Matthew W. Luedke, MD; Dan V. Blalock, PhD, MA; Karen M. Goldstein, MD, MSPH; Andrzej S. Kosinski, PhD; Saurabh R. Sinha, MD, PhD; Connor Drake, MPA; Jeffrey D. Lewis, PhD, MD; Aatif M. Husain, MD; Allison A. Lewinski, PhD, MPH, RN; Abigail Shapiro, MSPH; Jennifer M. Gierisch, PhD, MPH; Tung T. Tran, MD; Adelaide M. Gordon, MPH; Megan G. Van Noord, MSIS; Hayden B. Bosworth, PhD; John W. Williams, MD
Disclaimer: The views expressed here are those of the authors and do not reflect the official views or policy of the U.S. Department of Defense or its components.
Acknowledgment: The authors thank Glenn Graham, MD, PhD, for nominating the topic and providing input on project scope and methodology; Jennifer Patterson, PhD, and Paul Rutecki, MD, for input on project scope and methodological approaches; and Liz Wing, MA, for editorial assistance.
Grant Support: This project was funded by the U.S. Department of Veterans Affairs, VHA, Office of Research and Development, Quality Enhancement Research Initiative (ESP 09-010). This work was also supported by the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (CIN 13-410) at the Durham Veterans Affairs Health Care System.
Disclosures: Dr. Luedke reports grants, personal fees, and other (participation for charitable work) from Eisai Pharmaceuticals and grants from Biogen and UCB, outside the submitted work. Dr. Sinha reports grants and personal fees from UCB; personal fees from Monteris, Cadwell, and Springer Clinical Medicine; and nonfinancial support from Sunovion, the American Clinical Neurophysiology Society, the American Board of Clinical Neurophysiology, and ABRET Neurodiagnostic Credentialing and Accreditation, outside the submitted work. Dr. Husain reports personal fees and nonfinancial support from Jazz Pharmaceuticals; personal fees from Biogen Idec, Eisai, and Neurelis; and grants and personal fees from Marinus Pharmaceuticals, outside the submitted work; royalties from Springer Publishing, Demos Medical Publishing, and Wolters Kluwer; and an editorship stipend from the American Clinical Neurophysiology Society. Dr. Bosworth reports grants and personal fees from Sanofi and Otuska; grants from Improved Patient Outcome, Novo Nordisk, Proteus, the U.S. Department of Veterans Affairs, and the National Institutes of Health; and personal fees from Abbott, outside the submitted work. Dr. Williams reports grants from the VHA during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0458.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: Available at www.crd.york.ac.uk/prospero (PROSPERO: CRD42018098604). Statistical code and data set: Available from Ms. Gordon (e-mail, firstname.lastname@example.org).
Corresponding Author: Matthew W. Luedke, MD, Duke University Medical Center, DUMC 102350, 293 Hanes House, 315 Trent Drive, Durham, NC 27710; e-mail, email@example.com.
Current Author Addresses: Drs. Luedke, Sinha, Husain, and Tran: Duke University Medical Center, DUMC 102350, 293 Hanes House, 315 Trent Drive, Durham, NC 27710.
Drs. Blalock, Lewinski, Gierisch, Bosworth, and Williams, and Ms. Gordon: Durham Veterans Affairs Medical Center, 411 West Chapel Hill Street, Suite 600, Durham, NC 27701.
Dr. Goldstein: Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705.
Dr. Kosinski: Duke University, P.O. Box 17969, Durham, NC 27715.
Mr. Drake: Gillings School of Global Public Health, 1101 McGavran-Greenberg Hall, CB 7411, Chapel Hill, NC 27599.
Dr. Lewis: Uniformed Services University School of Medicine, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Ms. Shapiro: Durham Veterans Affairs Medical Center; 411 West Chapel Hill Street, Suite 700, Durham, NC 27701.
Ms. Van Noord: Carlson Health Sciences Library, One Shields Avenue, Davis, CA 95616.
Author Contributions: Conception and design: D.V. Blalock, K.M. Goldstein, S.R. Sinha, J.D. Lewis, J.M. Gierisch, T.T. Tran, M.G. Van Noord, J.W. Williams.
Analysis and interpretation of the data: M.W. Luedke, D.V. Blalock, K.M. Goldstein, A.S. Kosinski, S.R. Sinha, C. Drake, J.D. Lewis, A.M. Husain, A. Shapiro, J.M. Gierisch, T.T. Tran, H.B. Bosworth, J.W. Williams.
Drafting of the article: D.V. Blalock, S.R. Sinha, C. Drake, J.D. Lewis, A.M. Gordon, M.G. Van Noord, H.B. Bosworth, J.W. Williams.
Critical revision for important intellectual content: M.W. Luedke, D.V. Blalock, S.R. Sinha, J.D. Lewis, A.M. Husain, H.B. Bosworth, J.W. Williams.
Final approval of the article: M.W. Luedke, D.V. Blalock, K.M. Goldstein, A.S. Kosinski, S.R. Sinha, C. Drake, J.D. Lewis, A.M. Husain, A.A. Lewinski, A. Shapiro, J.M. Gierisch, T.T. Tran, A.M. Gordon, M.G. Van Noord, H.B. Bosworth, J.W. Williams.
Statistical expertise: A.S. Kosinski, J.W. Williams.
Obtaining of funding: J.M. Gierisch, J.W. Williams.
Administrative, technical, or logistic support: A.M. Gordon.
Collection and assembly of data: M.W. Luedke, D.V. Blalock, K.M. Goldstein, S.R. Sinha, C. Drake, J.D. Lewis, A.M. Husain, A.A. Lewinski, T.T. Tran, A.M. Gordon, M.G. Van Noord, J.W. Williams.
Although self-management is recommended for persons with epilepsy, its optimal strategies and effects are uncertain.
To evaluate the components and efficacy of self-management interventions in the treatment of epilepsy in community-dwelling persons.
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.
Randomized and nonrandomized comparative studies of self-management interventions for adults with epilepsy.
An investigator assessed study characteristics; intervention details, including 6 components of self-management; and outcomes, which were verified by a second reviewer. Risk of bias (ROB) was assessed independently by 2 investigators.
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.
High ROB in most studies, incomplete intervention descriptions, and studies limited to English-language publications.
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.
U.S. Department of Veterans Affairs. (PROSPERO: CRD42018098604)
Luedke MW, Blalock DV, Goldstein KM, et al. Self-management of Epilepsy: A Systematic Review. Ann Intern Med. 2019;171:117–126. [Epub ahead of print 2 July 2019]. doi: https://doi.org/10.7326/M19-0458
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Published: Ann Intern Med. 2019;171(2):117-126.
Published at www.annals.org on 2 July 2019
Neurology, Seizure Disorders.
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