Rehabilitation of cognition and psychosocial well‐being in epilepsy: Results of a randomized waiting list‐controlled trial

OBJECTIVE: Limited evidence supports the use of cognitive and psychosocial rehabilitation programs for people with epilepsy (PWE). We assessed the effects of a newly designed cognitive and psychological counseling intervention on patient-reported and neuropsychological outcomes in a mixed sample of PWE. METHODS: Seventy adult PWE (57.1% female, mean age = 35.9 ± 11.7 years, 57.1% with focal epilepsy) were randomized (1:1) to either an early intervention group (EIG) or a waiting list for a late intervention group (LIG). The intervention consisted of six individual and two group counseling sessions incorporating psychoeducation, cognitive training, coping strategies, and mindfulness. Both groups were assessed at baseline and 4 and 16 weeks. Primary endpoints were quality of life (Patient-Weighted Quality of Life in Epilepsy 31-item inventory [QOLIE-31-P]) and delayed verbal and visual recall at 4 weeks; secondary endpoints included symptoms of anxiety (Generalized Anxiety Disorder seven-item scale), depression (Neurological Disorders Depression Inventory in Epilepsy), and stigma. Linear mixed models with maximum likelihood estimation were used for repeated measures analysis. RESULTS: Follow-up data were available for 66 participants (94.3%) at 4 weeks and 61 (87.1%) at 16 weeks. The EIG showed significant improvements on the QOLIE compared with the LIG (group by time interaction p = .006), which were maintained at both follow-ups. Anxiety symptoms were also significantly reduced in the EIG (group by time interaction p = .006). These effects were observed in both focal and generalized epilepsy. No significant group differences were found for delayed verbal or visual recall over time. However, greater long-term forgetting on the word list task was observed in the LIG at 4 weeks. No significant changes were detected for symptoms of depression or perceived stigma. SIGNIFICANCE: An 8-week cognitive and psychosocial rehabilitation program improved quality of life and reduced anxiety in PWE, with effects sustained for up to 16 weeks. Cognitive benefits were limited, with a possible transient effect on long-term verbal recall. These findings support the use of rehabilitation interventions to enhance patient-reported outcomes across epilepsy subtypes.