Elizabeth Spurgeon, MD, on Lifestyle Interventions as an Adjunct to Epilepsy Care

Despite the availability of numerous antiseizure medications, nearly one-third of patients with epilepsy continue to experience seizures after multiple treatment trials, highlighting the need for additional approaches that address both seizure control and quality of life (QOL). A new systematic review and meta-analysis published in Epilepsia is, according to its authors, the first to quantitatively compare lifestyle interventions, including dietary approaches, mind-body practices, and behavioral therapies, as adjuncts to standard epilepsy care.¹

Elizabeth Spurgeon, MD, led the review, which included 118 prospective studies identified through November 2025, 71 of which contributed to the meta-analysis. Across all interventions, 44% of participants (95% CI, 38%-50%) achieved at least 50% seizure reduction at the earliest postintervention time point, and 50% (95% CI, 44%-56%) did so at the final reported time point.

Dietary interventions had the largest evidence base, with 33 studies, whereas meditation, yoga, and mindfulness had the highest response rates, although that category included only 8 studies. Exercise and supplements had the lowest response rates, at 30% to 35%. The authors noted substantial heterogeneity across studies, that fewer than half (44%) included a control group, and that no formal risk-of-bias assessment was performed.

Recently, lead author Spurgeon, an epileptologist at the Cleveland Clinic Epilepsy Center, spoke with NeurologyLive^® about the review’s goals and key findings. In the conversation, she discussed possible mechanisms behind the yoga and mindfulness signal and why lifestyle interventions should complement, rather than replace, antiseizure medications. She also shared what patients and clinicians should consider when adding these approaches to epilepsy care.

NeurologyLive: Before getting into the findings, what was the goal of your systematic review and meta-analysis?

Elizabeth Spurgeon, MD: Our primary goal was to take a comprehensive look at the existing research on lifestyle interventions in epilepsy, including everything from dietary approaches to yoga, mindfulness, and certain behavioral therapies. We wanted to better understand whether these interventions could have a meaningful impact on seizure control when used alongside standard epilepsy treatments.

For the systematic review and meta-analysis, we found 118 studies that fit our inclusion criteria, and 71 of those were included in the meta-analysis portion. The primary outcome we looked at for the meta-analysis was seizure frequency. At least 50% seizure reduction was considered a response, consistent with studies of antiseizure medications, so the studies that reported that value were the 71 included there.

Yoga, meditation, and mindfulness had the highest response rates in the review. How should clinicians interpret that finding?

That was one of the more interesting findings from our review. The yoga, meditation, and mindfulness group of studies demonstrated some of the highest response rates among the lifestyle interventions we looked at. Specifically, 62% of participants in the short-term analysis and 79% in the long-term analysis achieved at least 50% seizure reduction.

These are certainly promising findings, but there are a few important considerations to keep in mind in interpreting them. First, there were relatively few studies in this category, and there was considerable variability in both the interventions themselves and the results of the studies. For example, yoga can mean a wide variety of things to people. Some yoga practices focus more on meditation, that mindfulness component, or breathing techniques, and other yoga practices focus more on the physical postures.

Although these results suggest that yoga and mindfulness have a beneficial role in epilepsy management, larger, well-designed studies, including ones that look at different types of yoga practice, could help us better understand their effectiveness and role. But I think it gives us an idea that there’s something here that we should continue looking at. It’s a little signal.

What might explain this effect? Is there a plausible physiological mechanism, or is it more tied to stress reduction and better treatment adherence?

It seems like there could be several different mechanisms. We touch on this in another article that I’d like to reference, the proceedings of the 2022 Lifestyle Intervention for Epilepsy (LIFE) symposium.² We held the conference annually for a couple of years, and in 2022, we summarized the talks given by local, national, and international speakers on various lifestyle interventions and the evidence we have to date. Yoga, meditation, and mindfulness was one of those categories.

Some studies have shown that GABA, our inhibitory neurotransmitter that helps regulate neuronal excitability, can increase after practicing yoga. There have also been studies showing that yoga and the controlled breathing of certain meditation practices can increase the parasympathetic nervous system response and reduce sympathetic activity, which produces a more relaxed physiological state. Meditation has also been shown to have some impact on EEG findings.

These practices can help with stress reduction in general, improving anxiety and depression, and enhancing quality of life. That may be an indirect way of impacting seizure control or overall wellness in epilepsy, as well as adherence to medication by enhancing that mindfulness component. So there are multiple factors, including physiological factors, that may contribute.

