One-year follow-up of a remotely delivered epilepsy self-management program in high-risk people with epilepsy

Details

• Alternative Title:
  Epilepsy Behav
• Personal Author:
  Sajatovic, Martha ; Colon-Zimmermann, Kari ; Kahriman, Mustafa ; Fuentes-Casiano, Edna ; Burant, Christopher ; Aebi, Michelle E. ; Cassidy, Kristin A. ; Lhatoo, Samden ; Einstadter, Douglas ; Chen, Peijun
• Description:
  Objective:
  
  Self-management for people with epilepsy and a history of negative health events” (SMART) is a novel group-format epilepsy self-management intervention demonstrated to reduce negative health events (NHEs) such as accidents, emergency department visits, and seizures in adults with epilepsy in a 6-month prospective randomized controlled trial (RCT). SMART also reduced depressive symptoms and improved health functioning and quality of life. This report describes the longer-term (12-month) post-efficacy RCT outcomes in adults with epilepsy who received SMART.
  
  Methods:
  
  After completing a 6-month, prospective RCT that demonstrated efficacy of SMART vs. 6-month waitlist control (WL), adults ≥ age 18 with epilepsy were followed for an additional 12 months. Individuals originally randomized to WL received the 8-week SMART intervention immediately following the conclusion of the RCT. For this long-term extension analysis, assessments were conducted at 24 weeks (the 6-month primary outcome time-point of the efficacy RCT), at 32 weeks for individuals originally randomized to WL, and at 48 weeks and 72 weeks for all individuals. Outcomes assessed included past 6-month NHE counts, depressive symptoms assessed with the 9-item Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS), and quality of life assessed with the 10-item Quality of Life in Epilepsy (QOLIE-10).
  
  Results:
  
  At the beginning of this long-term observational period (24-week follow-up time point for the original RCT) there were 50 individuals in the group originally randomized to SMART and 52 originally randomized to WL. Mean age was 41.4 years, 70% women (N=71), 64% (N=65) African-American, 8% Hispanic (N=8). Study attrition from week 24 to week 72 was 8% in the arm originally randomized to SMART and 17% in the arm originally randomized to WL. During the 12-month observation period (24 weeks to 72 weeks) there were a total of 44 serious adverse events and 4 deaths, none related to study participation. There was no significant change in total past 6-month NHE counts in the group originally randomized to SMART, although the group had significantly reduced 6-month seizure counts. The group originally randomized to WL, who received SMART during this observational period, had a reduction in total NHE counts. The group originally randomized to SMART had relatively stable levels on other outcome variables except for a trend for improved MADRS (p=.08). In the group originally randomized to WL, there were significant improvements in PHQ-9 (p=.01), MADRS (p=<.01), and QOLIE-10 (p=.004).
  
  Conclusions:
  
  This post-RCT extension study suggests that adults with epilepsy who participate in the SMART intervention sustain clinical effects at 1-year follow-up and may have incremental improvements in seizure frequency and mood. Future research needs to identify opportunities for scale-up and outreach to other high-risk groups with epilepsy.
  
  
• Subjects:
  Adult Emergency Service, Hospital Epilepsy Female Follow-Up Studies Humans Male Middle Aged Prospective Studies Quality Of Life Self-Management

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• Keywords:
  Depression Epilepsy Quality Of Life Seizures Self-management
• Source:
  Epilepsy Behav. 96:237-243
• Pubmed ID:
  31126825
• Pubmed Central ID:
  PMC7370541
• Document Type:
  Journal Article
• Funding:
  U48 DP005030/DP/NCCDPHP CDC HHSUnited States/ ; U48DP005030/ACL/ACL HHSUnited States/ ; UL1 TR000439/TR/NCATS NIH HHSUnited States/ ; UL1 TR002548/TR/NCATS NIH HHSUnited States/
• Volume:
  96
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:fb93c88dac31bc22f439a22067a997548562db1c5be3883bfcb1235e842ef80e
• Download URL:
  https://stacks.cdc.gov/view/cdc/90854/cdc_90854_DS1.pdf
• File Type:
  [PDF - 207.96 KB ]