Sridharan Ramaratnam, Gus A Baker, Laura H Goldstein

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. To assess whether the treatment of epilepsy with psychological methods is effective in reducing seizure frequency or leads to a better quality of life (QOL), or both. We searched the Cochrane Epilepsy Group Specialized Register (11 January 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2010) and MEDLINE (1948 to December 2010). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies. Randomized or quasi-randomized studies assessing one or more types of psychological or behaviour modification techniques for people with epilepsy. 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. We found three small trials (total 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.Two trials found cognitive behavioural therapy (CBT) to be effective in reducing depression among people with epilepsy and a depressed affect, whilst another did not. Two trials of CBT found improvements in QOL scores. One trial of group cognitive therapy found no significant effect on seizure frequency while another trial found a statistically significant reduction in seizure frequency as well as seizure index (product of seizure frequency and seizure duration in seconds) among participants treated with CBT.One small trial compared CBT with yoga and found similar rates of seizure freedom and 50% responder rates at the end of one year. Compared to pretest scores, the CBT group showed an improvement in the World Health Organization quality of life instrument, short version (WHO QOL-BREF) (P ≤ 0.01) while the yoga group had an improvement in their QOL according to the satisfaction with life scale (SWLS) (P ≤ 0.05).Two trials of combined relaxation and behaviour therapy, one of electroencephalographic (EEG) bio-feedback and four of educational interventions did not provide sufficient information to assess their effects 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 cognitive and motor functions in individuals with the greatest seizure reduction. Educational interventions were found to be beneficial in improving knowledge and understanding of epilepsy, coping with epilepsy, compliance to medication and social competencies.Two trials investigated the effects of a self management program on QOL measures. One found no significant differences in overall QOL except for an improvement in the QOL in persons with epilepsy (QOLIE-89) role limitations - emotional score. The other study found no significant benefits in any of the outcomes studied except for more positive attitudes about the outcomes associated with taking medications. In view of methodological deficiencies and the limited number of individuals studied, we have found no reliable evidence to support the use of psychological treatments and further trials are needed. Since the last version of this review, none of the new relevant studies have provided additional information to change the conclusions.