Comprehensive educational plan for patients with epilepsy and comorbidity (EDU-COM): a pragmatic randomised trial

Beretta, Simone; Beghi, Ettore; Messina, Paolo; Gerardi, Francesca; Pescini, Francesca; Licata, Andrea La; Specchio, Luigi Maria; Ferrara, Mariangela; Canevini, Maria Paola; Turner, Katherine; Briola, Francesca La; Franceschetti, Silvana; Binelli, S.; Giglioli, Isabella; Galimberti, Carlo; Fattore, Cinzia; Zaccara, Gaetano; Tramacere, Luciana; Sasanelli, Francesco; Pirovano, Marta; Ferrarese, Carlo

doi:10.1136/jnnp-2013-306553

Cited by 13 publications

(17 citation statements)

References 27 publications

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“…Of the 15 RCTs investigating educational interventions, 4 studies were LOE II, 4 studies were LOE III, and 7 studies were LOE IV. All 4 LOE II studies reported improvements in their various primary outcomes: medication adherence, epilepsy knowledge and satisfaction with information and support, medication‐related problems, and HRQOL . The LOE II studies investigated psychoeducational interventions that were delivered by specialized epilepsy nurses or trained medical doctors to individuals and included personalized information during routine visits or a general information package during a series of scheduled sessions.…”

Section: Available Evidence For Psychological Treatment Across the Epmentioning

confidence: 99%

“…Education protocols can, for example, either be delivered en bloc as a 2-day course or in a weekly format. Half of all 14 studies investigating educational programs [53][54][55][61][62][63]66 had chosen to deliver their interventions using at least 2 sessions that were at least 1 month apart. LOE I and II studies of psychological interventions and 1 self-management intervention 89 reporting significant primary outcome results were implemented in at least 4 sessions 86 that were delivered with a maximum frequency of weekly sessions 84 and a minimum frequency of 2-3 weeks between sessions.…”

Section: Evaluation Of the Treatment Delivery And Implementation Momentioning

confidence: 99%

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Psychological treatments for adults and children with epilepsy: Evidence‐based recommendations by the International League Against Epilepsy Psychology Task Force

et al. 2018

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Given the significant impact that psychosocial factors and epilepsy treatments can have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is great clinical interest in the role of psychological evaluation and treatments to improve HRQOL and comorbidities. Therefore, the International League Against Epilepsy (ILAE) charged the Psychology Task Force with the development of recommendations for clinical care based on evaluation of the evidence from their recent Cochrane review of psychological treatments in individuals with epilepsy. The literature search for a recent Cochrane review of randomized controlled trials investigating psychological treatments for individuals with epilepsy constitutes the key source of evidence for this article. To provide practical guidance to service providers, we provide ratings on study research designs based on (1) the American Academy of Neurology's Level of Evidence system and (2) the Grading of Recommendations, Assessment, Development, and Evaluation system. This paper is the culmination of an international collaboration process involving pediatric and adult psychologists, neurologists, psychiatrists, and neuropsychiatrists. The process and conclusions were reviewed and approved by the ILAE Executive Committee. The strongest evidence for psychological interventions was identified for the most common mental health problems, including depression, neurocognitive disturbances, and medication adherence. Psychological interventions targeting the enhancement of HRQOL and adherence and a decrease in comorbidity symptoms (anxiety, depression) should be incorporated into comprehensive epilepsy care. There is a range of psychological strategies (ie, cognitive behavioral therapy and mindfulness-based therapies) that show promise for improving the lives of persons with epilepsy, and clinical recommendations are provided to assist epilepsy health care providers in treating the comorbidities and challenges associated with epilepsy and its treatments.

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Section: Available Evidence For Psychological Treatment Across the Epmentioning

confidence: 99%

Section: Evaluation Of the Treatment Delivery And Implementation Momentioning

confidence: 99%

Psychological treatments for adults and children with epilepsy: Evidence‐based recommendations by the International League Against Epilepsy Psychology Task Force

et al. 2018

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“…Three studies were identified that looked at the costeffectiveness of epilepsy surgery and compared it with 35 20 2 5 90.9 Beretta et al 47 15 5 7 75.0 Blais et al 36 19 2 6 90.5 Bolin et al 23 17 5 4 77.3 Bowen et al 40 22 1 4 95.7 Chisholm et al 20 16 7 4 69.6 Chisholm et al 21 14 9 4 60.9 Clements et al 39 19 4 4 82.6 Craig et al 32 12 11 4 52.2 De Kinderen et al 44 21 2 3 91.3 De Kinderen et al 43 19 1 7 95.0 Frew et al 33 16 6 5 72.7 Gharibnaseri et al 34 16 5 6 76.2 Gureje et al 22 5 17 5 22.7 Hawkins et al 29 22 0 4 100.0 Helmers et al 45 16 5 6 76.2 Jentink et al 66 31 18 5 4 78.3 Lee et al 51 22 1 4 95.7 Lee et al 52 19 3 5 86.4 Majoie et al 46 11 8 8 57.9 Maltoni and Messori 27 18 5 4 78.3 Marson et al 17 21 1 5 95.5 Noble et al 48 19 1 7 95.0 Oldham et al 42 9 11 7 45.0 Plumpton et al 49 16 6 5 72.7 Rane et al 50 4 16 7 20.0 Remak et al 16 18 5 4 78.3 Remak et al 28 16 5 6 76.2 Simoens et al 24 23 0 4 100.0 Spackman et al 30 20 3 4 87.0 Suh and Lee 37 18 4 5 81.8 Van Hout et al 15 11 11 5 50.0 Vera-Llonch et al 26 18 5 4 78.3 Verdian et al 38 23 0 4 100.0 Widjaja et al 41 18 4 5 81.8 Average quality score: 77.0 "Yes" indicates sufficiently/correctly described and conducted in the study; "No" indicates insufficient, wrong, or no information regarding the specific topic in the study; NA, not applicable. A full description of the items can be found in Appendix S2.…”

