Internet-Based Therapy Cuts Functional Seizure Frequency in Randomised Clinical Trial
A brief, self-guided internet-based intervention significantly reduced the frequency of functional seizures in adults compared with standard care, according to a randomised clinical trial published in JAMA Neurology. Led by researchers including Lana Higson at Monash University’s School of Translational Medicine, the trial offers a scalable option for patients unable to access specialist psychological care.
- Self-Guided Efficacy: Patients using the self-guided Re-PROGRAM platform achieved significant reductions in monthly seizure frequency compared to standard care.
- Sustained Outcomes: Treatment benefits remained consistent across twelve months of clinical follow-up.
- Anxiety Improvement: Secondary measures showed noticeable improvements in patient anxiety levels alongside seizure reduction.
Melbourne Trial Structure and Participant Demographics
Conducted at a specialist outpatient clinic in Melbourne, Australia, between February 2022 and April 2024, the three-arm randomised clinical trial monitored 107 eligible adults over 12 months. Participants had video electroencephalogram-confirmed functional seizures and experienced at least four seizures per month without comorbid active epilepsy. Out of 220 individuals initially screened, the randomised cohort presented a mean age of 36.0 years with a standard deviation of 12.4, comprising 89 female participants, representing 83% of the total group.
Participants were divided evenly in a 1:1:1 split among three distinct routes: either self-directed or clinician-assisted Re-PROGRAM—a five-part program combining lifestyle aspects, seizure control, and psychological techniques—supplemented by routine treatment, or routine treatment by itself.
Statistical Results Across 12 Months of Follow-Up
Data published in JAMA Neurology demonstrated that the self-guided arm achieved significantly greater overall reductions in monthly seizure frequency than standard care, expressed as a rate ratio of 0.35 with a Holm-Bonferroni adjusted p-value of 0.006. These improvements proved durable, remaining statistically significant at 6 weeks (rate ratio: 0.37; HB p=0.02), 6 months (rate ratio: 0.31; HB p=0.04), and 12 months (rate ratio: 0.35; HB p=0.03).
Anxiety symptoms also showed greater improvement in the self-guided arm across all three measured time points. Meanwhile, the therapist-guided arm demonstrated greater anxiety improvement specifically at the 6-month mark, though its overall seizure reductions did not reach statistical significance.
Clinical Implications
Neurology departments frequently encounter disabling functional seizures, yet patients often struggle to find accessible, evidence-based care. The results demonstrate that independent digital delivery serves as a viable, expandable solution for lowering seizure rates among adults dealing with functional seizures who lack entry to specialized psychological support. Because both active treatment groups yielded similar results, the precise benefits of having a therapist remain uncertain, highlighting the need for larger trials to guide future care guidelines and broaden patient availability.
References
- Higson L, et al. Internet intervention for functional seizures: a randomized clinical trial. JAMA Neurol. 2026; DOI:10.1001/jamaneurol.2026.3893.
Disclaimer: This article is for informational purposes only and does not substitute for professional medical advice, diagnosis, or treatment.
