Martha Sajatovic1,2, Kari Colon-Zimmermann1,2, Mustafa Kahriman3, Edna Fuentes-Casiano2, Hongyan Liu1, Curtis Tatsuoka1, Kristin A Cassidy1,2, Samden Lhatoo4, Douglas Einstadter5, Peijun Chen6. 1. Department of Neurology, Neurological & Behavioral Outcomes Center, Cleveland, Ohio. 2. Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio. 3. Department of Neurology, Lois Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. 4. Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. 5. MetroHealth Medical Center, Case Western Reserve University School of Medicine and Center for Health Care Research and Policy, Cleveland, Ohio. 6. Department of Psychiatry, Lois Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Abstract
OBJECTIVE: Despite advances in care, many people with epilepsy have negative health events (NHEs) such as accidents, emergency department visits, and poor quality of life. "Self-management for people with epilepsy and a history of negative health events" (SMART) is a novel group format epilepsy self-management intervention. A community participatory approach informed the refinement of SMART, which was then tested in a 6-month randomized controlled trial of SMART (n = 60) versus waitlist control (WL, n = 60). METHODS:Participants were adults aged ≥18 years with epilepsy and an NHE within the past 6 months (seizure, accident, self-harm attempt, emergency department visit, or hospitalization). Assessments were conducted at screening, baseline, 10 weeks, and 24 weeks (6 months). Primary outcome was 6-month change in total NHE count. Additional outcomes included depression on the nine-item Patient Health Questionnaire and Montgomery-Asberg Depression Rating Scale, quality of life on the 10-item Quality of Life in Epilepsy, functioning on the 36-item Short-Form Health Survey, and seizure severity on the Liverpool Seizure Severity Scale. RESULTS:Mean age was 41.3 years (SD = 11.82), 69.9% were African American, 74.2% were unemployed, and 87.4% had an annual income < US$25 000; 57.5% had a seizure within 30 days of enrollment. Most NHEs were seizures. Six-month study attrition was 14.2% overall and similar between arms. Individuals randomized to SMART had greater reduction in total median NHEs from baseline to 6 months compared to WL (P = 0.04). SMART was also associated with improved nine-item Patient Health Questionnaire (P = 0.032), Montgomery-Asberg Depression Rating Scale (P = 0.002), 10-item Quality of Life in Epilepsy (P < 0.001), and 36-item Short-Form Health Survey (P = 0.015 physical health, P = 0.003 mental health) versus WL. There was no difference in seizure severity. SIGNIFICANCE: SMART is associated with reduced health complications and improved mood, quality of life, and health functioning in high-risk people with epilepsy. Additional efforts are needed to investigate potential for scale-up. Wiley Periodicals, Inc.
RCT Entities:
OBJECTIVE: Despite advances in care, many people with epilepsy have negative health events (NHEs) such as accidents, emergency department visits, and poor quality of life. "Self-management for people with epilepsy and a history of negative health events" (SMART) is a novel group format epilepsy self-management intervention. A community participatory approach informed the refinement of SMART, which was then tested in a 6-month randomized controlled trial of SMART (n = 60) versus waitlist control (WL, n = 60). METHODS:Participants were adults aged ≥18 years with epilepsy and an NHE within the past 6 months (seizure, accident, self-harm attempt, emergency department visit, or hospitalization). Assessments were conducted at screening, baseline, 10 weeks, and 24 weeks (6 months). Primary outcome was 6-month change in total NHE count. Additional outcomes included depression on the nine-item Patient Health Questionnaire and Montgomery-Asberg Depression Rating Scale, quality of life on the 10-item Quality of Life in Epilepsy, functioning on the 36-item Short-Form Health Survey, and seizure severity on the Liverpool Seizure Severity Scale. RESULTS: Mean age was 41.3 years (SD = 11.82), 69.9% were African American, 74.2% were unemployed, and 87.4% had an annual income < US$25 000; 57.5% had a seizure within 30 days of enrollment. Most NHEs were seizures. Six-month study attrition was 14.2% overall and similar between arms. Individuals randomized to SMART had greater reduction in total median NHEs from baseline to 6 months compared to WL (P = 0.04). SMART was also associated with improved nine-item Patient Health Questionnaire (P = 0.032), Montgomery-Asberg Depression Rating Scale (P = 0.002), 10-item Quality of Life in Epilepsy (P < 0.001), and 36-item Short-Form Health Survey (P = 0.015 physical health, P = 0.003 mental health) versus WL. There was no difference in seizure severity. SIGNIFICANCE: SMART is associated with reduced health complications and improved mood, quality of life, and health functioning in high-risk people with epilepsy. Additional efforts are needed to investigate potential for scale-up. Wiley Periodicals, Inc.
Authors: Martha Sajatovic; Douglas D Gunzler; Stephanie W Kanuch; Kristin A Cassidy; Curtis Tatsuoka; Richard McCormick; Carol E Blixen; Adam T Perzynski; Douglas Einstadter; Charles L Thomas; Mary E Lawless; Siobhan Martin; Corinna Falck-Ytter; Eileen L Seeholzer; Christine L McKibben; Mark S Bauer; Neal V Dawson Journal: Psychiatr Serv Date: 2017-05-15 Impact factor: 3.084
Authors: Sandra L Helmers; Rosemarie Kobau; Martha Sajatovic; Barbara C Jobst; Michael Privitera; Orrin Devinsky; David Labiner; Cam Escoffery; Charles E Begley; Ross Shegog; Dilip Pandey; Robert T Fraser; Erica K Johnson; Nancy J Thompson; Keith J Horvath Journal: Epilepsy Behav Date: 2017-02-12 Impact factor: 2.937
Authors: Martha Sajatovic; Erica K Johnson; Robert T Fraser; Kristin A Cassidy; Hongyan Liu; Dilip K Pandey; Rakale C Quarells; Peter Scal; Samantha Schmidt; Ross Shegog; Tanya M Spruill; Mary R Janevic; Curtis Tatsuoka; Barbara C Jobst Journal: Epilepsia Date: 2019-09-05 Impact factor: 5.864
Authors: Rosa Michaelis; Venus Tang; Sarah J Nevitt; Janelle L Wagner; Avani C Modi; William Curt LaFrance; Laura H Goldstein; Milena Gandy; Rebecca Bresnahan; Kette Valente; Kirsten A Donald; Markus Reuber Journal: Cochrane Database Syst Rev Date: 2020-09-07
Authors: Anup D Patel; Andrea Debs; Debbie Terry; William Parker; Mary Burch; Debra Luciano; Lauren Patton; Jena Brubaker; Julie Chrisman; Kathy Moellman; James Herbst; Daniel M Cohen Journal: Neurol Clin Pract Date: 2021-10
Authors: Farren B S Briggs; Betsy K Wilson; Nataliya Pyatka; Kari Colón-Zimmermann; Martha M Sajatovic Journal: Epilepsy Res Date: 2020-02-24 Impact factor: 3.045