Objective - To investigate whether participation in a structured programme of fairly intensive leisure activities increased seizure occurrence. Material and methods - 212 adults with medically-in tractable epilepsy were closely monitored for seizure occurrence during an "activities day", i.e. a day consisting of various structured sessions of leisure pursuits (video game play, reading, ward puzzles, television, physical exercise), and during other days of relative rest, whilst undergoing prolonged video EEG monitoring. Results - The relative risk of seizures did not differ significantly during activities days compared with days of relative rest. Conclusions These findings fail to provide empirical support for the hypothesis that cognitive exertion has an adverse effect on seizure control.