouri, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Washington, and Wyoming.
§ Confidence interval.
Ά Respondents were classified as having active epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or
epilepsy and also responded that they either were currently taking medication for epilepsy, had one or more seizures in the preceding 3 months, or both. Respondents were classified as having inactive epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or epilepsy but were not taking medication for epilepsy and had not had a seizure in the preceding 3 months.
** Respondents who reported taking medication for epilepsy (i.e., were classified as having active epilepsy).
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Table 4

TABLE 4. Estimated prevalence of active and inactive epilepsy* among adults, by sex, age, and race/ethnicity — 13 states,†
Behavioral Risk Factor Surveillance System, 2005
Total
Active epilepsy
Inactive epilepsy
Characteristic
sample size
No.
%
(95% CI§)
No.
%
(95% CI)
Total
87,891
919
0.84
(0.74–0.96)
693
0.75
(0.65–0.86)
Sex
Male
32,954
333
0.77
(0.62–0.95)
231
0.69
(0.55–0.88)
Female
54,937
586
0.92
(0.79–1.07)
462
0.80
(0.67–0.95)
Age (yrs) 18–24
4,457
18
0.35Ά
(0.19–0.67)
40
0.79Ά
(0.48–1.3)
25–34
11,041
103
0.92
(0.61–1.37)
94
0.81
(0.55–1.2)
35–44
15,143
165
0.95
(0.73–1.24)
158
0.97
(0.73–1.3)
45–54
18,147
260
1.18
(0.95–1.46)
180
0.82
(0.63–1.1)
55–64
16,436
177
0.79
(0.60–1.02)
132
0.63
(0.47–0.85)
65–74
12,501
121
0.87
(0.62–1.22)
58
0.54
(0.41–0.98)
>75
9,691
68
0.53
(0.32–0.86)
30
0.23
(0.12–0.43)
Race/Ethnicity
White
73,151
756
0.87
(0.75–0.99)
561
0.72
(0.62–0.84)
Black
7,220
74
0.89
(0.55–1.45)
63
0.71
(0.45–1.10)
Hispanic
3,502
30
0.66Ά
(0.33–1.32)
25
0.90Ά
(0.40–1.98)
Other
3,239
42
0.51Ά
(0.26–0.98)
34
0.81Ά
(0.42–1.53)
* Respondents were classified as having active epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or
epilepsy and also responded that they either were currently taking medication for epilepsy, had one or more seizures in the preceding 3 months, or
both. Respondents were classified as having inactive epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure
disorder or epilepsy but were not taking medication for epilepsy and had not had a seizure in the preceding 3 months.
†Arizona, Delaware, Georgia, Kentucky, Michigan, Missouri, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Washington, and Wyoming.
§Confidence interval.
ΆRelative standard error of the estimate is >30%; estimate is unreliable.
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Table 5

TABLE 5. Number and percentage of adults with and without a history of epilepsy,* by selected characteristics and epilepsy
status† — 13 states,§ Behavioral Risk Factor Surveillance System, 2005
With history of epilepsy
Without history of epilepsy
Active epilepsy
Inactive epilepsy
(n = 86,258)
(n = 919)
(n = 693)
Characteristic
No.
%
(95% CIΆ)
No.
%
(95% CI)
No.
