Online Self-Guided Program Cuts Functional Seizure Frequency in RCT

A brief, self-guided internet-based intervention reduced monthly seizure frequency compared with standard care in adults with functional seizures (FS), according to a randomized clinical trial published in JAMA Neurology.

The investigators described FS as a common and disabling presentation in neurology clinics, with evidence-based treatments difficult to access in Australia and many other regions. The intervention, Re-PROGRAM, comprises 5 structured sessions integrating lifestyle factors, seizure management techniques, and elements of cognitive behavioral, acceptance and commitment, and dialectical behavior therapy.

The 3-arm trial (ACTRN12622000262707), conducted at a specialist outpatient clinic in Melbourne, Australia, from February 2022 to April 2024, randomized 107 adults with FS confirmed by video electroencephalogram monitoring, at least 4 seizures per month, and no comorbid active epilepsy. Participants (mean age, 36 years; 83% female) received the self-guided or therapist-guided intervention, each plus standard care, or standard care alone. The primary outcome was monthly seizure frequency at 6 weeks, 6 months, and 12 months, recorded in daily prospective seizure diaries. The self-guided arm had a significantly greater overall reduction in seizure frequency than standard care (rate ratio, 0.35; 95% CI, 0.18-0.69), with between-group effects sustained at all 3 time points.

The self-guided arm also showed greater improvement in anxiety at all 3 time points and in depression and mental quality of life at 1 or more time points. The therapist-guided arm showed greater improvement in anxiety at 6 months, but its reductions in seizure frequency did not reach statistical significance. A direct comparison of the 2 active arms did not establish a clear difference in seizure reduction (rate ratio, 0.67; 95% CI, 0.33-1.36). Sensitivity analyses supported the primary findings, and no adverse events occurred in any arm.

Ninety-six of the 107 randomized participants contributed to the full analysis set, and retrospective estimates were used when diary records were incomplete. The authors concluded that the self-guided intervention offers a scalable option for patients with FS who are unable to access specialist psychological care.

Source: Higson L, Chen Z, Rayner G, et al. Internet intervention for functional seizures: a randomized clinical trial. JAMA Neurol. Published online October 26, 2026. doi:10.1001/jamaneurol.2026.3893