Online Program Tied to Reduced Functional Seizure Frequency

TOPLINEA self-guided internet-based intervention was associated with reduced monthly seizure frequency compared with standard care in adults with functional seizures (FS), with reductions sustained at 6 weeks, 6 months, and 12 months, a trial showed. The program was also linked to reduced anxiety at all the timepoints and reduced depression and improved mental quality of life at 6 months, while a therapist-guided version of the same intervention showed improvement in anxiety at 6 months but did not achieve significant seizure reduction.METHODOLOGYA three-arm, parallel randomized clinical trial was conducted at a specialist outpatient clinic in Melbourne, Australia, between 2022 and 2024.A total of 107 adults (mean age, 36 years; 83% women) with FS verified using video EEG monitoring and at least four seizures per month were included, of whom 96 were included in the full analysis set.Participants received self-guided internet-based intervention plus standard care (n = 29), therapist-guided internet-based intervention plus standard care (n = 34), or standard care alone (n = 33).Re-PROGRAM was a brief, structured internet-based intervention comprising five sessions of 1-1.5 hours each, integrating lifestyle factors, seizure management techniques, and elements of cognitive-behavioral, acceptance and commitment, and dialectical behavior therapy. The self-guided arm delivered content via a personalized online platform with optional brief weekly check-ins, whereas the therapist-guided arm consisted of weekly telehealth sessions with one neuropsychologist.Researchers primarily assessed monthly seizure frequency at 6 weeks, 6 months, and 12 months after randomization, which was recorded prospectively every day in a seizure diary, with retrospective estimates used for incomplete records. Depression, anxiety, quality of life, psychosocial functioning, and somatic symptoms were also assessed.TAKEAWAYCompared with standard care, significantly greater reductions were observed with self-guided care in monthly seizure frequency (rate ratio [RR], 0.35; adjusted P = .006), with differences between the groups persistent at 6 weeks (RR, 0.37; adjusted P = .02), 6 months (RR, 0.31; adjusted P = .04), and 12 months (RR, 0.35; P = .03).Compared with standard care, the self-guided arm showed significantly greater reduction in anxiety at every timepoint (6 weeks: adjusted P = .003; 6 months: adjusted P < .001; 12 months: adjusted P = .012), as well as greater reduction in depression (adjusted P < .001) and improvement in mental quality of life (adjusted P = .048) at 6 months.Therapist-guided care outperformed standard care in terms of anxiety at 6 months (adjusted P = .02), but the difference in seizure frequency was not statistically significant.In a direct comparison, the two active arms did not differ significantly in seizure reduction. Treatment satisfaction was higher in both the self-guided (adjusted P = .002) and therapist-guided (adjusted P < .001) arms than in the standard-care arm, with no difference between active arms. Serious adverse events were not observed during the study.IN PRACTICE"The sustained between-group reduction in seizure frequency observed in the self-guided arm suggests that for FS specifically, structured behavioral content delivered flexibly may help to achieve sustained outcomes with a treatment burden that is far lower for patients and health care systems alike," the authors wrote, highlighting the potential of the approach "in a patient population for whom access to specialized psychological treatment is often limited in regions with fewer specialist FS services."SOURCEThe study was led by Lana Higson, PhD, School of Translational Medicine, Monash University, Clayton, Victoria, Australia. It was published online on October 26 in JAMA Neurology.LIMITATIONSThe single-site design of the trial with a single neuropsychologist delivering therapist-guided care may have limited the generalizability of the findings. Residual bias could not be excluded. Uneven dropout between groups and missing data were added limitations. Seizure counts relied on diary entries supplemented by recall and were not objectively verified, and the standard-care comparator involved regular specialist contact, which may have overstated its strength. Additionally, check-ins in the self-guided arm were not recorded, and structured assessment of potential adverse effects at the session level was not conducted.DISCLOSURESThe study was funded by the National Health and Medical Research Council and a Monash University postgraduate scholarship. Disclosure information for the study investigators is available in the original study publication.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.