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May 24, 2022; 98 (21) Research Article

Effectiveness of a Self-Management Program to Improve Cognition and Quality of Life in Epilepsy

A Pragmatic, Randomized, Multicenter Trial

Nicholas A. Streltzov, Samantha S. Schmidt, View ORCID ProfileLindsay M. Schommer, View ORCID ProfileWenyan Zhao, View ORCID ProfileTor D. Tosteson, Morgan T. Mazanec, Elaine T. Kiriakopoulos, View ORCID ProfileFelicia Chu, View ORCID ProfileHeidi L. Henninger, Keith Nagle, Robert M. Roth, View ORCID ProfileBarbara Jobst
First published April 6, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200346
Nicholas A. Streltzov
From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington.
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Samantha S. Schmidt
From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington.
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Lindsay M. Schommer
From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington.
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Wenyan Zhao
From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington.
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Tor D. Tosteson
From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington.
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Morgan T. Mazanec
From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington.
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Elaine T. Kiriakopoulos
From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington.
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Felicia Chu
From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington.
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  • ORCID record for Felicia Chu
Heidi L. Henninger
From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington.
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  • ORCID record for Heidi L. Henninger
Keith Nagle
From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington.
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Robert M. Roth
From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington.
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Barbara Jobst
From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington.
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  • ORCID record for Barbara Jobst
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Citation
Effectiveness of a Self-Management Program to Improve Cognition and Quality of Life in Epilepsy
A Pragmatic, Randomized, Multicenter Trial
Nicholas A. Streltzov, Samantha S. Schmidt, Lindsay M. Schommer, Wenyan Zhao, Tor D. Tosteson, Morgan T. Mazanec, Elaine T. Kiriakopoulos, Felicia Chu, Heidi L. Henninger, Keith Nagle, Robert M. Roth, Barbara Jobst
Neurology May 2022, 98 (21) e2174-e2184; DOI: 10.1212/WNL.0000000000200346

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Abstract

Background and Objectives We conducted a multisite, pragmatic replication trial at 4 New England epilepsy centers to determine the effectiveness of Home-Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH) in a real-world setting and to assess feasibility of a virtual intervention.

Methods HOBSCOTCH is an 8-session intervention addressing cognitive impairment and quality of life (QoL) for people with epilepsy (PWE). Participants were recruited from epilepsy centers in 4 states and block-randomized into the following groups: in-person HOBSCOTCH (H-IP), virtual HOBSCOTCH (H-V), and waitlist control. Outcome measures were assessed for all groups at baseline, 3 months, and 6 months; intervention groups received long-term follow-up at 9 and 12 months.

Results A total of 108 participants were recruited, of whom 85 were included in this analysis (age at baseline 47.5 ± 11.5 years; 68% female). Participants completing the in-person intervention (H-IP) had a 12.4-point improvement in QoL score compared with controls (p < 0.001). Pairwise comparisons found a 6.2-point treatment effect for subjective cognition in the H-IP group (p < 0.001). There were no meaningful group differences in objective cognition or health care utilization at any time points and the treatment effect for QoL diminished by 6 months. The virtual intervention demonstrated feasibility but did not significantly improve outcomes compared with controls. Within-group analysis found improvements in QoL for both H-V and H-IP.

Discussion This study replicated the effectiveness of the HOBSCOTCH program in improving QoL for PWE. The study was conducted prior to the COVID-19 pandemic, but the distance-delivered intervention may be particularly well-suited for the current environment. Future research will explore modifications designed to improve the efficacy of H-V and the sustainability of HOBSCOTCH's treatment effect.

Trial Registration Information ClinicalTrials.gov (NCT02394509).

Classification of Evidence This study provides Class III evidence that in-person HOBSCOTCH delivery improved subjective measures of cognition in persons with epilepsy.

Glossary

BTACT=
Brief Test of Adult Cognition by Telephone;
ESMS=
Epilepsy Self-Management Scale;
FWA=
Federalwide Assurance;
H-IP=
in-person HOBSCOTCH;
H-V=
virtual HOBSCOTCH;
HCU-E=
Healthcare Utilization in Epilepsy;
HOBSCOTCH=
Home-Based Self-Management and Cognitive Training Changes Lives;
IRB=
institutional review board;
MEW=
Managing Epilepsy Well;
Neuro-QoL=
Quality of Life in Neurological Disorders;
PHQ-9=
Patient Health Questionnaire–9;
PST=
problem-solving therapy;
PWE=
people with epilepsy;
QoL=
quality of life;
QOLIE-31=
31-item Quality of Life in Epilepsy

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 873

  • Class of Evidence: NPub.org/coe

  • CME Course: NPub.org/cmelist

  • Received April 8, 2021.
  • Accepted in final form February 21, 2022.
  • © 2022 American Academy of Neurology
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