Psychological treatments for adults and children with epilepsy: Evidence‐based recommendations by the International League Against Epilepsy Psychology Task Force

Abstract

Given the significant impact that psychosocial factors and epilepsy treatments can have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is great clinical interest in the role of psychological evaluation and treatments to improve HRQOL and comorbidities. Therefore, the International League Against Epilepsy (ILAE) charged the Psychology Task Force with the development of recommendations for clinical care based on evaluation of the evidence from their recent Cochrane review of psychological treatments in individuals with epilepsy. The literature search for a recent Cochrane review of randomized controlled trials investigating psychological treatments for individuals with epilepsy constitutes the key source of evidence for this article. To provide practical guidance to service providers, we provide ratings on study research designs based on (1) the American Academy of Neurology's Level of Evidence system and (2) the Grading of Recommendations, Assessment, Development, and Evaluation system. This paper is the culmination of an international collaboration process involving pediatric and adult psychologists, neurologists, psychiatrists, and neuropsychiatrists. The process and conclusions were reviewed and approved by the ILAE Executive Committee. The strongest evidence for psychological interventions was identified for the most common mental health problems, including depression, neurocognitive disturbances, and medication adherence. Psychological interventions targeting the enhancement of HRQOL and adherence and a decrease in comorbidity symptoms (anxiety, depression) should be incorporated into comprehensive epilepsy care. There is a range of psychological strategies (ie, cognitive behavioral therapy and mindfulness-based therapies) that show promise for improving the lives of persons with epilepsy, and clinical recommendations are provided to assist epilepsy health care providers in treating the comorbidities and challenges associated with epilepsy and its treatments.

Developments in depression in epilepsy: screening, diagnosis, and treatment

“…According to the National Institute for Clinical Excellence (NICE), psychological therapies represent first line treatment for mild to moderate depression in both the general population [72] and in subjects with a chronic health problem [73]. Data in people with epilepsy are still limited but systematic reviews and meta-analysis have shown that psychological therapies are associated with a significant improvement in quality of life [74,75] and a recent document from the ILAE Psychology Task Force confirmed that psychotherapeutic interventions are recommended in patients with epilepsy and mild to moderate depression, even if the level of evidence is still moderate and further studies are needed [76].…”

Self‐management for adults with epilepsy: Aggregate Managing Epilepsy Well Network findings on depressive symptoms

“…A key clinical implication is the potential utility of self‐management intervention to advance care for depressed people with epilepsy. A recent literature review found that psychological treatments that encompass a broad range of nonpharmacological interventions for individuals, families, or groups have strong evidence for improving depressive symptoms in epilepsy. However, this review only identified one study that specifically investigated depression outcomes for a self‐management intervention .…”

“…[13][14][15] A recent literature review of psychological treatments in people with epilepsy found that one-third of patients receiving cognitive behavioral therapy (CBT) interventions, compared to 10% of controls, could be considered "reliably improved." 16 However, given the great number of undertreated people with epilepsy who also have depression, the development of additional psychological approaches, including alternatives to CBT, is warranted. There is considerable conceptual overlap among psychological approaches intended to help improve health outcomes among people with epilepsy.…”

“…For example, both CBT and epilepsy self-management interventions include a focus on improving emotional regulation and the development of personal coping strategies that address solving current problems. 16,17 Although there is still a relative paucity of randomized controlled trials (RCTs) focused on epilepsy self-management interventions, 18 the CDC-supported MEW Network website describes evidence-based epilepsy self-management intervention such as the HOBSCOTCH (Home-Based Self-Management and Cognitive Training Changes Lives) approach intended to improve cognitive problems in adults with epilepsy and the TIME (Targeted Self-Management for Epilepsy and Mental Illness) approach targeting adults with epilepsy and comorbid mental health conditions, as well as emerging research for self-management interventions that are still in development. 8 Given the MEW Network's focus on depression comorbidity, a number of sites conducting RCTs in epilepsy self-management interventions have the PHQ-9 as a primary or secondary outcome.…”

Optimising Evidence-Based Psychological Treatment for the Mental Health Needs of Children with Epilepsy: Principles and Methods

“…These include improved identification of mental health needs, better access to evidencebased psychological treatment, provision of patient-centred care, avoiding fragmentation of health services, reducing stigma associated with mental health treatment, optimising both mental health and physical health outcomes and strengthening overall health systems (Patel et al 2013). Integration is needed as psychological interventions targeting the enhancement of health-related quality of life, medication adherence and comorbid mental health symptoms (for example anxiety, depression and disruptive behaviour) have been recommended as part of comprehensive epilepsy care (Michaelis et al 2018).…”