Service delivery, behavioural, and self-management interventions for children with epilepsy

Area of Science:

• Pediatric Neurology
• Evidence-Based Medicine
• Health Services Research

Background:

• Epilepsy affects a significant number of children in the UK, with prevalence rates of 1 in 1000 for ages 0-4 and 1 in 200 for ages 5-19.
• Current treatment models necessitate a focus on cognitive, psychological, and behavioral interventions to enhance seizure control and quality of life.

Purpose of the Study:

• To evaluate the impact of service delivery, behavioral, and self-management interventions on seizure control and health-related quality of life in pediatric epilepsy.
• To synthesize evidence from randomized controlled trials (RCTs) and quasi-RCTs.

Main Methods:

• A systematic search of multiple databases (Cochrane Register of Studies, MEDLINE, etc.) was conducted up to August 2023.
• Included studies were RCTs or quasi-RCTs of any design, involving children aged 18 or under with epilepsy.
• Primary outcomes included seizure control (frequency, freedom), with secondary outcomes encompassing quality of life, medication usage, and adverse events. Certainty of evidence was assessed using GRADE.

Main Results:

• Six studies (468 participants) were included, comprising four behavioral and two service delivery interventions. No self-management interventions were identified.
• Psycho-behavioral interventions showed a potential small reduction in seizure frequency at three months (low-certainty evidence). Evidence for quality of life improvements was very uncertain.
• Mind-body interventions (yoga) and a clinical pharmacist-led service delivery intervention yielded uncertain effects on seizure control and quality of life due to very low-certainty evidence and heterogeneity.

Conclusions:

• The available evidence on interventions for pediatric epilepsy is of low to very low certainty, with significant limitations including small sample sizes and lack of blinding.
• High-quality RCTs are urgently needed to assess service delivery, behavioral, and self-management interventions, measuring both short-term and long-term outcomes.
• Development of a core outcome set for pediatric epilepsy trials is recommended to ensure consistent and meaningful outcome evaluation.