In this narrative review, we will discuss some of the significant risks and dramatic consequences that are associated with epilepsy: depression, suicide, seizure-related injuries, and mortality, both in adults and in children. Considering the high prevalence of depression among people with epilepsy (PWE), routine and periodic screening of all PWE for early detection and appropriate management of depression is recommended. PWE should be screened for suicidal ideation regularly and when needed, patients should be referred for a psychiatric evaluation and treatment. When starting an antiepileptic drug (AED) or switching from one to another AED, patients should be advised to report to their treating physician any change in their mood and existence of suicidal ideation. The risk of injuries for the general epilepsy population is increased only moderately. The risk is higher in selected populations attending epilepsy clinics and referral centers. This being said, there are PWE that may suffer frequent, severe, and sometimes even life-threatening seizure-related injuries. The most obvious way to reduce risk is to strive for improved seizure control. Finally, PWE have a 2-3 times higher mortality rate than the general population. Deaths in PWE may relate to the underlying cause of epilepsy, to seizures (including sudden unexpected death in epilepsy [SUDEP] and seizure related injuries) and to status epilepticus, as well as to other conditions that do not appear directly related to epilepsy. Improving seizure control and patient education may be the most important measures to reduce epilepsy related mortality in general and SUDEP in particular.

Stammering has been defined as an interruption in the normal rhythm of speech of such a frequency and abnormality as to attract attention, interfere with communication or cause distress to a stammerer or his audience (Bloodstein, 1960).

In spite of strong prevalence of neck and shoulder musculoskeletal disorders among health care workers, the effect of their routine work activities, which demands physical exertion and high cognitive load, on the loading of neck-shoulder musculatures is not clearly understood. Additionally, it is currently unknown as to how the internal loading of the neck-shoulder musculature caused by the external work-related factors is affected by the individual personality. The purpose of this study was to evaluate the musculoskeletal loading of neck-shoulder musculature when human participants performed physically and cognitively demanding exertions. The loading of neck-shoulder musculature was evaluated using objective and subjective assessment methods. Electromyography (EMG) of the neck-shoulder musculature was used as the objective assessment method, whereas NASA-TLX scores were used as the subjective assessment method. Individual personality types were determined using MBIT personality test. Twenty (18 males and 2 females) participants were recruited for data collection. Each participant performed two experimental sessions: Session 1-physical exertion, participant performed 10 maximum static pulling exertions in semi standing posture simulating a bed-tostretcher patient transfer task. Session 2-physical and cognitive exertion, during this session, in addition to 10 static pulling exertions (same as session 1), the participant performed mentally demanding tasks such as memorizing and recalling a list of words. The activities of three major neck-shoulder muscles: upper trapezius, sternocleidomastoid, and cervical trapezius, were studied. Muscle activity data showed that the neck-shoulder muscles worked harder while performing a combination of physical and cognitive exertions than purely physical exertions. The effect of the loading of neck-shoulder muscles was found sensitive to the individual personality. In general for all the muscles, among the participants with feeling personalities, a higher increase in the activation level of muscles was observed. The knowledge gained from this study imply that investigations viewing the entire work system (the interaction of physical and psychosocial workplace issues, as well as individual factors) will most likely to derive the root causes of neck-shoulder MSDs among healthcare occupations. iii Acknowledgements I would like to express my sincere gratitude and deep appreciation to Dr. Ashish Nimbarte, my major advisor, for his guidance, invaluable recommendation, encouragement, understanding and wisdom. He was never lacking in kindness and support. He believed in me and gave me this opportunity at a crucial time in my life. Without his support this thesis would not have been a reality. I would also like to extend my appreciation to my committee members, Dr. Steve Guffey and Dr. Warren Myers, for their valuable suggestion on improving the quality of this thesis and for their teaching and advice during my graduate studies at West Virginia University. I wish to thank all my participan...