Authors :
Presenting Author: Lana Higson, MPsych(ClinNeuro) – Monash University
Terence J O'Brien, MBBS MD – School of Translational Medicine, Monash University, The Alfred Centre
Genevieve Rayner, PhD, MPsych(ClinNeuro) – The University of Melbourne
zhibin Chen, PhD – Monash University
Rubina Alpitsis, PhD – Monash University
Tobias Winton-Brown, MBBS, PhD – Alfred Health
Rationale:
Functional seizures are poorly understood and debilitating. We prospectively evaluated Re-PROGRAM, the first internet-based e-intervention for functional seizures.
Methods:
In this 3-arm parallel randomized controlled trial, adult participants with a documented diagnosis of functional seizures and ≥four seizures in the preceding four weeks were recruited and randomly assigned to Re-PROGRAM telehealth therapist-guided, Re-PROGRAM self-guided, or standard care. Re-PROGRAM comprises five weekly sessions based on behavioural activation, lifestyle modification, and seizure reduction techniques. Primary outcome was change in monthly seizure frequency between T0 (pre-randomisation) and T1 (approximately 6 weeks following randomisation) via self-report across four weeks prior to each timepoint. Secondary outcomes were anxiety, depression, physical and mental quality of life, psychosocial functioning, and somatic symptoms. The trial was prospectively registered (ACTRN 12622000262707).
Results:
Between Feb 22, 2022, and March 4, 2024, 220 potential participants were screened for eligibility; 113 (51%) were excluded, and 107 were randomly assigned (37 to the self-guided intervention, 36 to the therapist-guided intervention, and 34 to standard care). Primary and secondary outcome data were obtained for 83% of randomised participants. Intention-to-treat analyses showed that self-guided Re-PROGRAM demonstrated significantly better seizure reduction (relative rate ratio [RRR]=0.39, 95% confidence interval [CI]: 0.22 – 0.69, Holm-Bonferroni [HB]-corrected p=0.004), depression (mean difference [MD]=-2.26, 95% CI: -3.93 – -0.59, HB-corrected p=0.024), and anxiety reduction (MD=-3.73, 95% CI: -5.87 – -1.59, HB-corrected p=0.002) compared to standard care.
Conclusions: Short-term follow-up data suggest that self-guided Re-PROGRAM offers an accessible, scalable, and promising approach to reduce seizures and decrease anxiety and depression
Funding:
The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.