Smith Amelia, McKinlay Alison, Wojewodka Gabriella, Ridsdale Leone
GKT School of Medicine, King's College London, London, SE1 1UL, UK.
Institute of Psychiatry, Psychology & Neuroscience, Academic Neuroscience Centre, King's College London, PO Box 57, London, SE5 8AF, UK.
BMC Neurol. 2017 Jun 17;17(1):114. doi: 10.1186/s12883-017-0893-3.
Epilepsy is a serious and costly long-term condition that negatively affects quality of life, especially if seizures persist on medication. Studies show that people with epilepsy (PWE) want to learn more about the condition and some educational self-management courses have been trialled internationally. The objectives of this review were to evaluate research and summarise results on group self-management interventions for PWE.
We searched Medline and PsycINFO for results published in English between 1995 and 2015. Only studies evaluating face-to-face, group interventions for adults with epilepsy were included. Heterogeneity in study outcomes prevented the carrying out of a meta-analysis; however, a Cochrane style review was undertaken.
We found eleven studies, nine of which were randomised controlled trials. There were variable standards of methodological reporting with some risk of bias. Seven of the studies used quality of life as an outcome, with four finding statistically significant improvements in mean total score. Two found an improvement in outcome subscales. One study included some additional semi-qualitative data.
We identified promising trends in the trials reviewed. In particular, there were significant improvements in quality of life scales and seizure frequency in many of the interventions. However, considerable heterogeneity of interventions and outcomes made comparison between the studies difficult. Courses that included psychological interventions and others that had a high number of sessions showed more effect than short educational courses. Furthermore, the evidence was predominantly from pilot studies with small sample sizes and short follow-up duration. Further research is needed to better evaluate the role of group self-management interventions in outpatient epilepsy management.
癫痫是一种严重且成本高昂的长期病症，会对生活质量产生负面影响，尤其是在药物治疗后癫痫仍持续发作的情况下。研究表明，癫痫患者（PWE）希望更多地了解该病症，并且一些教育性自我管理课程已在国际上进行了试验。本综述的目的是评估针对癫痫患者的小组自我管理干预措施的研究并总结结果。
我们在Medline和PsycINFO中检索了1995年至2015年间以英文发表的研究结果。仅纳入评估针对成年癫痫患者的面对面小组干预措施的研究。研究结果的异质性使得无法进行荟萃分析；然而，我们进行了Cochrane式综述。
我们找到了11项研究，其中9项为随机对照试验。方法学报告的标准各不相同，存在一定的偏倚风险。7项研究将生活质量作为一项结果，其中4项发现平均总分有统计学上的显著改善。2项发现结果子量表有改善。1项研究纳入了一些额外的半定性数据。
我们在 reviewed 的试验中发现了有前景的趋势。特别是，许多干预措施在生活质量量表和癫痫发作频率方面有显著改善。然而，干预措施和结果的显著异质性使得各研究之间难以进行比较。包含心理干预的课程和课程节数较多的其他课程比简短的教育课程显示出更大的效果。此外，证据主要来自样本量小且随访时间短的试点研究。需要进一步的研究来更好地评估小组自我管理干预措施在门诊癫痫管理中的作用。