%
(95% CI)
Sex
Male
32,380
48.1
(47.4–48.8)
333
43.6
(37.1–50.2)
231
44.6
(37.5–52.0)
Female
53,878
51.9
(51.2–52.6)
586
56.4
(49.8–62.9)
462
55.4
(48.0–62.5)
Age (yrs)
18–24
4,397
12.8
(12.1–13.5)
18
5.3**
(2.9–9.7)
40
13.4
(8.4–20.7)
25–34
10,842
17.9
(17.3–18.4)
103
19.4
(13.6–26.8)
94
19.6
(13.7–27.1)
35–44
14,819
19.6
(19.1–20.1)
165
22.1
(17.2–27.8)
158
25.7
(20.0–32.5)
45–54
17,700
18.6
(18.1–19.1)
260
26.1
(21.3–31.5)
180
20.5
(15.9–25.9)
55–64
16,123
14.0
(13.6–14.4)
177
13.0
(10.0–16.8)
132
11.9
(8.8–16.0)
65–74
12,320
8.8
(8.6–9.1)
121
9.1
(6.5–12.6)
58
6.3
(4.1–9.8)
>75
9,590
8.3
(8.0–8.6)
68
5.1
(3.1–8.3)
30
2.5*
(1.3–4.8)
Race/Ethnicity
White
71,816
77.6
(76.9–78.2)
756
80.4
(73.8–85.7)
561
76.1
(68.0–82.6)
Black
7,081
10.2
(9.8–10.7)
74
11.0
(6.9–16.9)
63
9.8
(6.3–14.8)
Hispanic
3,447
7.0
(6.5–7.5)
30
5.5**
(2.8–10.6)
25
8.5*
(3.9–17.3)
Other
3,163
5.2
(4.9–5.6)
42
3.2
(1.6–6.0)
34
5.7*
(3.0–10.4)
Education
Less than high school
8,923
10.4
(10.0–10.9)
139
15.9
(11.9–20.9)
107
16.7
(12.0–22.8)
High school graduate
28,010
31.6
(31.0–32.3)
341
37.0
(31.1–43.2)
225
34.0
(27.6–41.1)
Some college or college graduate
49,165
58.0
(57.3–58.7)
439
47.1
(40.7–53.6)
361
49.3
(42.1–56.4)
Income
<$25,000
22,654
26.5
(25.8–27.2)
433
47.7
(40.7–54.9)
253
40.7
(33.4–48.4)
$25,000–$49,999
23,544
29.8
(29.2–30.5)
183
26.3
(20.7–32.9)
187
26.4
(20.6–33.2)
>$50,000
28,043
43.7
(43.0–44.4)
151
26.0
(19.7–33.4)
156
32.9
(25.6–41.1)
Marital status
Married or unmarried couple
50,029
62.5
(61.8–63.2)
424
53.9
(47.4–60.2)
347
58.0
(50.9–64.8)
Formerly married
25,055
18.2
(17.8–18.7)
335
26.6
(21.7–32.3)
230
22.2
(17.7–27.5)
Never married
10,913
19.2
(18.6–20.0)
154
19.5
(14.6–25.7)
113
19.8
(14.3–26.8)
Employment status
Employed
46,804
61.2
(60.5–61.9)
265
36.0
(30.0–42.6)
356
55.4
(48.2–62.3)
Unemployed
3,569
5.4
(5.1–5.9)
62
9.8
(6.4–14.6)
35
8.3**
(4.8–14.1)
Unable to work
5,213
4.9
(4.6–5.1)
316
31.3
(25.6–37.6)
131
15.4
(11.5–20.3)
Other (homemaker, student, or retired)
30,442
28.5
(27.9–29.1)
272
22.9
(18.4–28.1)
169
20.9
(16.0–27.0)
* Self-reported epilepsy as determined by response to the question “Have you ever been told by a doctor that you have a seizure disorder or epilepsy?”
† Respondents were classified as having active epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or epilepsy and also responded that they either were currently taking medication for epilepsy, had one or more seizures in the preceding 3 months, or both. Respondents were classified as having inactive epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or epilepsy but were not taking medication for epilepsy and had not had a seizure in the preceding 3 months.
§ Arizona, Delaware, Georgia, Kentucky, Michigan, Missouri, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Washington, and Wyoming. Ά Confidence interval. ** Relative standard error of the estimate is >30%; estimate is unreliable.
