Systematic review and meta‐analysis of lifestyle modification interventions and their impact on seizure reduction and quality of life

OBJECTIVE: This study was undertaken to provide an overview of the research landscape and evaluate the impact of lifestyle modifications on seizure reduction and quality of life in people with epilepsy receiving standard medical treatment. METHODS: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review of major databases (Medline, Embase, American Psychological Association PsycInfo, Cochrane Library, and Web of Science) through November 2025. After screening 5151 articles, 118 studies met inclusion criteria: prospective trials reporting seizure frequency in adults or mixed populations with epilepsy. Four epilepsy-trained reviewers independently assessed studies. A random-effects meta-analysis was performed on studies reporting ≥50% seizure reduction or data allowing its calculation. Short-term response was defined as the earliest postintervention time point, and long-term response as the final reported time point. RESULTS: The 118 studies covered diet (n = 33), supplements (n = 20), biofeedback (n = 14), psychosocial/behavioral therapy (n = 13), yoga/meditation/mindfulness (n = 8), music therapy (n = 7), and others. Fifty-two (44%) included control groups, whereas 91 (77%) reported statistical analysis of seizure frequency. Among those, 68% showed significant seizure reduction. Quality of life was assessed in 31 studies, 68% reporting improvement. Seventy-one studies (60%) were included in the meta-analysis. Overall, the ≥50% seizure reduction response rate was 44% for short-term outcomes (95% confidence interval [CI] = 38%-50%) and 50% for long-term outcomes (95% CI = 44%-56%). Dietary interventions had the largest evidence base (n = 33), with short- and long-term response rates of 40% and 51%, respectively. Meditation/yoga/mindfulness had the highest response rate (62% short term, 79% long term), whereas exercise and supplements had the lowest (30%-35%). SIGNIFICANCE: Lifestyle modifications may offer beneficial, adjunctive effects on seizure control. However, the current evidence is limited by variability in study design and quality. Larger, well-designed trials with standardized outcomes are needed to clarify how these interventions can complement epilepsy treatment. This systematic review and meta-analysis serves as a foundation for future research to better define the role of lifestyle interventions in epilepsy care.