Some questions remain to be answered. What types of yoga practice and meditation are most impactful? How often should you practice, and for how long before you would see an effect? Can larger or different types of studies help clarify this effect for this population? These findings give us some insight that there’s something here for yoga and mindfulness as adjunctive therapy alongside standard treatment for epilepsy, but there are so many other questions that future research can dive into.

That’s what we strive to do at Cleveland Clinic. We just finished the LIFE study, a randomized controlled trial looking at yoga therapy, music therapy, and cognitive behavioral therapy. We’re currently analyzing those results and are hopeful that they will add to the evidence base.

What would you say to a patient or family who reads about these findings and considers using diet, yoga, or meditation instead of their antiseizure medication?

It’s essential to emphasize that lifestyle interventions are intended to be complementary to traditional epilepsy treatment, not to replace it. Antiseizure medications remain the primary treatment for epilepsy, and there are risks that come with stopping them or reducing doses without the guidance of your neurologist or epileptologist. That can include breakthrough seizures, prolonged seizures, and potentially life-threatening situations. For that reason, our review specifically covered studies that looked at these interventions alongside standard treatment with medications. We’re exploring whether these interventions can provide additional benefits for seizure control and quality of life as part of comprehensive epilepsy care.

Based on what is known so far, are there particular patients or seizure types, such as drug-resistant epilepsy, for whom lifestyle interventions may help more or less?

That’s another really good question that additional research can dive into. One of the challenges of the review is that different studies used different outcome reporting, so there was quite a bit of variability in how they reported patient characteristics like epilepsy type or seizure type. That made it very challenging to compare or analyze that further in this review.

More than half, 64%, of the studies included in our analysis tested their interventions in patients with drug-resistant, or intractable, epilepsy. But that doesn’t necessarily mean these interventions work better for that population. When studying these interventions, including patients with drug-resistant epilepsy or more frequent seizures makes it more doable to study an effect, whereas with people who have less frequent seizures, it gets harder to look at that research-wise.

Right now, we don’t have the answer to that question, but standardizing how we report outcomes in our studies is going to be a helpful tool so that we can do more systematic reviews in the future to dive into these topics. We should also look at what the benefit is. Seizure frequency is one potential area of benefit, but there are also sleep quality, mental health conditions like anxiety and depression, and overall quality of life. Those are other areas where we could potentially find benefit in the population with epilepsy.

For patients who want to add a lifestyle intervention to their current treatment, what should they expect, and how should they approach it?

First and foremost, I would reiterate and emphasize continuing to follow the treatment plan provided by your neurologist or epileptologist, which primarily includes antiseizure medications, and that lifestyle interventions are meant to supplement and support care rather than replace it. I would also encourage patients to have open conversations about different factors of their health and lifestyle overall, particularly stress, sleep quality, and mental health conditions such as anxiety and depression. These are common challenges for people with epilepsy, and sometimes there are ways to help with these factors.

Another important consideration is what works best for the individual person, and that’s actually one of the biggest challenges in studying lifestyle interventions. Everyone has different qualities, preferences, and abilities. One patient may find yoga therapy or music therapy calming and relaxing and get a lot of benefit from it, while another patient may actually find those situations stress-inducing. It’s about being open-minded and exploring different lifestyle factors that could be beneficial on an individual basis.

For this reason, we have resources available on the Cleveland Clinic Epilepsy Center website under the resources tab, including prerecorded video sessions of yoga therapy, mindfulness, and breathing techniques, as well as music therapy and cognitive behavioral therapy, that are open to the public. These videos, as well as the LIFE study, were made possible by the generosity of the Charles L. Shor Foundation, which we greatly appreciate. Ultimately, our hope is that these resources can help patients explore approaches that may benefit their seizures, as well as their health and overall well-being, while continuing their standard epilepsy treatment.

Transcript edited for clarity. Click here for more epilepsy coverage.

REFERENCES
1. Spurgeon E, Ivanuik A, Sodani S, et al. Systematic review and meta-analysis of lifestyle modification interventions and their impact on seizure reduction and quality of life. Epilepsia. 2026;67(9):4572-4589. doi:10.1002/epi.70316
2. Spurgeon E, Saper R, Alexopoulos A, et al. Proceedings of the 2022 "Lifestyle Intervention for Epilepsy (LIFE)" symposium hosted by Cleveland Clinic. Epilepsia Open. 2024;9(5):1981-1996. doi:10.1002/epi4.13037