Organizing health care for people with seizures and epilepsy

Acceptance and Commitment Therapy and yoga for drug-refractory epilepsy: a randomized controlled trial

OBJECTIVE

There is a need for controlled outcome studies on behavioral treatment of epilepsy. The purpose of this study was to evaluate Acceptance and Commitment Therapy (ACT) and yoga in the treatment of epilepsy.

METHODS

The design consisted of a randomized controlled trial with repeated measures (N=18). All participants had an EEG-verified epilepsy diagnosis with drug-refractory seizures. Participants were randomized into one of two groups: ACT or yoga. Therapeutic effects were measured using seizure index (frequency x duration) and quality of life (Satisfaction with Life Scale, WHOQOL-BREF). The treatment protocols consisted of 12 hours of professional therapy distributed in two individual sessions, two group sessions during a 5-week period, and booster sessions at 6 and 12 months posttreatment. Seizure index was continuously assessed during the 3-month baseline and 12-month follow-up. Quality of life was measured after treatment and at the 6-month and 1-year follow-ups.

RESULTS

The results indicate that both ACT and yoga significantly reduce seizure index and increase quality of life over time. ACT reduced seizure index significantly more as compared with yoga. Participants in both the ACT and yoga groups improved their quality of life significantly as measured by one of two quality-of-life instruments. The ACT group increased their quality of life significantly as compared with the yoga group as measured by the WHOQOL-BREF, and the yoga group increased their quality of life significantly as compared with the ACT group as measured by the SWLS.

CONCLUSIONS

The results of this study suggest that complementary treatments, such as ACT and yoga, decrease seizure index and increase quality of life.

Prevalence of Active Epilepsy and Health-Related Quality of Life among Adults with Self-Reported Epilepsy in California: California Health Interview Survey, 2003

PURPOSE

To examine the prevalence of self-reported epilepsy and active epilepsy, associated burden of impaired health-related quality of life, risk factors, and access to care in adults with self-reported epilepsy, and those classified as having active epilepsy with and without recent seizures.

METHODS

We analyzed data from adults aged >or=18 years (n = 41,494) who participated in the 2003 California Health Interview Survey (CHIS).

RESULTS

In California, 1.2% of adults reported ever being told they had epilepsy or seizure disorder, and 0.7% were classified as having active epilepsy. About three-fourths of adults with active epilepsy with recent seizures reported fair or poor health status. Adults with active epilepsy with recent seizures reported almost two weeks of poor physical or mental health and activity limitation days compared with two to 4 days per month in those without epilepsy. Among adults with active epilepsy and recent seizures, about one-quarter reported not taking any medicine to control their seizure disorder or epilepsy. About one-third reported physical disability/unable to work compared to a small proportion of the general population. The majority of adults with active epilepsy reported having a regular source of medical care.

CONCLUSION

Our findings highlight the burden of epilepsy among adults in California. CHIS serves as a model demonstrating the value of including questions about epilepsy on public health surveillance systems to ascertain the burden of the disorder and to guide intervention research and public policy to improve HRQOL in people with epilepsy.

Elements of Effective Chronic Care: A Model for Optimizing Outcomes for the Chronically Ill

Current estimates are that there are 2.3 million individuals with epilepsy among 99 million Americans suffering from chronic medical conditions. The healthcare system is designed to treat acutely ill patients and, as a result, often fails to meet the needs of the chronically ill. Care is provided in brief, problem-focused visits. Multiple studies have shown that this type of standard practice produces suboptimal care and outcomes, and is unsatisfactory to both patients and care providers. We developed the Chronic Care Model in an effort to synthesize system and practice changes associated with better outcomes. In patient care as described in this model, patient-provider interactions are planned in advance in accordance with evidence-based guidelines. A primary focus is on assisting patients and their families in becoming competent self-managers. The Chronic Care Model has been successfully implemented by more than 200 healthcare systems. In this paper, we explore the applicability of the Chronic Care Model in managing patients with epilepsy.