3. A pilot study of a self-management intervention for cognitive impairment in epilepsy

Abstract

Background Approximately 50% of the 2 million people in the US living with epilepsy will have cognitive problems. Despite the significant impact cognitive functioning has on quality of life, there are limited treatment modalities. Our aim was to assess the feasibility and effectiveness of a self-management intervention to address cognitive dysfunction in adults with epilepsy at Dartmouth–Hitchcock Epilepsy Center. Methods HOBSCOTCH (HOme Based Self-management and Cognitive Training CHanges lives) was developed to teach problem-solving strategies and compensatory memory strategies. Adults age 18–65 with epilepsy and subjective cognitive complaints were randomized to receive HOBSCOTCH, HOBSCOTCH+ (which adds working memory training) or care as usual. The primary outcome was quality of life (QOLIE-31), with secondary outcomes of executive functioning, objective memory, and depression as measured by validated scales. In addition, a focus group was conducted to obtain quantitative data about patient satisfaction with the intervention. Results as of January 31, 2014, 38 have enrolled, 9 patients have completed the 8-week intervention and 8 controls have returned for 8 week assessments. Three patients enrolled in the intervention groups withdrew from the study. Pilot data (n = 14) demonstrated that HOBSCOTCH participants (n = 5) demonstrated an improvement in our primary outcome of QOLIE-31 scores as compared to controls (average improvement in score of 9.4 for intervention group vs decrease in score of −6.3 for controls, p = 0.001). There was also a significant reduction in depression scores and improvement in executive function and objective memory scores. Qualitative data indicate high satisfaction and subjective improvement in cognitive functioning in day-to-day life. Conclusions Cognitive problems are common in epilepsy, are multifactorial, & significantly affect quality of life. This pilot data suggests that a self-management intervention may improve cognitive performance in patients with epilepsy, and may be applicable to other patient populations or clinical settings. The effectiveness of HOBSCOTCH in epilepsy is currently being evaluated in a randomized trial. This work is supported by the CDC (3U48DP001935-04S3).