Psychological treatments for epilepsy.
BACKGROUND
Psychological interventions such as relaxation therapy, cognitive behaviour therapy, 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.


OBJECTIVE
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.


METHODS
We searched the Cochrane Epilepsy Group's Specialized Register (July 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), and MEDLINE (1966 to March 2005). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies.


METHODS
Randomized or quasi-randomized studies assessing one or more types of psychological or behaviour modification techniques for people with epilepsy.


METHODS
Two review authors 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.


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. One small study of galvanic skin response biofeedback reported significant reduction in 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.


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.
Ramaratnam
S
S
Apollo Hospitals, Department of Neurology, 21 Greams Lane, Off Greams Road, Madras, Tamil Nadu, India 60006. rsridharan@vsnl.com
Baker
G A
GA
Goldstein
L H
LH
D001676:Biofeedback, Psychology; D015928:Cognitive Behavioral Therapy; D004827:Epilepsy / Q000628:therapy*; D006801:Humans; D010353:Patient Education as Topic; D011613:Psychotherapy; D012064:Relaxation Therapy