Do self-management strategies improve seizure rates among epilepsy patients?
Self-management interventions do not seem to significantly improve essential outcomes among patients with epilepsy, according to the results of a systematic review.
The investigators conducted English-language searches of Medline, Cochrane, Central Register of Controlled Trials, PsycINFO and Cinahl in April 2018. An updated search of Medline was performed in March 2019. Randomized and nonrandomized comparative studies of self-management interventions for adults with epilepsy were identified.
One investigator evaluated study characteristics, intervention details, including six components of self-management, and outcomes, which were verified by another reviewer. Two investigators independently assessed risk of bias.
A total of 13 randomized and two nonrandomized (n=2,514 patients) studies that examined self-management strategies met the inclusion criteria. Interventions were delivered primarily in group settings, with a median of four components. Two general strategies were followed: one based on education and the other on psychosocial therapy.
Interventions based on education improved self-management behaviours (standardized mean difference, 0.52, 95 percent CI, 0.0–1.04), while those based on psychosocial therapy improved quality of life (mean difference, 6.64, 2.51–10.77).
Self-management strategies did not result in an overall reduction of seizure rate. However, one education-based approach reduced a composite of seizures, emergency department visits and hospitalization.
“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,” the investigators said.
This systematic review has certain limitations, including high risk of bias in most studies, incomplete intervention descriptions and studies limited to English-language publications.