1. Introduction

Epilepsy is one of the most prevalent neurological disorders, affecting 50 million individuals globally, according to the World Health Organization (WHO) [1]. Epilepsy is characterized by a chronic tendency to have repeated seizures that are not associated with an explicit immediate cause. Seizures are defined as transient signs and symptoms of abnormal excessive synchronous neuronal firing in a region of the brain or across the entire brain [2]. Seizure symptoms vary widely. They can manifest as brief motor or nonmotor (altered sensation, cognition, or mood) conditions with or without altered awareness [3, 4]. The most common causes of seizures in children are genetic factors, perinatal injuries, and cortical developmental abnormalities, while encephalitis/meningitis, traumatic brain injury, and brain tumors are major causes of seizures in older individuals without a genetic predisposition to the condition [1, 5, 6].

The prevalence of epilepsy in Saudi Arabia has been estimated to be 6.54/1000 individuals, which is similar to the rates reported in other locations [7]. According to the WHO, the estimated prevalence of active epilepsy in the general population at a given time is between four and 10 per 1000 people [1]. People with epilepsy (PWE) are likely to experience stigma because of their illness, leading to emotional and psychological consequences. Studies have shown that PWE have a higher prevalence of major depressive syndrome and anxiety, along with a decreased quality of life due to discrimination and negative attitudes [8, 9]. According to previous research, there is a lack of public awareness in Saudi Arabia regarding what causes seizures and how to respond when witnessing a seizure [10]. Moreover, negative attitudes toward PWE are commonly reported, highlighting the importance of public education and advancement in seizure knowledge [10–13]. Our research explored societal awareness of seizures among residents of Madinah to assess the need for educational initiatives and campaigns.

In 2022, research was conducted in Makkah City to assess public knowledge and awareness of seizure attacks. Of the 401 participants, 32.9% reported a good knowledge level versus 67.1% reporting a poor level [14]. In a study of 448 residents of the Eastern Province of Saudi Arabia, 24.8% of the sample reported a good level of knowledge about epilepsy, and males and females had similarly positive attitudes toward PWE (50.3% and 43.1%, respectively) [15]. In Rabigh Province, 87% of 511 respondents reported they were unsure of what to do if someone was having an active seizure, beyond removing them from danger [16]. A systematic review and meta-analysis of 27 studies in 2021 reported that people’s overall awareness level was unsatisfactory and that the population’s attitude regarding marriage, employment, and children was negative [10].

In 2019, Alsohibani et al. conducted a study with 3800 individuals in Al-Qassim, Saudi Arabia. The data revealed that 73.2% of parents would permit their children to play with a peer with epilepsy, 35.7% would allow their children to marry someone with epilepsy, and 74.9% believed that PWE are equally capable of fulfilling job responsibilities [13]. Another study conducted in Jeddah with 1940 participants reported that 17.1% of respondents thought epilepsy was the result of a genetic disorder, while 60% believed it is a brain disease. In terms of management, 50% of the participants thought epilepsy could be treated by medications, and 31.5% believed that recitation of the Quran could be a treatment for this disease [17]. A cross-sectional study conducted in local communities in Saudi Arabia found that 24.5% of male respondents and 26.2% of female respondents believed PWE should be allowed to drive [18].

Seizure episodes are a common neurological condition that affects a significant portion of the population. However, a lack of public understanding and misconceptions surrounding seizure episodes have been observed. These misconceptions can result in inappropriate responses when individuals witness a seizure episode. This study investigated public awareness, knowledge, and attitudes toward seizure episodes to gather valuable insights, identify areas where misinformation exists, and determine the need for public education. Additionally, the data provide insights into the effectiveness of current first aid and educational programs. By addressing these aims and objectives, we aimed to enhance public awareness and foster appropriate responses, leading to improved outcomes for individuals experiencing seizure episodes.

2. Research Objectives

3. Methodology

4. Results

After excluding 46 individuals who did not agree to participate in the study, the sample consisted of 2626 participants residing in Madinah with a response rate of 98.3%. Table 1 presents the sociodemographic characteristics of the sample. Of the participants, 32.9% identified as male, and 67.1% identified as female. Most participants (65.7%) fell within the age range of 18–30 years, and 50.3% of them were students. Additionally, 63.7% of the sample were single. Regarding education, most participants (61.8%) had completed a bachelor’s degree.

Figure 1 portrays the participants’ awareness of epilepsy. Most participants (92.2%) reported having heard or read about epilepsy, and 77.1% indicated having a personal acquaintance who has epilepsy. In contrast, a small portion (18.4%) of the sample had a family member diagnosed with epilepsy, and 12.8% had attended a course on controlling epileptic seizures. However, over half of the participants (56.9%) reported having witnessed someone experiencing a seizure.

