Patients with epilepsy struggle with multiple negative health effects, ranging from accidents to impaired mental health. A recent prospective randomized trial led by Martha N. Sajatovic, MD, showed that a novel group format epilepsy self-management intervention may help counteract some of these negative effects in patients identified as being at high-risk for them.
I spoke with Dr Sajatovic, a professor of psychiatry and neurology at Case Western Reserve University School of Medicine in Cleveland, Ohio, about why self-management is so crucial in epilepsy, the implications of her recent study, and its possible incorporation into routine care.
Andrew N. Wilner, MD: What exactly does the concept of self-management entail?
Martha N. Sajatovic, MD: This is definitely an area that has received increasing attention in recent years. Self-management is basically what a person can do to manage their chronic illness on their own. In epilepsy, that will include things to minimize seizure risk, such as treating comorbid conditions, staying on track with your sleep/wake cycles, et cetera; basically, everything that the evidence base tells us will give you the best health possible.
Wilner: This may sound a little naive, but given that these are obvious steps to improve health, doesn’t everybody already follow them?
Sajatovic: I would say it’s easy to understand but hard to do. People have a general idea of what they should do and good clinicians certainly reinforce that with their patients, since we prescribe antiepileptic drugs that can definitely help most people.
But they say the devil’s in the details, and that’s really true when you get down to the nitty-gritty of exactly how you manage sometimes competing recommendations and how you stay confident and encouraged even when the going gets tough over the long term. For most people with epilepsy, it’s a chronic condition that they must learn to live and cope with in spite of life’s ups and downs that all of us have.
Wilner: It’s so important for doctors to offer their patients very specific instructions.
Sajatovic: There has been a longstanding national effort for that here in the United States. I’m part of a research collaborative started in 2009 by the Centers for Disease Control and Prevention called the Managing Epilepsy Well Network. Its core mission is to develop, test, and disseminate evidence-based approaches for epilepsy self-management.
The participating centers have different approaches. Our center is affiliated with Case Western Reserve University School of Medicine, where we’ve developed a couple of evidence-based approaches. The most recent one was described in our publication in the journal Epilepsia, which details an approach called “Self-management for people with epilepsy and a history of negative health events” (SMART).