Determining the disease management process for epileptic patients: A qualitative study

Individualized Homeopathic Medicines as Adjunctive Treatment of Pediatric Epilepsy: A Double-Blind, Randomized, Placebo-Controlled Trial

INTRODUCTION

Epilepsy, one of the most common neurological diseases, contributes to 0.5% of the total disease burden. The burden is highest in sub-Saharan Africa, central Asia, central and Andean Latin America, and south-east Asia. Asian countries report an overall prevalence of 6/1,000 and that in India of 5.59/1,000. We examined whether individualized homeopathic medicines (IHMs) can produce a significantly different effect from placebos in treatment of pediatric epilepsy in the context of ongoing standard care (SC) using anti-epileptic drugs (AEDs).

METHODS

The study was a 6-month, double-blind, randomized, placebo-controlled trial (n = 60) conducted at the pediatric outpatient department of a homeopathic hospital in West Bengal, India. Patients were randomized to receive either IHMs plus SC (n = 30) or identical-looking placebos plus SC (n = 30). The primary outcome measure was the Hague Seizure Severity Scale (HASS); secondary outcomes were the Quality of Life in Childhood Epilepsy (QOLCE-16) and the Pediatric Quality of Life inventory (PedsQL) questionnaires; all were measured at baseline and after the 3rd and 6th month of intervention. The intention-to-treat sample was analyzed to detect group differences and effect sizes.

RESULTS

Recruitment and retention rates were 65.2% and 91.7% respectively. Although improvements were greater in the IHMs group than with placebos, with small to medium effect sizes, the inter-group differences were statistically non-significant - for HASS (F 1, 58 = 0.000, p = 1.000, two-way repeated measures analysis of variance), QOLCE-16 (F 1, 58 = 1.428, p = 0.237), PedsQL (2-4 years) (F 1, 8 = 0.685, p = 0.432) and PedsQL (5-18 years) (F 1, 47 = 0.000, p = 0.995). Calcarea carbonica, Ignatia amara, Natrum muriaticum and Phosphorus were the most frequently prescribed medicines. No serious adverse events were reported from either of the two groups.

CONCLUSION

Improvements in the outcome measures were statistically non-significantly greater in the IHMs group than in the placebos group, with small effect sizes. A different trial design and prescribing approach might work better in future trials.

TRIAL REGISTRATION

CTRI/2018/10/016027.

Role of occupational therapy in epilepsy patients after left temporal lobe surgery

There is a relevant risk of psychosocial as well as cognitive impairments in epilepsy patients with resective surgery in the left temporal lobe. Surgery in the speech-dominant hemisphere can be associated with deterioration of speech related functions including verbal memory. There are only limited studies addressing the impact of occupational therapy in postoperative rehabilitation of epilepsy patients.Method: In this study, a mixed-methods design based on the grounded theory concept was administered. Seven patients with left temporal lobe epilepsy and a risk profile for postoperative cognitive decline were investigated over various time points. Neuropsychological assessments occurred before surgery, 1 week, 3 months, and 6 months postoperatively. According to our rehabilitation concept, every patient started occupational therapy 1 month before surgery. Therapy lasted for at least 6 months after surgery. For all patients, extensive qualitative interviews with the occupational therapists and anamnestic data were analyzed.Results: In all patients, postoperative psychosocial difficulties emerged. Language and memory tests showed a decline after 6 months specifically for name retrieval. Occupational therapy was adapted to find individual solutions for the patients problems and to implement effective coping strategies.Conclusion: Cognitive training lead to consistent improvements over time. The results show that occupational therapy can be an efficient tool in the treatment of psychosocial and cognitive impairments after epilepsy surgery.

Managing everyday life: Self-management strategies people use to live well with neurological conditions

OBJECTIVE

This paper uses the Taxonomy of Everyday Self-management Strategies (TEDSS) to provide insight and understanding into the complex and interdependent self-management strategies people with neurological conditions use to manage everyday life.

METHODS

As part of a national Canadian study, structured telephone interviews were conducted monthly for eleven months, with 117 people living with one or more neurological conditions. Answers to five open-ended questions were analyzed using qualitative content analysis. A total of 7236 statements were analyzed.

RESULTS

Findings are presented in two overarching patterns: 1) self-management pervades all aspects of life, and 2) self-management is a chain of decisions and behaviours. Participants emphasized management of daily activities and social relationships as important to maintaining meaning in their lives.

CONCLUSION

Managing everyday life with a neurological condition includes a wide range of diverse strategies that often interact and complement each other. Some people need to intentionally manage every aspect of everyday life.

PRACTICE IMPLICATIONS

For people living with neurological conditions, there is a need for health providers and systems to go beyond standard advice for self-management. Self-management support is best tailored to each individual, their life context and the realities of their illness trajectory.

Caring electronically for young outpatients who have epilepsy

PURPOSE

The purpose of this study was to review electronic tools that might improve the delivery of epilepsy care, reduce medical care costs, and empower families to improve self-management capability.

METHOD

We reviewed the epilepsy-specific literature about self-management, electronic patient-reported or provider-reported outcomes, on-going remote surveillance, and alerting/warning systems.

CONCLUSIONS

The improved care delivery system that we envision includes self-management, electronic patient (or provider)-reported outcomes, on-going remote surveillance, and alerting/warning systems. This system and variants have the potential to reduce seizure burden through improved management, keep children out of the emergency department and hospital, and even reduce the number of outpatient visits.