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Table 6

TABLE 6. Number and percentage of adults with and without a history of epilepsy,* by risk factors, comorbid conditions, and epilepsy status† — 13 states,§ Behavioral Risk Factor Surveillance System, 2005 With history of epilepsy Without history of epilepsy Active epilepsy Inactive epilepsy (n = 86,258) (n = 919) (n = 693) Characteristic No. % (95% CIΆ) No. % (95% CI) No. % (95% CI)
Self-rated health
Good or excellent
69,824
84.2
(83.7–84.7)
444
51.5
(45.0–57.9)
460
71.5
(65.4–76.8)
Fair or poor
16,198
15.8
(15.3–16.3)
468
48.5
(42.1–55.0)
228
28.5
(23.2–34.6)
Health-care insurance
Yes
75,936
85.9
(85.3–86.4)
808
89.1
(85.1–92.2)
572
76.1
(68.8–82.1)
No
10,121
14.1
(13.6–14.7)
111
10.9
(7.8–14.9)
121
23.9
(17.9–31.2)
Could not visit doctor because of cost
Yes
10,613
12.8
(12.3–13.3)
201
20.4
(15.7–26.0)
162
24.7
(18.8–31.6)
No
75,469
87.2
(86.7–87.7)
716
79.6
(74.0–84.3)
528
75.3
(68.4–81.2)
Checkup
Within past year
60,048
67.5
(66.8–68.2)
679
71.5
(65.1–77.1)
465
63.1
(55.5–70.1)
Within past 2 years
10,946
14.6
(14.0–15.1)
93
13.3
(8.9–19.3)
88
11.5
(7.7–16.9)
Within past 5 years
6,412
8.7
(8.3–9.1)
65
7.8
(5.3–11.3)
60
11.2
(7.0–17.5)
>5 years
6,616
8.0
(7.6–8.3)
56
6.9
(4.3–10.7)
64
13.7
(8.8–20.7)
Never
966
1.2
(1.1–1.4)
—
—
—
—
—
—
Body mass index Underweight (<18.5 kg/m2)
10,114
6.4
(6.2–6.6)
131
8.7
(6.7–11.2)
80
9.4
(6.0–14.3)
Normal weight (18.5–24.9 kg/m2)
25,611
35.7
(35.0–36.4)
263
32.6
(26.7–39.0)
186
32.2
(25.7–39.6)
Overweight (25.0–29.9 kg/m2)
26,773
34.6
(33.9–35.3)
233
26.6
(29.7–33.4)
210
26.5
(21.0–33.0)
Obese (>30 kg/m2)
19,616
23.3
(22.7–23.9)
246
32.2
(26.3–38.7)
201
31.9
(25.3–39.2)
Exercise in past 30 days
Yes
63,905
75.4
(74.8–76.0)
539
60.7
(54.5–66.6)
468
71.7
(65.3–77.3)
No
22,275
24.6
(24.0–25.2)
376
39.3
(33.4–45.5)
224
28.3
(22.7–34.7)
Smoking status
Current smoker
17,519
21.6
(21.0–22.2)
299
32.4
(26.4–39.0)
211
32.0
(25.7–39.1)
Former smoker
24,661
25.5
(24.9–26.1)
251
26.5
(21.4–32.3)
188
21.7
(16.9–27.6)
Never smoked
43,720
52.9
(52.2–53.6)
367
41.2
(35.0–47.6)
292
46.2
(39.1–53.5)
Alcohol consumption in past month
Yes
42,466
53.4
(52.7–54.1)
278
30.4
(25.0–36.4)
289
45.2
(38.1–52.5)
No
43,641
46.6
(45.9–47.3)
640
69.6
(63.6–75.0)
404
54.8
(47.5–61.9)
* Self-reported epilepsy as determined by response to the question “Have you ever been told by a doctor that you have a seizure disorder or epilepsy?”
† Respondents were classified as having active epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or epilepsy and also responded that they either were currently taking medication for epilepsy, had one or more seizures in the preceding 3 months, or both. Respondents were classified as having inactive epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or epilepsy but were not taking medication for epilepsy and had not had a seizure in the preceding 3 months.
§ Arizona, Delaware, Georgia, Kentucky, Michigan, Missouri, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Washington, and Wyoming. Ά Confidence interval. ** Relative standard error of the estimate is >30%; estimate is unreliable.

