Sajatovic Martha, Ghearing Gena R, Tyrrell Maegan, Black Jessica, Krehel-Montgomery Jacqueline, Barigye Richard, Yala Joy, Adeniyi Clara, Privitera Michael, Rossi Marvin A, Briggs Farren
Department of Psychiatry and of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
Department of Neurology, Carver College of Medicine and Iowa Health Care, Iowa City, IA, USA.
Epilepsy Behav. 2025 May 23;171:110495. doi: 10.1016/j.yebeh.2025.110495.
This 2-site, 6-month randomized controlled trial of an epilepsy self-management (ESM) curriculum (SMART) vs. 6-month waitlist (WL) control assessed effects on epilepsy outcomes in 160 people with epilepsy (PWE).
PWE had at least 1 negative health event (NHE) defined as a seizure, emergency department visit, hospitalization or self-harm attempt in the last 6 months. Primary outcomes were differences in proportions of PWE with reductions in NHEs from baseline to 6 months follow up and change in NHE/seizure counts between SMART and WL. Secondary outcomes included the Patient Health Questionnaire (PHQ-9), 36-Item Short Form Survey (SF-36), Quality of Life in Epilepsy (QOLIE-31), Epilepsy Self-Management Scale (ESMS), Epilepsy Stigma Scale (ESS), Multidimensional Scale of Perceived Social Support (MSPSS) and Epilepsy Self-Efficacy Scale (ESES).
Mean age was 39.4 (SD 12.2), 66.9 % (N = 107) women, and 31 % (N = 50) rural. Mean PHQ-9 of 10.5 (SD 7) suggested mild/moderate depression. Seizures were the most common NHE with mean baseline past 6-month seizure count of 20.6 (SD 41.0). SMART was significantly associated with a 2-fold increase in odds of having at least 10-30 % improvement in NHEs vs. WL (p < 0.05). SMART was associated with significant seizure reduction (p < 0.05), significantly improved PHQ-9 (p = 0.014), QOLIE-31 seizure worry (p = <0.001) and social functioning (p = 0.021), ESES (p = 0.046) and ESMS (p < 0.001).
Compared to WL, SMART participants had improvement in NHEs and seizures, depressive symptoms, self-management competency and self-efficacy and selected elements of quality of life. Inclusion of effective ESMs into a comprehensive care of model for PWE may be warranted.
这项为期6个月的双中心随机对照试验，比较了癫痫自我管理（ESM）课程（SMART）与6个月等待列表（WL）对照，评估了其对160名癫痫患者（PWE）癫痫相关结局的影响。
PWE在过去6个月中至少有1次负面健康事件（NHE），定义为癫痫发作、急诊就诊、住院或自残企图。主要结局是从基线到6个月随访期间NHE减少的PWE比例差异，以及SMART组和WL组之间NHE/癫痫发作次数的变化。次要结局包括患者健康问卷（PHQ-9）、36项简短调查问卷（SF-36）、癫痫生活质量量表（QOLIE-31）、癫痫自我管理量表（ESMS）、癫痫耻辱感量表（ESS）、多维感知社会支持量表（MSPSS）和癫痫自我效能量表（ESES）。
平均年龄为39.4岁（标准差12.2），66.9%（N = 107）为女性，31%（N = 50）来自农村。平均PHQ-9评分为10.5（标准差7），提示轻度/中度抑郁。癫痫发作是最常见的NHE，过去6个月的平均基线癫痫发作次数为20.6次（标准差41.0）。与WL相比，SMART组NHE改善至少10%-30%的几率显著增加了2倍（p < 0.05）。SMART组与癫痫发作显著减少（p < 0.05）、PHQ-9显著改善（p = 0.014）、QOLIE-31癫痫担忧（p = <0.001）和社会功能（p = 0.021）、ESES（p = 0.046）和ESMS（p < 0.001）相关。
与WL相比，SMART组参与者在NHE和癫痫发作、抑郁症状、自我管理能力和自我效能以及生活质量的某些方面有改善。将有效的ESM纳入PWE的综合护理模式可能是必要的。
