***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 r and omized 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 . SIGNIFICANCE 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 BACKGROUND The objective of the ZMILE study was to compare the effectiveness of a multicomponent self-management intervention ( MCI ) with care as usual ( CAU ) in adult patients with epilepsy ( PWE ) over a six-month period . METHODS Participants ( PWE & relative ) were r and omized into intervention or CAU groups . Self-report question naires were used to measure disease-specific self-efficacy as the primary outcome measure and general self-efficacy , adherence , seizure severity , emotional functioning , quality of life , proactive coping , and side-effects of antiepileptic drugs ( AED ) as secondary outcome measures . Instruments used at baseline and during a six-month follow-up period were the following : disease-specific self-efficacy ( Epilepsy Self-Efficacy Scale [ ESES ] , General Self-Efficacy Scale [ GSES ] ) ; adherence ( Medication Adherence Scale [ MARS ] and Medication Event Monitoring System [ MEMS ] ) ; seizure severity ( National Hospital Seizure Severity Scale [ NHS3 ] ) ; emotional well-being ( Hospital Anxiety and Depression Scale [ HADS ] ) ; quality of life ( Quality of Life in Epilepsy [ QOLIE-31P ] ) ; proactive coping ( Utrecht Proactive Coping Competence [ UPCC ] ) ; and side-effects of antiepileptic drugs [ SIDAED ] . Multilevel analyses were performed , and baseline differences were corrected by inclusion of covariates in the analyses . RESULTS In total , 102 PWE were included in the study , 52 of whom were in the intervention group . On the SIDAED and on three of the quality of life subscales QOLIE-31P , a significant difference was found ( p<0.05 ) in the intervention group . Self-efficacy , however , showed no significant differences between the MCI and the CAU groups . None of the other outcome measures showed any significant difference between the two groups . SIGNIFICANCE Although we found no statistically significant difference in the primary outcome measure , disease-specific self-efficacy , this MCI could prove promising , since we found improvement in some domains of quality of life in epilepsy scale and a decrease in AED side-effects in the MCI group compared with the CAU group WebEase ( Epilepsy Awareness , Support , and Education ) is an online epilepsy self-management program to assist people with taking medication , managing stress , and improving sleep quality . The primary study aims were to determine if those who participated in WebEase demonstrated improvements in medication adherence , perceived stress , and sleep quality .  Participants were r and omized to a treatment ( T ) or waitlist control ( WCL ) group ( n=148 ) . At follow-up , participants in the T group reported higher levels of medication adherence than those in the WLC group . Analyses were also conducted comparing those who had completed WebEase modules with those who had not . Those who had completed at least some modules within the WebEase program reported higher levels of self-efficacy and a trend toward significance was observed for the group × time interactions for medication adherence , perceived stress , self-management , and knowledge . The results highlight the usefulness of online tools to support self-management among people with epilepsy Few studies have examined the effectiveness of cognitive behavior therapy to manage seizures and improve psychosocial functioning in older adults with epilepsy . This study evaluated the efficacy of a 6 week group CBT program in community dwelling adults with epilepsy who were aged over 60 years . A total of 37 participants were r and omly assigned to either a CBT group or a control group . Measures of depression , dysthymia , psychosocial functioning and seizure frequency were completed at pre and post intervention . Seizure frequency was significantly reduced in the CBT group compared to the control group ( Cohen ’s d 0.63 ) . The results suggest that the relationship between seizure frequency and psychological and psychosocial well being in older adults requires further investigation . Although there were no significant between group differences on measures of depression and psychosocial functioning , both the CBT and control groups improved significantly from baseline We determined the efficacy of progressive muscle relaxation in reducing seizure frequency .  Subjects were 24 people with epilepsy attending an urban neurology clinic . The experimental design consisted of an 8-week baseline period , a treatment period of six sessions of progressive relaxation training ( PRT , n = 13 ) or quiet sitting ( QS , n = 11 ) and an 8-week follow up . In the PRT group , 11 subjects reported a decrease in seizure frequency ( p less than 0.01 ) , and in the QS group , 7 reported a decrease ( p greater than 0.05 ) . The mean decrease in seizure frequency was 29 % for the PRT group ( p less than 0.01 ) but only 3 % for the QS group ( p greater than 0.05 ) . This is the fifth recent report of a controlled study documenting the success of progressive relaxation therapy in seizure reduction . PRT is inexpensive and noninvasive and facilitates patient participation . Such a technique should be incorporated into clinical practice The present study evaluated the efficacy of the  Sepulveda Epilepsy Education program ( SEE ) , using a controlled outcome design . SEE is a 2-day psychoeducational treatment program design ed to provide medical education and psychosocial therapy .  Thirty-eight out patients , matched according to seizure type and frequency , were r and omly assigned to treatment ( n = 20 ) or waiting-list control ( n = 18 ) groups . The major outcome measures used were a 50-item true-false test specifically design ed to evaluate the SEE program , the Washington Psychosocial Seizure Inventory , the Beck Depression Inventory , Lubin 's Depression Adjective Checklist , the State-Trait Anxiety Inventory , the Acceptance of Disability Scale , and Sherer 's Self-Efficacy Scale . Significant differences between the two groups were found on the three major subscales of the 50-item true-false test . The treatment group demonstrated a significant increase in overall underst and ing of epilepsy , a significant decrease in fear of seizures , and a significant decrease in hazardous medical self-management practice s. In addition , an objective measure of blood levels of antiepileptic drugs ( AEDs ) showed the treatment group to have a significant increase in medication compliance This study evaluated the efficacy of a newly developed , home-based