A new treatment could transform the mental health of children with epilepsy

A new psychological treatment for children with epilepsy developed by a UCL-led team of scientists has been shown to reduce mental health problems compared to standard care, a new study has found.

Mental health problems such as worry, low mood and behavioral problems are more common in children and young people with brain diseases such as epilepsy than in the general population – up to 60% of people with epilepsy have associated mental disorders and many have more than a mental health condition.

These conditions can have a major impact on patients’ quality of life and overall health.

Currently, mental health problems in children and young people with epilepsy often go unrecognized because centers that treat epilepsy are usually separate from those that treat mental health problems. When mental health problems are identified, standard treatment for children who also have epilepsy is usually provided by specialists such as child and adolescent mental health services (CAMHS) or hospital-based pediatric psychological services. Treatment usually involves individualized treatment of each mental health condition (ie, anxiety, depression, behavioral problems).

The new treatment, called the Mental Health Intervention for Children with Epilepsy (MICE), is based on treatments that the National Institute for Health and Care Excellence (NICE) recommends for treating common mental health problems such as cognitive- behavioral therapy for anxiety and depression. However, it uses a modular approach that allows multiple mental health conditions to be treated at once, rather than having different treatments for different mental health problems.

It has also been modified specifically for children and young people with epilepsy, for example, including sessions that explain the link between epilepsy and mental health.

Plus, treatment can be done over the phone or via video call, so people don’t have to travel to the hospital and miss time from school or work. And rather than being outsourced to services like CAMHS, it is integrated into epilepsy services – meaning it can be delivered by non-mental health professionals.

Lead author Dr Sophie Bennett, who carried out the research while working at UCL Great Ormond Street’s Institute of Child Health, said: “This treatment breakthrough means we have a new way of helping children and young people with epilepsy, who also have mental health difficulties.

“Treatment can be delivered by epilepsy services to join care. It does not need to be provided by mental health professionals such as psychologists. Integrating care can help children with epilepsy and their families more effectively and efficiently. We were particularly pleased that the benefits persisted after the treatment ended.”

The new treatment described in The lancetwas created in partnership with young people and their families and the professionals who care for them, including doctors, nurses and psychologists.

Patients were given an initial assessment followed by weekly discussions with the clinician – although face-to-face therapy was available if preferred. Sessions were delivered either directly to the young person or through their carer, based on their individual circumstances.

Researchers tested the treatment on 334 children and young people aged three to 18. Of these, 166 received the new MICE treatment and 168 received the usual treatment for psychiatric problems in children with epilepsy.

They assessed adolescent mental health and overall well-being using the parent-reported Strengths and Difficulties Questionnaire (SDQ), covering areas such as emotional problems, behavior, hyperactivity, and peer problems.

The results showed that children who had MICE treatment had fewer mental disabilities than those who had usual treatment, and the change was equivalent to a 40% reduction in the likelihood of having a psychiatric disorder.

Co-principal researcher Professor Roz Shafran (UCL Great Ormond Street Institute of Child Health and GOSH) said: “These ground-breaking findings not only promise a brighter future for children with epilepsy, but also pave the way for revolutionary change in care mental health The collaborative efforts of scientists, patients and healthcare professionals has ushered in a new era in the treatment of epilepsy-related mental health challenges, offering a beacon of hope for families facing the mental health challenges of epilepsy.”

Co-principal investigator Professor Helen Cross (UCL Great Ormond Street Institute of Child Health and GOSH) added: “This study shows real progress for clinicians, given the high rate of mental health problems in children with epilepsy, as we demonstrate the benefit of a therapy that can be implemented within existing epilepsy services.”

Co-author Professor Isabel Hayman (UCL Great Ormond Street Institute of Child Health and Clinical Co-Lead for Mental Health at the Children’s Hospital Cambridge) said: “These promising results show that staff working in pediatric settings can be trained to provides effective mental health treatment for children with a physical health condition (epilepsy). It clearly demonstrates that children’s health needs can be met in a holistic way to treat the ‘whole child’, in the same place at the same time.”

The work was carried out in collaboration with experts from Great Ormond Street Children’s Hospital (GOSH), King’s College London and UCLA.