Neurology · Psychiatry · 12 h ago
Self-guided online intervention reduced functional seizure frequency in randomized trial
In a three-arm randomized clinical trial of 107 adults with functional seizures in Melbourne, a self-guided internet intervention plus standard care reduced seizure frequency compared with standard care alone. The difference persisted through 12 months; seizure reduction with therapist-guided treatment did not reach statistical significance versus standard care.
- Self-guided Re-PROGRAM reduced seizure frequency versus standard care.
- The difference persisted at 6 weeks, 6 months, and 12 months.
- Therapist-guided treatment did not significantly reduce seizures versus standard care.
- Trial enrolled 107 adults at one Melbourne specialist clinic.
Functional seizures can be disabling, and access to evidence-based psychological treatment is limited in many regions. This three-arm randomized clinical trial compared Re-PROGRAM, a five-session internet intervention, with standard care alone in adults treated at a specialist outpatient clinic in Melbourne, Australia. Participants had video-EEG-confirmed functional seizures, at least four seizures per month, and no active epilepsy. Of 107 randomized participants, 96 were included in the full analysis set; 83% were female, and mean age was 36 years. The primary outcome was monthly seizure frequency through 12 months.
Compared with standard care, the self-guided intervention was associated with a greater overall reduction in seizure frequency (rate ratio, 0.35; 95% CI, 0.18-0.69; adjusted P=.006). Differences were also significant at 6 weeks, 6 months, and 12 months. The self-guided group showed greater improvement in anxiety at all three time points and in depression and mental quality of life at one or more time points. Therapist-guided treatment improved anxiety at 6 months, but its seizure-frequency reduction versus standard care was not statistically significant. The two active-treatment arms did not differ significantly in seizure reduction.
No adverse events were reported. The findings support further consideration of a scalable treatment option, but come from one specialist clinic and a relatively small sample. The results do not establish effectiveness across other settings or populations.
In practice
For adults with video-EEG-confirmed functional seizures and frequent events, this single-center randomized trial found that a five-session self-guided internet intervention added to standard care reduced seizure frequency compared with standard care alone, with differences maintained through 12 months. Anxiety also improved. The results do not establish effectiveness in other settings or populations, and the trial was relatively small; the therapist-guided arm did not show a statistically significant seizure-frequency reduction versus standard care. The findings are promising but do not by themselves establish a standard of care.
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JAMA Neurology: Internet Intervention for Functional Seizures ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.