In a recent publication in The Lancet, researchers from the University College London (UCL) conducted a study to assess the clinical effectiveness of integrated mental health treatment for children and young people with epilepsy.

The authors noted that up to 60% of those with epilepsy have associated mental health struggles, and many have more than one mental health challenge.

The parallel-group, multicenter, open-label, randomized, controlled trial included subjects aged 3 to 18 years who were attending epilepsy clinics across England and Northern Ireland and met diagnostic criteria for a common mental health disorder.

The study participants were randomized (1:1, applying an independent Web-based system) to receive either a new treatment known as the Mental Health Intervention for Children with Epilepsy (MICE) in addition to traditional care (intervention group) or assessment-enhanced usual care alone (control group).

Subjects in both groups received a full diagnostic mental health assessment. MICE is a modular psychological intervention constructed to treat common mental health conditions in children and young people; it employs evidence-based approaches such as cognitive behavior therapy and behavioral parenting strategies. Typical care for mental health disorders differed by site but generally included referral to appropriate services.

The authors wrote, “Participants, along with their caregivers and clinicians, were not masked to treatment allocation, but statisticians were masked until the point of analysis. The primary outcome, analyzed by modified intention-to-treat, was the parent-report Strengths and Difficulties Questionnaire (SDQ) at 6 months post-randomization.”

Between May 20, 2019, and January 31, 2022, 1,401 subjects were considered potentially eligible for study inclusion. Following the elimination of 531 young people, 870 participants were evaluated for eligibility and completed the SDQ, and 480 caregivers provided consent for study inclusion.

Between August 28, 2019, and February 21, 2022, 334 participants (average age 10.5 years [standard deviation (SD) 3.6] in the MICE group vs. 10.3 [4.0] in the control group at baseline) were randomly assigned to an intervention using minimization balanced by age, primary mental health disorder, diagnosis of intellectual disability, and autistic spectrum disorder at baseline. Of this study population, 168 (50%) were female, and 166 (50%) were male. The researchers randomly assigned 166 participants to the MICE group, and 168 were randomly assigned to the control group.

The results revealed that at 6 months, the average SDQ difficulties scores for the 148 participants in the MICE group and the 148 participants in the control group were 17.6 (SD 6.3) and 19.6 (SD 6.1), respectively. The adjusted effect of MICE was –1.7 (95% CI, –2.8 to –0.5; P = .0040; Cohen’s d, 0.3). A total of 14 (8%) patients in the MICE group experienced at least one serious adverse event compared with 24 (14%) in the control group. A total of 68% of serious adverse events (50 events) was admission due to seizures.

Based on their findings, the authors concluded that the use of MICE was superior to assessment-enhanced standard care in improving symptoms of emotional and behavioral difficulties in young people with epilepsy and common mental health disorders.

The authors wrote, “The trial, therefore, shows that mental health comorbidities can be effectively and safely treated by a variety of clinicians, utilizing an integrated intervention across ages and in the context of intellectual disability and autism. The evidence from this trial suggests that such a model should be fully embedded in epilepsy services and serves as a model for other chronic health conditions in young people.”

In a press release on the UCL website, lead author Dr. Sophie Bennett stated, “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.”

Dr. Bennett added, “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.”

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