Psychological treatments for epilepsy
Abstract
Background
Psychological interventions such as relaxation therapy, cognitive behaviour therapy, electroencephalogram (EEG) bio‐feedback and educational interventions have been used alone or in combination in the treatment of epilepsy, to reduce the seizure frequency and improve the quality of life.
Objectives
To assess whether the treatment of epilepsy with psychological methods is effective in reducing seizure frequency and/or leads to a better quality of life.
Search methods
We searched the Cochrane Epilepsy Group trial register (11 June 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 2, 2003), MEDLINE (on 11 June 2003) and cross references from identified publications.
Selection criteria
Randomized or quasi‐randomized studies assessing one or more types of psychological or behaviour modification techniques for people with epilepsy.
Data collection and analysis
Two reviewers independently assessed the trials for inclusion and extracted data. Primary analyses were by intention to treat. Outcomes included reduction in seizure frequency and quality of life.
Main results
We found three small trials (50 participants) of relaxation therapy. They were of poor methodological quality and a meta‐analysis was therefore not undertaken. No study found a significant effect of relaxation therapy on seizure frequency. One trial found cognitive behavioural therapy to be effective in reducing depression, among people with epilepsy with a depressed affect, whilst another did not.
One trial of group cognitive therapy found no significant effect on seizure frequency. Two trials of combined relaxation and behaviour therapy and one of EEG bio‐feedback and four of educational interventions did not provide sufficient information to assess their effect on seizure frequency. Combined use of relaxation and behaviour modification was found beneficial for anxiety and adjustment in one study. In one study EEG bio‐feedback was found to improve the cognitive and motor functions in individuals with greatest seizure reduction. Educational interventions were found to be beneficial in improving the knowledge and understanding of epilepsy, coping with epilepsy, compliance to medication and social competencies.
Authors' conclusions
In view of methodological deficiencies and limited number of individuals studied, we have found no reliable evidence to support the use of these treatments and further trials are needed.
PICOs
Plain language summary
No reliable evidence to support psychological treatments for people with epilepsy
Psychological interventions are used in attempts to reduce seizure frequency, improve the quality of life and avoid adverse effects of drugs among people with epilepsy. Of the trials found, some were of poor methodological quality, whilst others had contradictory results. We found no evidence that relaxation therapy, cognitive behaviour therapy, EEG biofeedback used alone or in combination have an impact on seizures or quality of life. Educational interventions may reduce anxiety, improve medication compliance and social competency, but further well designed trials are needed.
