A BRIEF, self-guided internet-based intervention has significantly reduced the frequency of functional seizures in adults compared with standard care, according to a new randomised clinical trial, offering a scalable option for those unable to access specialist psychological care and improve long-term clinical outcomes.
Trial Design
Functional seizures are a common and disabling presentation in neurology clinics, but evidence-based treatments remain difficult to access. A brief, internet-delivered intervention could narrow this gap, yet its effect on the frequency of functional seizures was unclear.
This three-arm randomised clinical trial was conducted at a specialist outpatient clinic in Melbourne, Australia (February 2022–April 2024), with 12 months of follow-up. Eligible adults had video electroencephalogram-confirmed functional seizures and at least four seizures per month, without comorbid active epilepsy.
Of 220 individuals screened, 107 (mean age: 36.0 years; standard deviation: 12.4; 89 female [83%]) were randomised 1:1:1 to self-guided or therapist-guided Re-PROGRAM, a five-session intervention integrating lifestyle factors, seizure management, and psychological therapy elements, each plus standard care, or to standard care alone.
Greater Reductions in Seizure Frequency
The self-guided arm achieved significantly greater overall reductions in monthly seizure frequency than standard care (rate ratio [RR]: 0.35; Holm-Bonferroni [HB] p=0.006), sustained at 6 weeks (RR: 0.37; HB p=0.02), 6 months (RR: 0.31; HB p=0.04) and 12 months (RR: 0.35; HB p=0.03).
Anxiety also improved more at all three time points. The therapist-guided arm showed greater anxiety improvement at 6 months, but seizure reductions were not significant.
Future Implications
These findings have shown that self-guided delivery is a scalable option for reducing seizure frequency in adults with functional seizures who cannot access specialist psychological care. As the active arms did not differ significantly, the comparative value of therapist guidance remains unclear, warranting further investigation in larger studies to inform future treatment recommendations and improve patient access to care.
Reference
Higson L et al. Internet intervention for functional seizures: a randomized clinical trial. JAMA Neurol. 2026;DOI:10.1001/jamaneurol.2026.3893.
