A 6-Month Prospective Randomized Controlled Trial of Remotely Delivered Group-Format Epilepsy Self-Management vs. Wait-List Control for High-Risk People With Epilepsy
Abstract number :
1.218
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2018
Submission ID :
479850
Source :
www.aesnet.org
Presentation date :
12/1/2018 6:00:00 PM
Published date :
Nov 5, 2018, 18:00 PM
Authors :
Martha Sajatovic, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center; Kari Colon-Zimmermann, Case Western Reserve University School of Medicine; Mustafa Kahriman, Lois Stokes Cleveland VAMC, Case Western R
Rationale: In spite of advances in care, many people with epilepsy do poorly and have negative health events (NHEs) such as accidents, emergency department (ER) visits and low quality of life. “Self-management for people with epilepsy and a history of negative health events” (SMART) is a novel group-format epilepsy self-management approach. A community participatory approach informed the refinement of SMART which was then tested in a 6-month randomized controlled trial of SMART (N=60) vs. wait-list control (WL, N=60). Methods: Participants were adults = age 18 with epilepsy and an NHE within the last six months (seizure, accident, self-harm attempt, ER visit, or hospitalization). Assessments were conducted at screening, baseline, 10 weeks and 24 weeks (six-months). Primary outcome was 6-month change in total NHE count. Additional outcomes included depression on the 9-item Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS), quality of life on the 10-item Quality of Life in Epilepsy (QOLIE-10), functioning on the 36-item short-form health survey (SF-36), and seizure severity on the Liverpool Seizure Severity Scale. Results: Mean age was 41.3 years (SD = 11.82), 69.9% African-American, 74.2% unemployed and 87.4% with an annual income < U.S. $25,000. 57.5% had a seizure within 30 days of enrollment. Most NHEs were seizures. Six month study attrition was 14.2% overall and similar between arms. Individuals randomized to SMART had greater reduction in total median NHEs from baseline to 6-months compared to WL (p=.04). SMART was also associated with improved PHQ-9 (p=.032), MADRS (p= .002), QOLIE-10 (p< 0.001) and SF-36 (p=.015 physical health, p=.003 mental health) vs. WL. There was no difference in seizure severity. Conclusions: SMART appears to be associated with reduced health complications and improved mood, quality of life and health functioning in high-risk people with epilepsy. Additional efforts are needed to investigate potential for scale-up. Funding: This study was supported by a grant from the Centers for Disease Control and Prevention SIP 14-007 1U48DP005030.