Figure 2 depicts the responses to knowledge questions, indicating an acceptable level of understanding about epilepsy among the participants in the current study. When asked about the cause of epilepsy, 73.7% identified it as a neurological disease, 57.9% as a brain disease, and half of the respondents (50.3%) said it was a hereditary disease. However, 36% indicated they believe epilepsy is a psychiatric disease, with 21.9% stating it is caused by an “evil eye.”

The majority of responders (93.7%) indicated convulsions as a manifestation of epilepsy, whereas 26.3% thought it could manifest as a change in behavior. In terms of immediate management of acute seizing episodes, 64.5% mentioned putting a spoon or cloth in the patient’s mouth, and 53.4% indicated they would place the patient on one side and hold their head down. Regarding the best treatment for epilepsy, 83.1% stated that medical treatment and follow-up were the best option. However, 40.8% mentioned reciting the Quran as an appropriate form of treatment, and 7% believed that epilepsy is untreatable. Additionally, 56.2% of participants were unaware that surgery could be a treatment option for medically uncontrollable epilepsy, and 26.5% expressed uncertainty about whether surgery is a viable option. The average knowledge score about epilepsy for the sample was 22 (SD ± 3.2), indicating that the participants had moderate knowledge about epilepsy.

The attitudes of the respondents toward epilepsy are depicted in Figure 3. Most respondents (95.2%) disagreed with the idea that epilepsy is contagious, and 71.6% disagreed with the claim that it is a form of insanity or madness. Additionally, 83% and 78% of individuals agreed that epileptic women can marry and have children, respectively. Similarly, 77.1% agreed that epileptic children can succeed in regular classes, and 76.1% agreed that epileptic persons should have equal employment opportunities. Further, 84.7% would permit their children to play with a peer who has epilepsy. Most participants expressed a willingness to work with PWE and form close friendships with them (88.6% and 90.1%, respectively). However, only 38.2% of respondents were accepting of the idea of their children or family members marrying someone with epilepsy. The mean attitude toward epilepsy was 27.14 (SD ± 3.1).

Figure 4 shows responses to seizure attacks. The majority (93.9%) of participants indicated they would call an ambulance during a convulsive seizure. Additionally, 51.4% would hold the patient tightly, 51.2% would try to hold the patient’s tongue, 29.6% would spray water over the patient’s face, while 8.3% would choose to merely observe without intervening.

Females demonstrated significantly higher knowledge of epilepsy, a more positive attitude toward epilepsy, and a more appropriate response when witnessing a seizure compared to males (p < 0.001). Participants aged 18–30 exhibited good knowledge of epilepsy and a more appropriate response when witnessing a seizure compared to those in other age groups (p < 0.001). We noted significant differences in epilepsy knowledge and actions when witnessing a seizure based on marital status, occupation, and family income. Single individuals and students demonstrated better knowledge and responses during seizures (p = 0.002, p < 0.001, and p < 0.001, respectively). Participants with incomes less than 15,000 SR also demonstrated better knowledge (p = 0.001) and responses during seizures (p = 0.045) compared to those with higher incomes. Participants who had prior exposure to information about epilepsy, had a family member diagnosed with epilepsy, or had attended a course on controlling epileptic seizures displayed a higher level of knowledge about epilepsy (p < 0.001), a positive attitude toward epilepsy (p < 0.001), and better actions during seizure attacks (p < 0.001) (Tables 2, 3, and 4).

Pearson’s correlation analysis was conducted to analyze the association between knowledge, attitude, and awareness about epilepsy. The results indicated that all variables were significantly and positively associated with each other (p < 0.001) (Table 5).

5. Discussion

The study found a high level of awareness about epilepsy in the Madinah community, as a significant proportion of respondents had heard or read about epilepsy (92.2%). However, only a small proportion of people had received formal education about epilepsy (12.8%), which significantly affected their understanding of the disease. They strongly believed that epilepsy is a form of psychiatric disease (36.1%) or mental and emotional stress (43.5%), showing their misconceptions about the disease. In addition, half of the respondents attributed epilepsy to hereditary factors (50.3%), which, although it may be accurate in certain instances, is not universally correct. Such beliefs also had a significant impact on people’s attitudes, particularly regarding marrying someone with epilepsy. Moreover, a notable proportion associated seizures with possession by demons (7.8%) or an evil spirit (21.9%). This finding is consistent with previous studies conducted across various regions in Saudi Arabia, including Jeddah [11], Rabigh [16], Majmaah [19], Taif [20], and Al-Kharj [21] as well as in other Gulf countries like Yemen [23] and Iran [24]. Such beliefs may contribute to the societal stigma surrounding epilepsy. Addressing these misconceptions is crucial, as they play a pivotal role in fostering a more informed and empathetic community attitude toward PWE.

