DAY 2 | Telehealth Intervention Improves Access to Care for Individuals with Epilepsy and Cognitive Impairment

A hub-and-spoke model for epilepsy self-management led to a steady increase in physician referrals over 2 years, providing patients with epilepsy with options for self-management outside traditional clinical settings, according to a study designed to evaluate the effects of the HOBSCOTCH Institute Translational Network (HITN) project. Findings from the study, presented at the 2025 American Epilepsy Society Annual Meeting (AES 2025) in Atlanta, Georgia, showed that the HOBSCOTCH network of epilepsy centers can provide the much-needed infrastructure for epilepsy self-management programs, which can increase accessibility for patients with seizures and cognitive issues in the United States and across the globe. 

Home-Based Self-Management and Cognitive Training CHanges Lives (HOBSCOTCH) is an evidence-based cognitive-behavioral program delivered via virtual coaching for people with epilepsy who are experiencing cognitive difficulties. Mobile apps are used for monitoring and coaching sessions to improve self-management, cognition, and quality of life remotely. “The program teaches self-management like problem-solving, compensatory strategies, self-awareness to help patients understand when they are more likely to experience a memory problem, and relaxation [techniques],” Wren S. Kaden, BA, a research project manager at Dartmouth Health, in Lebanon, New Hampshire, explained during a poster presentation. “Stress is really high in this population and that can also affect cognition.” 

Dartmouth’s HOBSCOTCH Institute has partnered with 18 local clinics across the United States to deliver evidence-based epilepsy management programs to patients via telehealth. The hub-and-spoke HITN project that began in 2023 was designed to increase healthcare capacity, enabling more patients with epilepsy to access self-management programs without traveling to specialized centers. Some of the participating centers provide telehealth education and coaching locally, while others act as referral points only, or adopt a hybrid model combining referrals and delivery of some program components. “A lot of patients with epilepsy cannot drive, so telehealth-based programs are really helpful,” Kaden noted. “As long as they have self-reported seizures, self-reported cognitive or memory difficulties, and an Internet connection, that’s all we need [to deliver the program].” 

In the study presented at AES 2025, Kaden and co-authors analyzed the rates of patient referrals received from the 18 participating centers in the United States in the first 2 years since the beginning of the HITN project. The results showed that the number of referrals continued to increase during every quarter of the second year compared to the first year. Almost 600 patients were referred through the program during the second year, nearly doubling the number of referrals received in the first year (353). Overall, 150 patients had access to sessions delivered from spoke epilepsy centers, while the rest were managed directly by the HOBSCOTCH Institute. The patients with epilepsy screened at the Institute resided in 36 states and reported various degrees of epilepsy severity, from not severe to extremely severe. More than half (52%) of the screened patients reported uncontrolled seizures. 

The research team analyzed the area deprivation index to determine to what degree the program has been able to reach underserved communities. “For the most part, it seems like we are doing a much better job in reaching people who have less deprivation, which makes sense,” Kaden said. “But one of the things that we really want to work on is expanding [this service] into those underserved areas.” The program has also continued to cross geographic borders, expanding to various centers in other countries, including Australia and Kenya. 

The researchers noted that the best way to reach vulnerable populations is to facilitate clinician referral by educating clinicians and integrating prompts into the electronic health records. The study showed that 70 providers at HITN sites received HOBSCOTCH Cognitive Coach training over the first 2 years, and all 18 epilepsy center sites received targeted epilepsy self-management education.
“We also work with community organizations and other medical centers,” Kaden added. “We are trying to integrate it into the community, to help community providers share it with their patients. Usually, community providers do not have the time to deliver the program, so, we often try to open these referral pathways. We have had some luck lately getting neuropsychologists and speech pathologists involved in the delivery of the program.” Collaborative network efforts have the best odds of growing systems capacity and expanding equitable access to self-management programs for people with epilepsy who struggle with cognitive difficulties.