TABLE 6. (Continued ) Number and percentage of adults with and without a history of epilepsy,* by risk factors, comorbid conditions, and epilepsy status† — 13 states,§ Behavioral Risk Factor Surveillance System, 2005 With history of epilepsy Without history of epilepsy Active epilepsy Inactive epilepsy (n = 86,258) (n = 919) (n = 693) Characteristic No. % (95% CIΆ) No. % (95% CI) No. % (95% CI)
Ever told had a stroke
Yes
2,857
2.4
(2.3–2.6)
168
15.7
(11.3–21.4)
58
7.3
(4.3–12.0)
No
83,184
97.6
(97.4–97.7)
737
84.3
(78.6–88.7)
628
92.7
(88.0–95.7)
Ever told had heart disease
Yes
4,901
4.6
(4.3–4.8)
110
8.4
(5.6–11.8)
50
4.8
(3.0–7.4)
No
80,635
95.4
(95.2–95.7)
793
91.6
(88.2–94.1)
635
95.2
(92.6–97.0)
Ever told had asthma
Yes
7,470
8.2
(7.8–8.6)
181
20.3
(15.3–26.4)
108
11.9
(8.1–17.0)
No
78,324
91.8
(91.4–92.2)
727
79.7
(73.6–84.7)
576
88.1
(83.0–91.9)
Ever told had diabetes
Yes
8,841
7.7
(7.4–8.0)
120
13.0
(8.3–19.7)
91
14.9
(10.4–20.8)
No
77,690
92.3
(92.0–92.6)
797
87.0
(80.3–91.7)
602
85.1
(79.2–89.6)
Ever told had arthritis
Yes
31,132
28.0
(27.5–28.6)
476
43.0
(37.0–49.2)
303
41.8
(34.8–49.1)
No
54,736
72.0
(71.4–72.5)
440
57.0
(50.8–63.0)
389
58.2
(50.9–65.2)
Current joint pain
Yes
40,394
40.8
(40.2–41.5)
573
57.7
(51.1–64.1)
394
54.1
(46.8–61.2)
No
45,673
59.2
(58.5–59.8)
343
42.3
(35.9–48.9)
299
45.9
(38.8–53.2)
5 servings/day of fruits and vegetables
Yes
25,391
26.4
(25.8–27.0)
275
21.6
(17.4–26.3)
193
27.4
(21.2–34.6)
No
60,764
73.6
(73.0–74.2)
640
78.4
(73.7–82.6)
500
72.6
(65.4–78.8)
Flu shot in past year
Yes
26,809
26.0
(25.4–26.6)
323
32.5
(26.7–38.9)
190
23.1
(17.9–29.3)
No
59,221
74.0
(73.4–74.6)
593
67.5
(61.1–73.3)
503
76.9
(70.7–82.1)
Human immunodeficiency virus risk situations
Yes
1,862
3.8
(3.4–4.2)
24
4.6**
(2.4–8.7)
29
5.2**
(2.6–9.9)
No
62,267
96.2
(95.8–96.6)
703
95.4
(91.3–97.6)
576
94.8
(90.1–97.4)
Receipt of emotional support
Always or usually
66,901
79.0
(78.4–79.6)
571
59.3
(52.5–65.8)
468
66.6
(59.3–73.2)
Sometimes
11,340
13.4
(12.9–13.9)
181
21.6
(16.3–27.9)
118
21.1
(15.8–27.6)
Rarely or never
6,564
7.6
(7.2–8.0)
149
19.1
(14.0–25.6)
94
12.3
(7.9–18.6)
Life satisfaction
Very satisfied or satisfied
80,377
94.3
(93.9–94.6)
719
81.2
(76.3–85.3)
581
84.7
(78.1–89.6)
Dissatisfied or very dissatisfied
5265
5.7
(5.4–6.1)
184
18.8
(14.7–23.7)
102
15.3
(10.4–21.9)
* Self-reported epilepsy as determined by response to the question “Have you ever been told by a doctor that you have a seizure disorder or epilepsy?”
† Respondents were classified as having active epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or epilepsy and also responded that they either were currently taking medication for epilepsy, had one or more seizures in the preceding 3 months, or both. Respondents were classified as having inactive epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or epilepsy but were not taking medication for epilepsy and had not had a seizure in the preceding 3 months.
§ Arizona, Delaware, Georgia, Kentucky, Michigan, Missouri, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Washington, and Wyoming. Ά Confidence interval. ** Relative standard error of the estimate is >30%; estimate is unreliable.
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Table 7

TABLE 7. Number and percentage of adults with active epilepsy* and any seizures within past 3 months, by selected characteristics
— 13 states,† Behavioral Risk Factor Surveillance System, 2005
Total with
Any seizures in past 3 months
Characteristic
active epilepsy
No.