The study also found that a considerable percentage of respondents had witnessed someone having a seizure (43.1%). However, it also revealed certain misconceptions about appropriate first aid measures, such as placing a spoon or piece of cloth in the patient’s mouth. Similar results were reported in studies conducted in Al-Majmaah [19], Rabigh [16], and Taif [20] in Saudi Arabia as well as in the United Kingdom [25] and Palestine [26]. Additionally, nearly half of the respondents said they would “try to hold the patient’s tongue to prevent tongue swallowing” (51.2%) or “hold the patient tight and try preventing them from seizing” (51.4%). Furthermore, 29.6% of respondents said they would “spray water over the patient’s face,” which is a higher percentage than reported in Jeddah [17] and Palestine [26]. This highlights a critical area for educational intervention to improve public response during seizures. Surprisingly, the participants also failed to recognize that surgery is a treatment option in refractory cases, reflecting a knowledge and awareness gap in medical treatment. This finding is similar to public awareness of surgery outcomes reported in Makkah City [14] and Palestine [26] but dissimilar to public awareness of surgical outcomes in western countries such as Canada [27], the United States [28], and Norway [29]. This suggests a strong need for targeted educational initiatives in Saudi Arabia to enhance awareness of available medical treatments, potentially bridging the gap between nonmedical beliefs and essential medical intervention.

In terms of attitudes toward PWE, the participants generally reported a positive attitude. For instance, a majority (95.2%) disagreed with the statement that “Epilepsy is contagious.” Additionally, positive attitudes were expressed regarding the reproductive rights of women with epilepsy and the potential success of children with epilepsy in regular classrooms. The participants also showed positive attitudes toward the employment of individuals with epilepsy, contrasting with findings from other regions [11, 16, 19–21].

The study also found several significant associations between sociodemographic characteristics and the participants’ knowledge, attitudes, and actions. For example, females were found to be more knowledgeable and more likely to have positive attitudes and engage in positive actions in relation to epilepsy. Similar findings about sex differences were previously established in both local and international studies [20, 21, 25, 26, 30–35]. However, these findings contrast with those published in other studies, which found negative attitudes to be more associated with the female sex [22, 36]. Although a study conducted in Taif found that male individuals have stigmatizing and negative attitudes [20], one study in Qassim and one in the Eastern Province of Saudi Arabia found that males reported having higher levels of knowledge [13, 15]. Another study conducted in the United Kingdom found more positive attitudes in men than in women [25]. While a study in Iran did not find any significant association between knowledge and gender, it did report a significant association between attitude and female gender [33]. On the contrary, a study conducted in Palestine revealed a significant association between gender and knowledge but no significant association between gender and attitude [26]. In a Moscow-based study, gender was only significantly associated with the understanding of epilepsy as a curable disease but not with attitude [34]. Previous research has also revealed gender-specific attitudes toward people living with epilepsy in Nigeria [35] and Bahrain [32]. The inconsistent findings regarding sex and its association with knowledge and attitudes toward epilepsy might indicate that the effect of sex may be influenced by a multitude of factors.

In this study, younger people aged 18–30 years were more knowledgeable about epilepsy than older adults. This finding is consistent with studies conducted in Qassim [13], the Eastern Province of Saudi Arabia [15], the rural Cameroon Region in Central Africa [36], Ethiopia [28], and Norway [29], which also concluded that younger age is associated with better knowledge of epilepsy. One possible explanation for this trend could be the increased accessibility and exposure to information through modern educational resources, including the Internet and educational campaigns, which are more commonly utilized by members of the younger age group. However, age was not found to be significantly associated with knowledge among school teachers in Bahrain [32] and Iran [24, 33]. Moreover, age was not significantly associated with attitudes toward epilepsy in a study conducted in Moscow [34]. This insignificant association could be attributed to the fact that people of all ages in these countries are susceptible to developing epilepsy, causing them to become more knowledgeable and have positive attitudes toward it.

A higher level of education is another factor that was found to positively influence the level of knowledge and attitudes of the residents of Madinah Al-Munawara toward epilepsy. This finding is consistent with several published studies in different regions [20–23, 26, 28, 33, 34, 36–38]. However, previous studies reported no significant association between education and knowledge among school teachers in Bahrain [32] as well as between education and attitudes toward epilepsy in the general UK population [25]. Nevertheless, it is evident that in most of the cases, education is associated with a high level of knowledge and positive attitudes toward epilepsy, which highlights the importance of educational initiatives to spread awareness and create a positive understanding of this disease.