depression intervention for people with epilepsy . Based on mindfulness-based cognitive therapy ( MBCT ) , the eight-session , weekly intervention was design ed for group delivery via the Internet or telephone . Forty participants were r and omly assigned to intervention or waitlist . Depressive symptoms and other outcomes were measured at baseline , after intervening in the intervention group ( ~8 weeks ) , and after intervening in the waitlist group ( ~16 weeks ) . Depressive symptoms decreased significantly more in the intervention group than the waitlist group ; Internet and telephone did not differ . This effect persisted over the 8 weeks when those waitlisted received the intervention . Knowledge/skills increased significantly more in the intervention than the waitlist group . All other changes , though not significant , were in the expected direction . Findings indicate that distance delivery of group MBCT can be effective in reducing symptoms of depression in people with epilepsy . Directions for future research are proposed The present study evaluated the efficacy of group cognitive-behavior therapy for the alleviation of psychosocial problems and reduction of seizures with adult epileptic patients . Twenty-seven out patients were r and omly assigned to one of three groups : Cognitive-Behavior Therapy , Supportive Counseling ( attention-placebo control ) , and Waiting list ( no treatment control ) . The major outcome measures used were : patient 's , neurologist 's , and therapist 's global ratings of psychological adjustment , patient 's target complaints and weekly seizure frequency , patient 's and neurologist 's ratings of seizure control , the Minnesota Multiphasic Personality Inventory , the Washington Psychosocial Seizure Inventory , and the Beck Depression Inventory . No significant differences were found among the three groups on these measures except for therapist 's global ratings of psychological adjustment , on which both the Cognitive-Behavior Therapy and Supportive Counseling groups improved significantly after therapy , but the Waiting List control group did not . Overall , little support was found for the efficacy of group cognitive behavior therapy ( eight 2-h weekly sessions ) for the reduction of psychosocial difficulties or seizures . Implication s of the present findings are discussed , with the need for further controlled outcome research stressed This study compared a 9-week individualised Cognitive Behaviour Therapy ( CBT ) programme for people with epilepsy ( PWE ) , with a wait-list control . Fifty-nine PWE were r and omised and 45 ( 75 % ) completed post-treatment outcomes . People with lower quality of life ( QoL ) , particularly for cognitive functioning , were more likely to drop out . Analyses based on treatment completers demonstrated significant improvements on the Neurological Depressive Disorders Inventory for Epilepsy ( p = .045 ) and Hospital Anxiety Depression Scale-Depression subscale ( p = .048 ) . Importantly , CBT significantly reduced the likelihood of clinical depressive symptoms ( p = .014 ) and suicidal ideation ( p = .005 ) . Improvements were not observed for anxiety , QoL or maintained overtime for depression . Results suggest that CBT was effective , however , and could be improved to increase patient retention and long-term outcomes Self‐management challenges facing adults with epilepsy include limited underst and ing of the condition and treatment , associated psychosocial issues , and lack of community integration .  Self‐management interventions  improve patients ' medical , life role , and emotional management . Previous interventions , developed from expert opinion , indicated issues with participant engagement/retention , and limited follow‐up periods . PACES in Epilepsy addressed method ologic concerns by utilizing patient needs assessment data ( n = 165 ) to derive self‐management content and program features for evaluation via r and omized controlled trial ( RCT ) PURPOSE To evaluate the efficacy of the educational program MOSES ( Modular Service Package Epilepsy ) . It was developed to improve patients ' knowledge and underst and ing about their epilepsy , its treatment , and psychosocial consequences . The program intends to improve patients ' coping with the disease , to strengthen self-esteem , and to support patients to become experts in managing their epilepsy . METHODS A controlled , r and omized study design was used to examine the efficacy of MOSES .  Patients from 22 epilepsy centers in Germany , Austria , and Switzerl and were r and omly allocated to either  MOSES group ( treatment group ) or waiting-list group ( control group ) . The 242 patients were aged from 16 to 80 years . The MOSES group ( n = 113 ) completed the question naires immediately before the educational course ( T1 ) and 6 months later ( T2 ) , and the control group ( n = 129 ) , 6 months before ( T1 ) and immediately before ( T2 ) the course . The question naires included generic instruments ( SF-36 , Rosenberg self-esteem Scale , von Zerssen Depression Scale ) , and epilepsy-specific scales ( Restrictions in Daily Life , Epilepsy-Related Fears , Coping with Epilepsy and Adaptation ) . Depression was used as a moderator variable . Seizure frequency and satisfaction with therapy also were assessed . Multivariate analysis of variance ( MANOVA ) with repeated measurements and univariate analyses of variance were performed . RESULTS The MANOVA showed that participants of the educational program improved significantly . Univariate analyses revealed improvements in knowledge ( p < 0.001 ) and coping with epilepsy ( p = 0.004 ) , whereas important effects of MOSES on other epilepsy-specific measures and on generic question naires ( SF-36 , self-esteem ) were not found . Participants of the MOSES program also improved in seizure outcome ( p = 0.041 ) and became more satisfied with the therapy [ better tolerability of antiepileptic drug ( AED ) therapy , fewer 
    Output:
    
Systematic review s have shown that  self-management support for patients with chronic illness improves symptoms and role function , but these positive effects are influenced by the type of chronic illness and the self-management skills taught ( 1719 ) .
Further , the effectiveness of self-management may be diminished by conditions associated with epilepsy , such as traumatic brain injury or depressive disorders , and by low health literacy .
For patients with epilepsy , robust self-management skills may improve self-efficacy and medication adherence , prevent seizure triggers , and increase patient and family knowledge regarding when to seek urgent medical care .