Abstracts

Rationale: Cognitive problems are common in epilepsy, are multifactorial, and significantly affect quality of life; yet there are limited treatment modalities. Our aim was to assess the effectiveness of a self-management intervention to address cognitive dysfunction in adults with epilepsy at Dartmouth-Hitchcock Epilepsy Center. Methods: HOBSCOTCH (HOme Based Self-management and Cognitive Training CHanges lives) is a self-management intervention delivered by a nurse or nurse practitioner which encompasses: (1) education on cognitive function in epilepsy, (2) self-awareness training, (3) memory compensatory strategies, and (4) application of these strategies in day-to-day life using problem solving therapy. Sixty-six adults aged 18-65 with epilepsy and subjective cognitive complaints were randomized to receive 8 weeks of HOBSCOTCH, HOBSCOTCH+ (which adds daily working memory training), or care as usual. The primary outcome was quality of life (QOLIE-31), with secondary outcomes of executive functioning, objective memory, and depression as measured by validated scales at baseline, 8-weeks (post-intervention), and 6-month follow-up. In addition, a focus group was conducted to obtain quantitative data about patient satisfaction with the intervention. Results: At present, 58 patients have been randomized and 32 patients have completed post-intervention assessments at 8-weeks. Preliminary data demonstrate that HOBSCOTCH participants (n=9) demonstrated an improvement in quality of life as compared to controls (average change in QOLIE-31 score 4.3 vs -0.8 decrease in controls, p=0.24; average change in NeuroQOL score 3.8 vs. -2.6, p=0.04) and showed statistically significant improvements in executive function (p=0.02). There was a trend towards reduction in depression scores. HOBSCOTCH+ participants (N=9) had a statistically significant improvement in objective memory scores compared to controls (p=0.002). Qualitative data indicate high satisfaction and subjective improvement in cognitive functioning in day-to-day life. All patients will have completed post-intervention assessments by September 2014. Conclusions: A self-management intervention may improve subjective and objective cognitive performance and quality of life in patients with epilepsy, and may be applicable to other patient populations or clinical settings. Funding source: Centers for Disease Control and Prevention (3U48DP001935-04S3)