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 difficulties compared to standard care, a new study finds.

Mental health problems such as worries, low mood and behavior problems are more common in children and young people with brain conditions such as epilepsy, than in the general population—with up to 60% of those with epilepsy having associated mental health disorders and many having more than one mental health condition.

These conditions can have a big impact on patients' quality of life and overall health.

Currently, mental health problems in children and young people with epilepsy are often not identified because centers that treat epilepsy are usually separated from those that treat mental health difficulties. When mental health difficulties are identified, standard treatment for children who also have epilepsy is usually carried out by specialists, such as child and adolescent mental health services (CAMHS) or hospital-based pediatric psychology services. The treatment given usually involves treating each mental health condition (i.e., anxiety, depression, behavioral issues) individually.

The new treatment, named the Mental Health Intervention for Children with Epilepsy (MICE), is based on the treatments that the National Institute for Health and Care Excellence (NICE) recommends for the treatment of common mental health difficulties, like cognitive behavioral therapy for anxiety and depression. However, it uses a modular approach that enables multiple mental health conditions to be treated at once, instead of having different treatments for different mental health difficulties.

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

Additionally, the treatment can be delivered over the phone or via video call so that people do not have to travel to the hospital and miss time from school or work. And rather than being outsourced to services such as CAMHS, it is integrated into epilepsy services—meaning that it could be delivered by non-mental health specialists.

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

"The treatment can be delivered from within epilepsy services to join up care. It doesn't need to be delivered by specialist mental health clinicians like psychologists. Integrating the care can help children with epilepsy and their families more effectively and efficiently. We were particularly pleased that benefits were sustained when treatment ended."

The new treatment, outlined in The Lancet, was created together 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 calls with the clinician—although face-to-face therapy was available if preferred. The sessions were delivered to either the young person directly, or via their caregiver, based on their individual circumstances.

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

They assessed adolescents' mental health and overall well-being from a parent-reported Strengths and Difficulties Questionnaire (SDQ)—covering areas such as emotional problems, conduct, hyperactivity and peer problems.

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

Co-Chief Investigator, Professor Roz Shafran (UCL Great Ormond Street Institute of Child Health and GOSH), said, "These groundbreaking findings not only promise brighter futures for children with epilepsy, but also pave the way for a revolutionary shift in mental health care practices. The collaborative efforts of scientists, patients, and health care professionals have brought forth a new era of treatment of mental health challenges associated with epilepsy, offering a beacon of hope for families in the face of mental health challenges associated with epilepsy."

Co-Chief Investigator, Professor Helen Cross (UCL Great Ormond Street Institute of Child Health and GOSH), added, "This study shows real progress for clinicians considering 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 Isobel Heyman (UCL Great Ormond Street Institute of Child Health and Clinical Co-Lead for mental health at Cambridge Children's Hospital), noted, "These promising results show that staff working in pediatric settings can be trained to deliver effective mental health treatment to children with a physical health condition (epilepsy). It clearly demonstrates that children's health care needs can be met in a holistic way to treat the 'whole child," in the same place at the same time."

The work was conducted in collaboration with experts at Great Ormond Street Children's Hospital (GOSH), King's College London and UCLA.