A 6-month prospective randomized controlled trial of remotely delivered group format epilepsy self-management versus waitlist control for high-risk people with epilepsy.

Abstract

Despite advances in care, many people with epilepsy have negative health events (NHEs) such as accidents, emergency department visits, and poor 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 intervention. A community participatory approach informed the refinement of SMART, which was then tested in a 6-month randomized controlled trial of SMART (n=60) versus waitlist control (WL, n=60). Participants were adults aged ≥18 years with epilepsy and an NHE within the past 6months (seizure, accident, self-harm attempt, emergency department visit, or hospitalization). Assessments were conducted at screening, baseline, 10weeks, and 24weeks (6 months). Primary outcome was 6-month change in total NHE count. Additional outcomes included depression on the nine-item Patient Health Questionnaire and Montgomery-Asberg Depression Rating Scale, quality of life on the 10-item Quality of Life in Epilepsy, functioning on the 36-item Short-Form Health Survey, and seizure severity on the Liverpool Seizure Severity Scale. Mean age was 41.3years (SD=11.82), 69.9% were African American, 74.2% were unemployed, and 87.4% had an annual income < US$25000; 57.5% had a seizure within 30days 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=0.04). SMART was also associated with improved nine-item Patient Health Questionnaire (P=0.032), Montgomery-Asberg Depression Rating Scale (P=0.002), 10-item Quality of Life in Epilepsy (P<0.001), and 36-item Short-Form Health Survey (P=0.015 physical health, P=0.003 mental health) versus WL. There was no difference in seizure severity. SMART is 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.