Enhancing memory and quality of life through novel home-based neuropsychological rehabilitation for epilepsy: A randomized controlled trial

ABSTRACT

Background and aims: Memory impairment in epilepsy is a critical determinant of Quality of Life (QoL). Subjective complaints may reflect depression. 6-week home based Neuropsychological Rehabilitation (NR) program was developed for patients with Drug Refractory Epilepsy (DRE) [Post-Operative (PO) & Not Cleared for Surgery (NCS)]. This includes psychoeducation, compensatory training and cognitive retraining aimed at improving memory. Neuropsychological outcomes were studied. Methods: 27 adults with DRE were recruited in a single blind RCT (CTRI/2019/10/021777) with 14 patients in the Intervention (IG) (PO = 13, NCS = 1), and 13 in the Treatment As Usual (TAU) (PO = 11, NCS = 2) groups. They were aged 18–45 years with minimum primary level of education, IQ > 80 and available primary caregiver. Pre-post neuropsychological assessment included Auditory Verbal Learning Test, Everyday Memory Questionnaire (EMQ), Hamilton Depression Inventory and Quality of Life in Epilepsy-31. Due to COVID-19, a booster session (focused on internal & external aids) was given at 3 months and all follow-ups were done through tele-assessment at 6 months. Results: At baseline, there was no significant difference between the groups on objective and subjective measures. Linear regression analysis post adjustment for depression at follow-up revealed a significant difference between the groups on objective cognitive measures of learning (p = 0.019), delayed recall (p = 0.003), retention (p = 0.045) with IG showing higher performance. Similar results were noted for subjective measures of EMQ (p = 0.001) and cognitive (p = 0.001), seizure freedom (p = 0.030), overall QoL (p = 0.046) subdomains of QoL with its total score (p < 0.001). Conclusions: Despite depression, IG reported higher performance on objective tests, lower subjective complaints and better QoL at long term follow-up.