%
(95% CI§)
Total
892Ά
377
43.9
(37.5–50.4)
Sex
Male
324
126
37.6
(27.7–48.7)
Female
568
251
48.8
(40.9–56.6)
Race/Ethnicity
White
737
294
40.0
(33.6–46.8)
Black
70
32
53.9
(30.4–75.7)
Hispanic
28
17
79.2
(50.3–93.5)
Other
41
24**
23.2
(9.9–45.4)
Age (yrs)
18–34
116
65
55.2
(37.7–71.5)
35–44
162
85
46.3
(33.4–59.7)
45–64
427
184
43.7
(35.5–52.3)
>65
182
39**
20.1
(10.0–36.4)
Income
<$25,000
420
226
57.3
(47.5–66.5)
$24,999–$49,999
183
65
44.0
(31.2–57.6)
>$50,000
148
28**
20.9
(12.1–33.7)
Employment status
Employed
260
81
33.2
(23.8–44.1)
Unemployed or unable to work
369
219
59.2
(49.0–68.7)
Other (homemaker, student, or retired)
260
74
33.5
(23.2–45.7)
* Respondents were classified as having active epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or epilepsy and also responded that they either were currently taking medication for epilepsy, had one or more seizures in the preceding 3 months, or both.
† Arizona, Delaware, Georgia, Kentucky, Michigan, Missouri, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Washington, and Wyoming.
§ Confidence interval.
Ά Total number of persons with active epilepsy who provided a valid response to the question on seizure frequency.
** Relative standard error of the estimate is >30%; estimate is unreliable.
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Table 8

TABLE 8. Health-related quality of life indicators among adults with and without a history of epilepsy,* by epilepsy status and seizure activity† — multiple states, Behavioral Risk Factor Surveillance System, 2005
Indicators
Mentally
Physically
Overall
Activity-limitation
unhealthy days
unhealthy days
unhealthy days
days
Epilepsy status
No.§
No.
(95% CIΆ)
No.
(95% CI)
No.
(95% CI)
No.
(95% CI)
With history of epilepsy**
2,150
7.3
(6.5–8.1)
9.1
(8.2–10.1)
13.0
(11.9–14.0)
6.8
(6.0–7.7)
Without history of epilepsy**
117,279
3.2
(3.2–3.3)
3.5
(3.4–3.6)
5.9
(5.8–6.0)
2.1
(2.0–2.2)
Epilepsy classification and seizure activity††
No history of epilepsy
85,223
3.4
(3.3–3.5)
3.6
(3.5–3.7)
6.1
(6.0–6.3)
2.2
(2.1–2.3)
Inactive epilepsy
680
6.1
(5.0–7.3)
6.9
(5.4–8.5)
11.0
(9.2–12.8)
5.2
(4.1–6.3)
Active epilepsy
895
9.3
(7.9–10.8)
10.7
(9.3–12.1)
15.1
(13.4–16.7)
8.4 (6.9–10.0)
No seizures in past 3 months
507
7.6
(5.8–9.4)
8.8
(7.2–10.4)
13.0
(11.0–14.9)
6.4
(4.6–8.1)
Any seizures in past 3 months
364
11.4
(9.1–13.7)
13.1
(10.7–15.5)
17.6
(14.9–20.2)
11.1
(8.4–13.8)
* Self-reported epilepsy as determined by response to the question “Have you ever been told by a doctor that you have a seizure disorder or epilepsy?”
† Respondents were classified as having active epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or epilepsy and also responded that they either were currently taking medication for epilepsy, had one or more seizures in the preceding 3 months, or both. Respondents were classified as having inactive epilepsy if they responded “yes” to ever having been told by a doctor that they had a seizure disorder or epilepsy but were not taking medication for epilepsy and had not had a seizure in the preceding 3 months.
§ Sample size is based on largest number of respondents to health-related quality of life questions within epilepsy category.Ά Confidence interval. ** 19 states: Arizona, Delaware, Florida, Georgia, Kansas, Kentucky, Michigan, Missouri, New Hampshire, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington, Wisconsin, and Wyoming.
†† 13 states: Arizona, Delaware, Georgia, Kentucky, Michigan, Missouri, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Washington, and Wyoming.
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Figure

FIGURE. Definitions of active and inactive epilepsy — Behavioral Risk Factor Surveillance System, 2005
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