Abstracts

Rationale: There are 2 million people in the US living with epilepsy. Approximately 50% will also have cognitive problems, which significantly impair daily activities such as remembering medications, holding a job, and maintaining relationships. Despite the significant impact cognitive functioning has on quality of life, epilepsy care frequently focuses on seizure control and ignores comorbid symptoms. Dartmouth-Hitchcock Epilepsy Center (DHEC) is a Level 4 Epilepsy Center providing care to 1500 patients per year in a rural setting. A major gap in care at DHEC is a lack of resources or treatment options to address cognitive dysfunction. Our aim was to develop and implement an intervention to improve cognitive function in the adult epilepsy population at DHEC.Methods: The burden of comorbidities in epilepsy at DHMC was assessed using a screening questionnaire. Memory problems were reported in 55% of adults with epilepsy at DHEC, and we identified 3 domains of cognitive problems: seizure management, organization skills, & social situations. A multidisciplinary workgroup was formed between Neurology and Psychiatry to develop an intervention to improve cognitive functioning. Patient needs and barriers (such as cost and transportation) were identified. Resources and barriers within the DHEC care process were identified. We reviewed existing interventions used in other departments at our institution. The intervention was developed & tailored to meet the needs of epilepsy patients.Results: HOBSCOTCH (HOme Based Self-management and Cognitive Training CHanges lives) was implemented in March 2013, with the aim of improving quality of life and reducing memory-related disability & depression in adults with epilepsy. HOBSCOTCH promotes self-efficacy skills, empowering patients so that they become part of the treatment. Compensatory strategies for enhancing memory in day-to-day life are taught, & are applied to memory-related problems in day to day life using a technique called problem solving therapy (PST). Distribution of a day planner with seizure diary facilitates organization & self-management skills. To avoid necessitating need for a neuropsychologist, HOBSCOTCH was designed to enable our epilepsy nurse practitioner or other nursing staff to deliver the intervention. The intervention is primarily delivered over the telephone to minimize patient barriers. At time of abstract submission, 1 patient has successfully completed the intervention, 4 are enrolled, and 12 are scheduled to start. Conclusions: Cognitive problems are common in epilepsy, are multifactorial, & significantly affect quality of life, yet there are limited treatment modalities available. Self-management interventions such as HOBSCOTCH are feasible and may potentially improve cognitive performance in patients with epilepsy. The effectiveness of HOBSCOTCH for epilepsy patients is currently being evaluated in a randomized trial. This intervention may be applicable to other patient populations or clinical settings. This work is supported by the CDC (3U48DP001935-04S3).