Abstracts

Rationale: Comprehensive treatment of epilepsy involves many facets including self-management behaviors. The most common self-management strategy is adherence to an Antiepileptic Drug (AED) regimen. Non-drug related behaviors include management of information, concern for personal safety, management of the seizures themselves, and lifestyle issues. The purpose of this study was to determine the impact of clinical factors on self-management behaviors.Methods: Adult epilepsy patients were recruited for this cross-sectional, descriptive study. A convenience sample of patients filled out two surveys aimed at assessing various self-management behaviors. The Morisky medication-taking behavior is a four question, non-Epilepsy specific adherence measure. Based on responses to the Morisky questions, patients are grouped into low, medium or high medication-taking behavior. DiIorio’s 38-item Epilepsy Self-Management Scale (ESMS) assesses frequency of use of epilepsy self-management practices. Responses are divided into 5 subscales that address patient management of medication, information, safety, seizure and lifestyle. Additionally, clinical and demographic data was collected.Results: Fifty patients (male=27, female=23) with a mean age of 40 participated in the study; 46 were Caucasian and 4 non-Caucasian. Sixteen (32%) reported having AED adverse events at the current clinic visit and 35 (70%) were determined to have AED resistance (failed more than 2 AEDs). Twenty-six (51%) patients indicated yes to the question 'Do you ever forget to take your medications?'. Based on one-way ANOVA of the ESMS subscales, women had higher scores on information (F=4.55, p=0.038) and safety management (F=4.68, p=0.036). Persons with lower levels of education reported higher scores on the safety subscale (F=2.94, p=0.043). A lower health status rating was found for those reporting adverse events from AEDs (F=4.49, p=0.039). No significant differences were found on the ESMS subscales, based on number of AEDs taken or 3-month seizure frequency. The ESMS medication management subscale and the Morisky scale were highly correlated (r=0.583, p=0.000). Total number of medications was highly correlated with the ESMS medication management subscale (r=0.40, p=0.004), while 3-month seizure frequency (r= -0.42, p=0.003) and ethnicity (r=-0.35, p=0.01) were negatively correlated with the Morisky Scale. Regression modeling of the ESMS medication management scale found total number of medications, treatment for depression and poor medication compliance (when a patient feels better) were predictors (r2=0.386, F=5.42, p=0.001). For the Morisky Score, ethnicity and 3-month seizure frequency were predictors (r2=0.327, F=5.34, p=0.001).Conclusions: Epilepsy self-management skills are critical to patients. Scores on a domain specific assessment and a general assessment of medication compliance, while highly correlated, are predicted by different clinical factors. Since depression is a common co-morbidity, the ESMS scale may be more useful; however it may be strengthened by including questions from a general assessment, like the Morisky scale.