Interventions for Children With Epilepsy

A Cochrane review of interventions for children with epilepsy determined that most improve care and some outcomes, but more research is needed.

The Cochrane Collaboration has re-released a review of interventions for children who have epilepsy that was originally published in 2010, making it available online for the first time. The authors report that much usual epilepsy care—care without planned, specific educational, or self-management intervention—lacks impact. Most experts will agree that the situation hasn’t changed since 2010.

The review compares care provided by specialists or dedicated teams with that in usual care settings. Dedicated interventions were directed at the child with epilepsy only. Two interventions were aimed at children and their parents, and others were designed for teenagers and their parents. This is a small review compared with many others from Cochrane; the authors identified only 4 trials and 5 reports. Regardless, each of the included intervention programs demonstrated some benefit for children with epilepsy.

The analysts looked at a variety of educational or dedicated interventions provided in health care settings. The outcomes they examined included:

• seizure frequency and severity
• medication use, appropriateness, and toxicity
• patient or caregiver knowledge of information and advice received from professionals
• patient/caregiver report of health and quality of life (including medication side effects)
• objective measures of general health status
• objective measures of social or psychological functioning (including days spent on sick leave or absence from school and work)
• treatment and care cost

Although comparisons among studies were difficult, the authors’ analysis found that most educational and counseling interventions improved care and some outcomes. Above all, they determined that more research is needed.

Provision of counseling for children who have epilepsy is an area in which pharmacists are well-situated to help. Because epilepsy patients take medication chronically, pharmacists see them frequently. In fact, this is an area in which pharmacists’ skills will help them design interventions and conduct prospective research.

The review suggests that good quality research is needed that:

• describes the intervention and includes a process evaluation and a multi-center assessment of benefits for more than one population and service provider;
• evaluates the intervention’s effects in subgroups most likely to benefit (eg, newly diagnosed children, learning disabled children);
• assesses cost-effectiveness

Pharmacists often are interested in conducting trials, but need support. Pharmacists can contact a nearby school of pharmacy to ask for assistance to jumpstart the process. Working collaboratively with other health care providers and involving students on rotations can help, too, lending the important reinforcement that interdisciplinary approaches offer.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.