Abstract
Background: Although self-management is recommended for persons with epilepsy, its optimal strategies and effects are uncertain. Purpose: To evaluate the components and efficacy of selfmanagement interventions in the treatment of epilepsy in community-dwelling persons. Data Sources: English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL in April 2018; the MEDLINE search was updated in March 2019. Study Selection: Randomized and nonrandomized comparative studies of self-management interventions for adults with epilepsy. Data Extraction: An investigator assessed study characteristics; intervention details, including 6 components of selfmanagement; and outcomes, which were verified by a second reviewer. Risk of bias (ROB) was assessed independently by 2 investigators. Data Synthesis: 13 randomized and 2 nonrandomized studies (2514 patients) evaluated self-management interventions. Interventions were delivered primarily in group settings, used a median of 4 components, and followed 2 general strategies: 1 based on education and the other on psychosocial therapy. Education-based approaches improved self-management behaviors (standardized mean difference, 0.52 [95% CI, 0.0 to 1.04]), and psychosocial therapy–based approaches improved quality of life (mean difference, 6.64 [CI, 2.51 to 10.77]). Overall, self-management interventions did not reduce seizure rates, but 1 educational intervention decreased a composite of seizures, emergency department visits, and hospitalizations. Limitation: High ROB in most studies, incomplete intervention descriptions, and studies limited to English-language publications. Conclusion: There is limited evidence that self-management strategies modestly improve some patient outcomes that are important to persons with epilepsy. Overall, self-management research in epilepsy is limited by the range of interventions tested, the small number of studies using self-monitoring technology, and uncertainty about components and strategies associated with benefit.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 117-126 |
| Number of pages | 10 |
| Journal | Annals of internal medicine |
| Volume | 171 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jul 16 2019 |
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ASJC Scopus subject areas
- Internal Medicine
Cite this
Self-management of Epilepsy A Systematic Review. / Luedke, Matthew W.; Blalock, Dan V.; Goldstein, Karen M.; Kosinski, Andrzej S.; Sinha, Saurabh R.; Drake, Connor; Lewis, Jeffrey D.; Husain, Aatif M.; Lewinski, Allison A.; Shapiro, Abigail; Gierisch, Jennifer M.; Tran, Tung T.; Gordon, Adelaide M.; Van Noord, Megan G.; Bosworth, Hayden B.; Williams, John W.
In: Annals of internal medicine, Vol. 171, No. 2, 16.07.2019, p. 117-126.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Self-management of Epilepsy A Systematic Review
AU - Luedke, Matthew W.
AU - Blalock, Dan V.
AU - Goldstein, Karen M.
AU - Kosinski, Andrzej S.
AU - Sinha, Saurabh R.
AU - Drake, Connor
AU - Lewis, Jeffrey D.
AU - Husain, Aatif M.
AU - Lewinski, Allison A.
AU - Shapiro, Abigail
AU - Gierisch, Jennifer M.
AU - Tran, Tung T.
AU - Gordon, Adelaide M.
AU - Van Noord, Megan G.
AU - Bosworth, Hayden B.
AU - Williams, John W.
PY - 2019/7/16
Y1 - 2019/7/16
N2 - Background: Although self-management is recommended for persons with epilepsy, its optimal strategies and effects are uncertain. Purpose: To evaluate the components and efficacy of selfmanagement interventions in the treatment of epilepsy in community-dwelling persons. Data Sources: English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL in April 2018; the MEDLINE search was updated in March 2019. Study Selection: Randomized and nonrandomized comparative studies of self-management interventions for adults with epilepsy. Data Extraction: An investigator assessed study characteristics; intervention details, including 6 components of selfmanagement; and outcomes, which were verified by a second reviewer. Risk of bias (ROB) was assessed independently by 2 investigators. Data Synthesis: 13 randomized and 2 nonrandomized studies (2514 patients) evaluated self-management interventions. Interventions were delivered primarily in group settings, used a median of 4 components, and followed 2 general strategies: 1 based on education and the other on psychosocial therapy. Education-based approaches improved self-management behaviors (standardized mean difference, 0.52 [95% CI, 0.0 to 1.04]), and psychosocial therapy–based approaches improved quality of life (mean difference, 6.64 [CI, 2.51 to 10.77]). Overall, self-management interventions did not reduce seizure rates, but 1 educational intervention decreased a composite of seizures, emergency department visits, and hospitalizations. Limitation: High ROB in most studies, incomplete intervention descriptions, and studies limited to English-language publications. Conclusion: There is limited evidence that self-management strategies modestly improve some patient outcomes that are important to persons with epilepsy. Overall, self-management research in epilepsy is limited by the range of interventions tested, the small number of studies using self-monitoring technology, and uncertainty about components and strategies associated with benefit.
AB - Background: Although self-management is recommended for persons with epilepsy, its optimal strategies and effects are uncertain. Purpose: To evaluate the components and efficacy of selfmanagement interventions in the treatment of epilepsy in community-dwelling persons. Data Sources: English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL in April 2018; the MEDLINE search was updated in March 2019. Study Selection: Randomized and nonrandomized comparative studies of self-management interventions for adults with epilepsy. Data Extraction: An investigator assessed study characteristics; intervention details, including 6 components of selfmanagement; and outcomes, which were verified by a second reviewer. Risk of bias (ROB) was assessed independently by 2 investigators. Data Synthesis: 13 randomized and 2 nonrandomized studies (2514 patients) evaluated self-management interventions. Interventions were delivered primarily in group settings, used a median of 4 components, and followed 2 general strategies: 1 based on education and the other on psychosocial therapy. Education-based approaches improved self-management behaviors (standardized mean difference, 0.52 [95% CI, 0.0 to 1.04]), and psychosocial therapy–based approaches improved quality of life (mean difference, 6.64 [CI, 2.51 to 10.77]). Overall, self-management interventions did not reduce seizure rates, but 1 educational intervention decreased a composite of seizures, emergency department visits, and hospitalizations. Limitation: High ROB in most studies, incomplete intervention descriptions, and studies limited to English-language publications. Conclusion: There is limited evidence that self-management strategies modestly improve some patient outcomes that are important to persons with epilepsy. Overall, self-management research in epilepsy is limited by the range of interventions tested, the small number of studies using self-monitoring technology, and uncertainty about components and strategies associated with benefit.
UR - http://www.scopus.com/inward/record.url?scp=85072009648&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85072009648&partnerID=8YFLogxK
U2 - 10.7326/M19-0458
DO - 10.7326/M19-0458
M3 - Review article
C2 - 31261386
AN - SCOPUS:85072009648
VL - 171
SP - 117
EP - 126
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
SN - 0003-4819
IS - 2
ER -