Behavioral Interventions May Have Some Benefit in Refractory Epilepsy

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Participants in the progressive muscle relaxation group reported greater reductions in stress vs those randomized to the focused-attention activity.

Progressive muscle relaxation (PMR) with deep breathing as well as focused attention with extremity movements are equally associated with seizure reduction in patients with epilepsy and medication-resistant focal seizures, yet PMR may be more effective than focused attention in relieving stress, according to a multicenter randomized controlled trial published in Neurology.

In this randomized study, a total of 66 adult patients with medication-resistant focal epilepsy from 3 different centers were assigned to undergo either PMR with diaphragmatic breathing (n=33) or a control focused-attention activity with extremity movements (n=33). All participants underwent double-blind treatment for 12 weeks following an 8-week baseline period. Patients reported seizure frequency as well as mood and stress levels during and at the end of treatment. Investigators compared the groups with regard to seizure reduction from baseline.

Participants from both groups in the intention-to-treat analysis (n=66) experienced a significant reduction in seizure frequency from baseline (PMR: 29%, P <.05; focused attention: 25%, P <.05). Overall, there was no significant difference between the two groups with regard to the reduction in number of seizures (P =.38). Participants in the PMR group reported greater reductions in stress vs participants randomly assigned to the focused-attention activity (P <.05).

The findings from this study are limited to a small patient group and therefore may lack generalizability across the entire epilepsy population. Also, low depression and anxiety rates reported in this cohort may not be fully representative of patients with refractory epilepsy or patients with medication-resistant focal seizures.

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Since seizure reductions observed in both groups did not appear to be directly associated with stress reduction, the investigators suggest there is “a yet-to-be-determined moderator or mediator for seizure reduction in behavioral interventions.”


Haut SR, Lipton RB, Cornes S, et al. Behavioral interventions as a treatment for epilepsy: A multicenter randomized controlled trial [published online February 14, 2018]. Neurology. doi:10.1212/WNL.0000000000005109