A Pilot Study of a Self-Management Intervention for Cognitive Impairment in Epilepsy (S43.001)

OBJECTIVE: To assess the feasibility and effectiveness of a self-management intervention to address cognitive dysfunction in adults with epilepsy at Dartmouth-Hitchcock Epilepsy Center. 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 with which to intervene. DESIGN/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 objective memory function 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: Pilot data (n=16) demonstrated that HOBSCOTCH participants (n=9) demonstrated an improvement in QOLIE-31 scores as compared to controls (average change in score 6.3 vs -5.8, p=0.01). There was a trend towards reduction in depression and improvement in 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. Study Supported by: Centers for Disease Control and Prevention (3U48DP001935-04S3). Disclosure: Dr. Caller has nothing to disclose. Dr. Secore has nothing to disclose. Dr. Ferguson has nothing to disclose. Dr. Roth has nothing to disclose. Dr. Alexandre has nothing to disclose. Dr. Harrington has nothing to disclose. Dr. Jobst has received personal compensation for activities with NeuroPace, Inc. Dr. Jobst has received personal compensation in an editorial capacity for Medlink Inc. Dr. Jobst has received research support from NeuroPace, Inc., UCB Pharma, and Lundbeck Inc.