Self-management of Epilepsy: A Systematic Review

Abstract

Background: Although self-management is recommended for persons with epilepsy, its optimal strategies and effects are uncertain.

Purpose: To evaluate the components and efficacy of self-management interventions in the treatment of epilepsy in community-dwelling persons.

Data sources: English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL in April 2018; the MEDLINE search was updated in March 2019.

Study selection: Randomized and nonrandomized comparative studies of self-management interventions for adults with epilepsy.

Data extraction: An investigator assessed study characteristics; intervention details, including 6 components of self-management; and outcomes, which were verified by a second reviewer. Risk of bias (ROB) was assessed independently by 2 investigators.

Data synthesis: 13 randomized and 2 nonrandomized studies (2514 patients) evaluated self-management interventions. Interventions were delivered primarily in group settings, used a median of 4 components, and followed 2 general strategies: 1 based on education and the other on psychosocial therapy. Education-based approaches improved self-management behaviors (standardized mean difference, 0.52 [95% CI, 0.0 to 1.04]), and psychosocial therapy-based approaches improved quality of life (mean difference, 6.64 [CI, 2.51 to 10.77]). Overall, self-management interventions did not reduce seizure rates, but 1 educational intervention decreased a composite of seizures, emergency department visits, and hospitalizations.

Limitation: High ROB in most studies, incomplete intervention descriptions, and studies limited to English-language publications.

Conclusion: There is limited evidence that self-management strategies modestly improve some patient outcomes that are important to persons with epilepsy. Overall, self-management research in epilepsy is limited by the range of interventions tested, the small number of studies using self-monitoring technology, and uncertainty about components and strategies associated with benefit.

Primary funding source: U.S. Department of Veterans Affairs. (PROSPERO: CRD42018098604).