Self-management Lifts Cognitive Function in Epilepsy

A simple self-management intervention may improve the cognitive performance of patients who have epilepsy, according to the results of a new study.

“About half of the 2 million people in the US living with epilepsy have cognitive problems. Despite the significant impact cognitive functioning has on quality of life, there are limited treatment modalities with which to intervene. This program teaches epilepsy patients self-efficacy and strategies on how to manage memory problems. It also helps ease anxiety about memory problems and enhances the ability to cope with memory deficits,” Tracie Caller, MD, Neurophysiology Fellow at Dartmouth Hitchcock Medical Center in Hanover, New Hampshire, told ConsultantLive in an exclusive interview before her presentation at the American Academy of Neurology annual meeting in Philadelphia.

Epileptic seizures typically interrupt cognitive functioning. “Small epileptic discharges impair cognition. Eventually, this interrupts the encoding process for new memories. Also, many epileptic patients have overlying anxiety and depression, which can affect concentration, which in turn affects memory,” said Dr Caller. In addition, certain epilepsy medications, such as topiramate, can cause fatigue and affect memory and concentration. The underlying brain abnormality that causes seizures, for example, scarring in the temporal lobe, also may affect memory, she said.

Dr Caller and colleagues conducted a pilot study of a self-management intervention for cognitive impairment in epilepsy. HOBSCOTCH (HOme Based Self-management and COgnitive Training CHanges lives) is an 8-week, telephone-based intervention developed to teach problem-solving strategies and compensatory memory strategies.

Dr Caller reported on the results of 16 adult patients with epilepsy and subjective cognitive complaints who were randomized to receive HOBSCOTCH, HOBSCOTCH+ (which adds working memory training), or usual care.

“We found that the 9 HOBSCOTCH participants had significantly improved quality of life scores as compared to 7 controls, and significant changes in depression, as well as improvement in executive function,” said Dr Caller. “As a pleasant surprise, we also found improvement in objective memory function.”

The program is “designed to teach memory strategies, to work around deficits, and improve memory confidence,” Dr Caller said. “People with epilepsy often lose confidence in their memory, and this becomes a vicious cycle.”

The structure of the program is similar to problem-solving therapy now used in primary care settings applied to depression and in chronic diseases, such as heart disease and diabetes mellitus. “We teach patients how to solve their own problems, for example, how to remember to take their medication by setting a reminder alarm on a cell phone or putting the medication next to their tooth brush or coffee machine,” Dr Caller stated.

She said the program would be “easy to implement in a primary care practice. We have nurse practitioners deliver HOBSCOTCH. A variety of practitioners, including psychologists and social workers, can deliver the intervention.”

So far, the researchers have enrolled 50 of a planned 60 patients with epilepsy in a clinical trial to test the effectiveness of HOBSCOTCH. The patients in the pilot study “are satisfied with the program. We have a low drop-out rate compared to similar interventions,” said Dr Caller.

She thinks the program also would be helpful in other neurological disorders, such as multiple sclerosis, in which patients often have memory difficulties and depression, as well as for chemotherapy patients who suffer so-called “chemobrain” post-therapy.