Service delivery, behavioural, and self-management interventions for adults with epilepsy: summary of a Cochrane systematic review.

Non-pharmacological interventions, including behavioural, self-management, and service delivery approaches, are increasingly incorporated into adult epilepsy care to address persistent seizures, impaired quality of life, and psychosocial burden. However, the effectiveness of these interventions remains uncertain. This article summarises and critically appraises a recent Cochrane systematic review that evaluated service delivery, behavioural, and self-management interventions for adults with epilepsy. The review included 36 randomised or quasi-randomised controlled trials involving 5,834 participants. Outcomes of interest comprised seizure frequency, seizure-related outcomes, health-related quality of life, psychosocial functioning, and adverse events. Risk of bias was assessed using the Cochrane tool, and certainty of evidence was graded using the GRADE framework. Psycho-behavioural interventions were associated with modest short-term reductions in seizure frequency at three to six months, based on moderate-certainty evidence, although no sustained long-term benefit was demonstrated. Mind–body interventions showed mixed and generally small short-term effects with low-certainty evidence. Self-management programmes did not reduce seizure frequency but were associated with an increased likelihood of seizure freedom in some studies. Across most intervention categories, no consistent improvement in health-related quality of life was observed. Evidence for physical exercise and service delivery interventions was limited and highly uncertain. Safety outcomes were inconsistently reported, and no clear evidence of harm was identified. Current evidence suggests that non-pharmacological interventions may offer modest and context-specific benefits as adjuncts to pharmacological therapy in adult epilepsy. More research is needed to determine the effects of non-pharmacological interventions for adults with epilepsy.