• Sridharan Ramaratnam, Gus A Baker, and Laura H Goldstein.
• Department of Neurology, Apollo Hospitals, 21 Greams Lane, Off Greams Road, Chennai, Tamil Nadu, India, 600006. rsridharan@vsnl.com
• Cochrane Db Syst Rev. 2008 Jul 16 (3): CD002029.

BackgroundPsychological 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.ObjectivesTo assess whether the treatment of epilepsy with psychological methods is effective in reducing seizure frequency and/or leads to a better quality of life.Search StrategyWe searched the Cochrane Epilepsy Group's Specialized Register (1 July 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2007), and MEDLINE (1966 to March 2007). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies.Selection CriteriaRandomized or quasi-randomized studies assessing one or more types of psychological or behaviour modification techniques for people with epilepsy.Data Collection And AnalysisTwo 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.Main ResultsWe 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. Two trials found cognitive behavioural therapy (CBT) to be effective in reducing depression, among people with epilepsy with a depressed affect, whilst another did not. Two trials of CBT found improvement in quality of life scores. One trial of group cognitive therapy found no significant effect on seizure frequency while another trial found statistically significant reduction in seizure frequency as well as in seizure index (product of seizure frequency and seizure duration in seconds) among subjects treated with CBT. 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.Authors' ConclusionsIn 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.

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