Epilepsy: behavioural, psychological, and ketogenic diet treatments.

Introduction: About 3% of people will be diagnosed with epilepsy during their lifetime, but about 70% of people with epilepsy eventually go into remission.

Methods and outcomes: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of behavioural and psychological treatments in people with epilepsy? What are the effects of ketogenic diets in people with epilepsy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version).

Results: Searching of electronic databases retrieved 259 studies. After deduplication and removal of conference abstracts, 253 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 208 studies and the further review of 45 full publications. Of the 45 full articles evaluated, six systematic reviews and seven RCTs were included at this update. We performed a GRADE evaluation for six PICO combinations.

Conclusions: In this systematic overview we categorised the efficacy for seven interventions, based on information relating to the effectiveness and safety of: biofeedback, cognitive behavioural therapy (CBT), educational programmes, family counselling, ketogenic diet, relaxation therapy (alone or plus behavioural modification therapy), and yoga.