2026 Volume 11 Article ID: 20260061
Objectives: Drug-resistant epilepsy (DRE) affects 20%–30% of individuals with epilepsy and is associated with persistent seizures, cognitive and psychosocial impairments, and reduced health-related quality of life (HRQoL). Although surgery and neuromodulation are established non-pharmacological options, the role of rehabilitation remains unclear. This systematic review synthesized evidence on rehabilitation for DRE and aimed to clarify its clinical relevance in terms of seizure, motor, cognitive, and quality-of-life outcomes.
Methods: Five databases (PubMed, CENTRAL, CINAHL, PEDro, and ProQuest) were searched for studies published between January 2015 and March 2025. Eligible studies included randomized controlled trials (RCTs), controlled clinical trials, and observational studies in patients with DRE receiving rehabilitation. The outcomes included seizure frequency, cognitive function, HRQoL, psychological health, and physical function. The methodological quality of RCTs was assessed using the PEDro scale. A narrative synthesis was performed, and meta-analyses of studies on physical exercise therapy were conducted to compare outcomes.
Results: Eleven studies met the criteria: four RCTs, one non-RCT, and six observational studies. The interventions included physical exercise therapy (n = 4), postoperative rehabilitation after anterior temporal lobe resection or hemispherotomy (n = 4), neuropsychological rehabilitation (n = 1), monitoring daily activities (n = 1), and a qualitative study (n = 1). Meta-analyses of RCTs found no significant effects of exercise therapy on seizure frequency or HRQoL.
Conclusions: DRE rehabilitation is multifaceted and encompasses exercises, cognitive training, and postoperative rehabilitation. Exercise therapy appears safe; however, the effects on seizure control and HRQoL are inconclusive. The limited evidence in DRE rehabilitation underscores the need for larger, methodologically rigorous trials with standardized outcomes.