Section: Epilepsy Surgerymentioning

confidence: 99%

“…Three studies looked at the cost-effectiveness of selfmanagement interventions in adults with epilepsy. Beretta et al 47 compared a standard educational plan with usual care only (i.e., medical management). The standardized educational plan, which consisted of 1 hour of counselling patients, was administered on admission and in the same form after 1 month, as a reminder.…”

Section: Self-management Interventionsmentioning

confidence: 99%

A systematic review of economic evaluations of treatments for patients with epilepsy

et al. 2017

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The increasing number of treatment options and the high costs associated with epilepsy have fostered the development of economic evaluations in epilepsy. It is important to examine the availability and quality of these economic evaluations and to identify potential research gaps. As well as looking at both pharmacologic (antiepileptic drugs [AEDs]) and nonpharmacologic (e.g., epilepsy surgery, ketogenic diet, vagus nerve stimulation) therapies, this review examines the methodologic quality of the full economic evaluations included. Literature search was performed in MEDLINE, EMBASE, NHS Economic Evaluation Database (NHS EED), Econlit, Web of Science, and CEA Registry. In addition, Cochrane Reviews, Cochrane DARE and Cochrane Health Technology Assessment Databases were used. To identify relevant studies, predefined clinical search strategies were combined with a search filter designed to identify health economic studies. Specific search strategies were devised for the following topics: (1) AEDs, (2) patients with cognitive deficits, (3) elderly patients, (4) epilepsy surgery, (5) ketogenic diet, (6) vagus nerve stimulation, and (7) treatment of (non)convulsive status epilepticus. A total of 40 publications were included in this review, 29 (73%) of which were articles about pharmacologic interventions. Mean quality score of all articles on the Consensus Health Economic Criteria (CHEC)-extended was 81.8%, the lowest quality score being 21.05%, whereas five studies had a score of 100%. Looking at the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), the average quality score was 77.0%, the lowest being 22.7%, and four studies rated as 100%. There was a substantial difference in methodology in all included articles, which hampered the attempt to combine information meaningfully. Overall, the methodologic quality was acceptable; however, some studies performed significantly worse than others. The heterogeneity between the studies stresses the need to define a reference case (e.g., how should an economic evaluation within epilepsy be performed) and to derive consensus on what constitutes "standard optimal care."

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“…There were 7 studies (29%) examining the benefit of educational interventions. All of them comprised epilepsy knowledge, advocacy topics, daily self‐management behaviors, and psychosocial aspects primarily to enhance QoL (n = 4, 57%), increase knowledge and coping, increase satisfaction of patients with information and support, or reduce drug‐related problems …”

Section: Resultsmentioning

confidence: 99%

Cochrane systematic review and meta‐analysis of the impact of psychological treatments for people with epilepsy on health‐related quality of life

et al. 2018

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SummaryObjective: Given the significant impact epilepsy can have on health-related quality of life (HRQoL) of individuals with this condition and their families, there is great clinical interest in evidence-based psychological treatments aimed at enhancing well-being in people with epilepsy (PWE). An evaluation of the current evidence is needed to assess the effects of psychological treatments for PWE on HRQoL outcomes to inform future therapeutic recommendations and research designs. Methods: The operational definition of psychological treatments included a broad range of interventions that use psychological or behavioral techniques designed to improve HRQoL, psychiatric comorbidities, and seizure frequency and severity for adults and children with epilepsy. A systematic literature search was conducted in line with Cochrane criteria for randomized controlled trials (RCTs) and quasi-RCTs investigating psychological treatments and using HRQoL outcome measures as primary or secondary outcome measures. Standard methodological procedures required by the Cochrane Collaboration were used for data collection and analysis. Results: Twenty-four completed RCTs were included in this review (2439 participants). Based on satisfactory methodological homogeneity, data from 9 studies (468 participants) providing Quality of Life in Epilepsy-31 (QOLIE-31) outcomes were pooled for meta-analyses, showing significant mean changes for QOLIE-31 total score and 6 subscales. The significant mean changes of QOLIE-31 total score (mean improvement of 5.68 points; 95% confidence interval = 3.11-8.24, P < .0001) and 3 subscales (emotional well-being, energy/fatigue, overall quality of life [QoL]) exceeded the threshold of minimally important change, indicating a clinically meaningful postintervention improvement of QoL. Overall, the metaanalysis quality of evidence was characterized as "moderate" due to the risk of R.M. and V.T. contributed in equal measure to this article and should be considered joint first authors. This article is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2017, Issue 10: CD012081, https://doi. org/10.1002/14651858.cd012081 (see www.cochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review.

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Comprehensive educational plan for patients with epilepsy and comorbidity (EDU-COM): a pragmatic randomised trial

Cited by 13 publications

References 27 publications

Psychological treatments for adults and children with epilepsy: Evidence‐based recommendations by the International League Against Epilepsy Psychology Task Force

Psychological treatments for adults and children with epilepsy: Evidence‐based recommendations by the International League Against Epilepsy Psychology Task Force

A systematic review of economic evaluations of treatments for patients with epilepsy

Cochrane systematic review and meta‐analysis of the impact of psychological treatments for people with epilepsy on health‐related quality of life

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