Epilepsy
Conditions
Keywords
Epilepsy Self Management, Epilepsy, Seizure, Reduction medication, Anti-seizure medication
Brief summary
This study will be done in two phases. Using stakeholder input (community advisory board (CAB)), the study team will adapt the SMART program to incorporate education and self-management support for use of Rescue Medication (RM) to manage seizure occurrence among Persons With Epilepsy (PWE) who have repetitive seizures. Additional content/support materials, pending input stakeholder might include posters/hand-outs that present information on the use of RM in a way that is engaging and salient to PWE. It is expected that participants will be in Phase 1 for about 3 months and participate in the CAB 2 or 3 times via zoom for 60-90 minutes/meeting. The advisory board will provide input on needed refinement of an adapted version of SMART based on their individual experiences. It is anticipate the total time commitment to be no more than 6 hours over 3 months, spread out over 2-3 meetings with review of materials possible in between meetings. Phase 2: The investigators will use a 6-month prospective trial design to test engagement with and effects of SMART-RM among approximately 35 adult (≥ 18 years) PWE who have repetitive seizures.
Interventions
BEHAVIORALSMART RM
The SMART-RM will consist of 8 group-format, 45-60 minute sessions (up to 11 participants per group), which will be collaboratively delivered by a Nurse Educator (NE) and a Peer Educator (PE).
DRUGValtoco Nasal Product
Medication dosing will follow recommendations in the Valtoco package insert and managed by the epilepsy clinician.
Sponsors
University Hospitals Cleveland Medical Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Phase 1 Patient with epilepsy inclusion criteria: * Have epilepsy * Have experience with RM * Be 18 years or older * Be able to speak and understand English * Be able to provide written, informed consent to study participation Phase 1 Caregiver inclusion criteria * Provide care support to an individual with epilepsy * Be 18 years or older * Be able to speak and understand English * Be able to provide written, informed consent to study participation Phase 1 Provider inclusion criteria * Provide care for individuals with epilepsy - this may include (not limited to) physician, nurse practitioner, physician assistant, nurse, social worker, psychologist * Be 18 years or older * Be able to speak and understand English * Be able to provide written, informed consent to study participation Inclusion criteria for PEs: * Have epilepsy * Have experience with RM * Be 18 years or older * Be able to speak and understand English * Be able to provide written, informed consent to study participation Inclusion criteria for participants who will receive SMART-RM: * Have received a previous diagnosis of epilepsy * Be adults ≥ age 18, * While on a regimen of anti-epileptic medication, still be experiencing bouts of seizures (e.g. frequent break through or acute repetitive seizures) distinct from their usual seizure pattern , and, in the opinion of the study epilepsy clinician, may need benzodiazepine intervention for seizure control * Have experienced at least 3 seizures but not more than 100 seizures in the previous 6 months. If there have only been 3 seizures in the last 6 months, two of the seizures should be within approximately 24 hours of each other (not more than 48 hours apart) * Be able to speak and understand English * Be able to provide written, informed consent to study participation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change in number of seizures as measured by patient report. | Baseline, 6 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in quality of life as measure by QOLIE-31 | Baseline, 10 week, 24 week | Quality of life (QOL) will be assessed using the QOLIE-31, a validated tool to assess quality of life specifically in people with epilepsy with higher numbers reflecting a more favorable health state. |
| Change in functional status as measure by Short-Form Health Survey (SF-36) | Baseline, 10 week, 24 week | Functional status will be assessed using the 36-item Short-Form Health Survey (SF-36), a multipurpose, short-form health survey with 36 questions that yields two psychometrically based components: a physical component summary and mental component summary. Scores range from 0 (worst functioning) to 100 (best functioning). The SF-36 is a generic measure of functional health status and has proven useful for comparing the relative burden of diseases. |
| Change in depressive symptoms as measure by Patient Health Questionnaire (PHQ-9) | Baseline, 10 week, 24 week | Depressive symptom severity will be assessed using the nine- item Patient Health Questionnaire (PHQ-9), a widely used and validated self-rated depression scale. The PHQ-9 incorporates Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria, with scores ranging from 0 to 27. Higher scores indicate worse depression severity. The PHQ-9 has been widely used to measure depressive symptom severity in epilepsy. |
| Change in epilepsy self management as measure by Epilepsy Self-Efficacy Scale (ESES) | Baseline, 10 week, 24 week | Self-efficacy will be measured using the 33-item Epilepsy Self-Efficacy Scale (ESES), with scores ranging from 0 to 330 and higher scores indicating better self-efficacy. Social support will be measured with the 12-item. |
| Change in epilepsy self management as measure by Multidimensional Scale of Perceived Social Support (MSPSS) | Baseline, 10 week, 24 week | Multidimensional Scale of Perceived Social Support (MSPSS), which measures perception of social support provided by family and friends, as well as satisfaction with that support. The MSPSS score ranges from 1 to 84, with higher scores indicating better social support. |
| Change in epilepsy self management as measure by Epilepsy Self-Management Scale (ESMS) | Baseline, 10 week, 24 week | Overall epilepsy self-management competency will be measured using the Epilepsy Self-Management Scale (ESMS); scores range from 1 to 190, with higher scores indicating better self-management of epilepsy. |
| Change in epilepsy self management as measure by Epilepsy Stigma Scale (ESS) | Baseline, 10 week, 24 week | Stigma for epilepsy will be measured using the Epilepsy Stigma Scale (ESS) In the ESS, scores range from 7 to 70; each item is rated on a 7-point scale from strongly disagree to strongly agree, with higher numbers indicating greater perceived stigma |
| Change in number of emergency room visit as measure by patient report | Baseline, 10 week, 24 week | — |
| Change in number of hospitalizations as measure by patient report | Baseline, 10 week, 24 week | — |
| Change in number of non study outpatient services utilization as measure by patient report | Baseline, 10 week, 24 week | — |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORMartha Sajatovic, MD
University Hospitals
Outcome results
None listed