In this study, people who had family members with epilepsy and those who had attended a course on controlling seizures had better knowledge, took more positive actions, and had higher attitude scores. Similar results were reported in the populations of Al-Kharj [21], Cameroon [36], the Eastern Province of Saudi Arabia [15], the United Kingdom [25], Palestine [26], and Moscow [34]. However, economic status was not found to be significantly associated with knowledge among school teachers in Bahrain [32] and Iran [33]. Based on these findings, educational programs are needed to increase awareness about epilepsy and emphasize positive attitudes and actions toward it.

Surprisingly, in our study, people with an income of less than 15,000 SR were found to be more knowledgeable and take more action in comparison to those with a higher income. This contradicts the results of four studies that correlated higher income with more knowledge and positive attitudes and vice versa [16, 23, 31, 35]. A possible explanation for this unexpected finding could be that individuals with lower incomes might be more motivated to seek information and education about epilepsy due to a perceived need for self-reliance in managing their health concerns. Additionally, lower-income individuals might have more exposure to educational programs or community outreach initiatives that focus on health issues, including epilepsy. It is crucial to explore the specific factors influencing knowledge acquisition and positive actions in different income groups through further research and targeted investigations.

6. Strengths and Limitations

The study contributes to the literature by associating demographic characteristics with knowledge, awareness, attitudes, and actions taken in relation to epilepsy. It critically explored how specific factors influence knowledge acquisition and actions to combat epilepsy as well as how awareness translates into people’s attitudes and actions in relation to epilepsy. Further, the study highlighted the impact of spreading information on epilepsy on public knowledge obtained through educational programs. It also pinpointed the demographic groups that are more likely to have good knowledge, positive attitudes, high awareness, and good action plans in relation to epilepsy. The findings of this study can be used to focus on demographic groups that lack knowledge and awareness and have bad attitudes toward epilepsy to help mitigate the negative impact of this disease on society.

This study is aimed at evaluating the awareness, knowledge level, and attitudes toward seizure attacks of the general population of Madinah City. Every attempt was made to obtain precise, reliable, and satisfactory results. Nonetheless, some limitations must be acknowledged. First, an online questionnaire was used for the study. A physical form could have yielded more accurate results given that older adults may not have the computer skills to access such a survey, and part of the population that may have lacked reliable internet service could not be reached. Second, since the survey was distributed by 50 volunteers, family and friends with similar attitudes may have been recruited. As a result, further research on this subject is needed using various study designs and sociodemographic data. Third, the study only focused on knowledge, attitudes, and awareness about epilepsy without considering the experiences and general practices of PWE. Future research should focus on how experiences and general practices related to epilepsy are shaped and may affect individuals’ knowledge, attitudes, and awareness about epilepsy.

7. Conclusion

Our results showed that the general public’s attitudes toward epilepsy were reasonably favorable and their knowledge levels were acceptable. However, the data also revealed that the respondents had some misconceptions, such as the incorrect belief that epilepsy is a psychological disorder or that it is caused by an “evil eye.” Additionally, most of the participants were unaware that surgery is a treatment option for refractory cases, and the majority lacked knowledge of appropriate actions to take when witnessing a seizure. Consequently, educational awareness initiatives are needed to increase public understanding of epilepsy and appropriate actions to take during a seizure. This could help to reduce stigma and better support PWE. The results of this study can be used to support global comparisons of epilepsy with the situation in Saudi Arabia.

Conflicts of Interest

The authors declare no conflicts of interest.

Author Contributions

The authors confirm their contribution to the paper as follows: study conception and design: Bayan M. Almarwani and Abdullah A. Tawakul; data collection: Sadin Ayman Alamri, Aseel Ayman Alamri, Ahmad Salim Badawi, Afnan Mohammad Akhwan, Zakaria Yahya Khawaji, and Basel MohammedBassam Garah; analysis and interpretation of results: Bayan M. Almarwani; draft manuscript preparation: Sadin Ayman Alamri, Aseel Ayman Alamri, Ahmad Salim Badawi, Afnan Mohammad Akhwan, Zakaria Yahya Khawaji, Basel MohammedBassam Garah, and Abdullah A. Tawakul. All authors reviewed the results and approved the final version of the manuscript. All authors agree to be accountable for the content and conclusions of the article.

Funding

No funding was received for this research.