title: A cognitive behavioral intervention (HOBSCOTCH) improves quality of life and attention in epilepsy.
abstract: OBJECTIVE
  Cognitive difficulties in epilepsy are common and add to disability beyond seizures alone. A self-management intervention targeting cognitive dysfunction was developed and assessed for whether it improves quality of life, objective memory, and mood in adults with epilepsy.
  
  
  METHODS
  The HOme Based Self-management and COgnitive Training CHanges lives (HOBSCOTCH) program was developed to incorporate (1) psychoeducation, (2) self-awareness training, (3) compensatory strategies, and (4) application of these strategies in day-to-day life using problem solving therapy. Adults aged 18-65 years with epilepsy (n=66) were randomized into 3 groups, to receive 8 weeks of HOBSCOTCH, with (H+) or without (H) additional working memory training on a commercial gaming device, or to a waitlisted control group. The primary outcome was quality of life (Quality of Life in Epilepsy scale, QOLIE-31) with secondary outcomes of objective cognition measured with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and depression (as measured by PHQ9 and NDDIE).
  
  
  RESULTS
  Both intervention arms showed a significant improvement in quality of life, as compared with controls who demonstrated a decline in QOLIE-31 scores. There was significant improvement in objective cognitive performance among the intervention groups, most notably in attention, compared with the waitlisted controls. There was no significant change in depression scores.
  
  
  CONCLUSIONS
  The HOBSCOTCH program significantly improved quality of life and appeared to be an effective intervention to address cognitive dysfunction in adults with epilepsy. Further studies are needed to assess the generalizability and cost-effectiveness of this intervention.
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
authors.forename: Tracie A
authors.initials: TA
authors.lastname: Caller
authors.affiliation: Eastern Maine Medical Center, Bangor, ME, United States.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ferguson
authors.affiliation: Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Roth
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Secore
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
authors.forename: Faith P
authors.initials: FP
authors.lastname: Alexandre
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; Division of Biostatistics, Geisel School of Medicine at Dartmouth, United States.
authors.forename: Wenyan
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; Division of Biostatistics, Geisel School of Medicine at Dartmouth, United States.
authors.forename: Tor Devin
authors.initials: TD
authors.lastname: Tosteson
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Henegan
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Birney
authors.affiliation: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States. Electronic address: Barbara.C.Jobst@hitchcock.org.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Jobst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001288:Attention; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004827:Epilepsy / Q000523:psychology*; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D008570:Memory, Short-Term; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011788:Quality of Life / Q000523:psychology*; D012640:Seizures; D012648:Self Care; D055815:Young Adult
keywords: Cognition; Cognitive remediation; Comorbidities; Depression; Epilepsy; Memory; Self-management