Neuropsychological and psychological treatments for adults with newly diagnosed epilepsy

Background

Epilepsy is a neurological condition characterised by involuntary activity of the brain which manifests in seizures. People with newly diagnosed epilepsy often report psychological (such as symptoms of depression or anxiety) and neuropsychological (for example, memory or thinking problems) difficulties. Despite this, there is little research into interventions for these difficulties for people with newly diagnosed epilepsy. We reviewed the available evidence for these interventions within this population

Study characteristics

The evidence in this review is current to 30 June 2015. We found two studies that evaluated the effectiveness of psychological interventions targeting depression and anxiety symptoms in people with newly diagnosed epilepsy. One study compared the effectiveness of treatment as usual (TAU) versus usual care plus two 20-minute appointments, three months apart, with a specialist nurse. This was conducted in a sample of 90 people with newly diagnosed epilepsy.

The second study assessed the effectiveness of a cognitive behavioural intervention (CBI). This approach aims to challenge individuals' negative thoughts alongside behavioural interventions such as graded exposure to situations that prompt anxiety. This entailed 12 group sessions over a six-month period compared with an equal number of sessions in which counselling without CBI was delivered. This control group was referred to as TAU.

We identified no studies that evaluated the effectiveness of neuropsychological interventions aimed at addressing memory and thinking problems.

Key results

There were two main findings from these studies. First, CBI was more effective than TAU in reducing self reported depressive symptoms. Second, more time spent with a medical professional may have some benefit in improving individuals' knowledge of epilepsy.

Quality of evidence

Of the interventions included in this review, one study enrolled people aged from 13 to 19 years (adolescents) rather than just adults and, therefore, generalising these results to all adults with newly diagnosed epilepsy is limited. The second study used an individualised patient-led approach, in which the patient guided the content of each session. Therefore, it is difficult to determine which intervention factor(s) were effective and which were not. The content of the interventions assessed in the studies within this review was unclear. Overall, the present review identified a paucity of information for assessing the effectiveness of psychological and neuropsychological interventions for epilepsy and, therefore, we can draw no robust conclusions from the evidence presented.

Authors' conclusions: 

Meta-analysis was not possible as we identified only two studies and they utilised different interventions and outcome measures.

Previous research has highlighted the impact of psychological and neuropsychological difficulties experienced by people with epilepsy and the negative effect this has on their quality of life. The main finding of this review is that there is a paucity of research assessing possible neuropsychological and psychological interventions for adults with newly diagnosed epilepsy.

Read the full abstract...
Background: 

Many people with epilepsy report experiencing psychological difficulties such as anxiety, depression and neuropsychological deficits including memory problems. Research has shown that these difficulties are often present not only for people with chronic epilepsy but also for people with newly diagnosed epilepsy. Despite this, there are very few published interventions that detail means to help people with newly diagnosed epilepsy manage these problems.

Objectives: 

To identify and assess possible psychological and neuropsychological interventions for adults with newly diagnosed epilepsy.

Search strategy: 

We searched the following databases on 30 June 2015: the Cochrane Epilepsy Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), SCOPUS, PsycINFO, CINAHL, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP).

Selection criteria: 

This review includes all randomised controlled trials, quasi-randomised controlled trials, prospective cohort controlled studies, and prospective before and after studies which include psychological or neuropsychological interventions for people with newly diagnosed epilepsy. We excluded studies that included people with epilepsy and any other psychological disorder or neurological condition. We excluded studies carried out which recruited only children.

Data collection and analysis: 

We used the standard methodological procedure expected by The Cochrane Collaboration. Two authors independently completed data extraction and risk of bias analysis. The results of this were cross-checked and third author resolved any discrepancies. In the event of missing data, we contacted the study authors. Meta-analysis was not completed due to differences in the intervention and outcomes reported in the two studies.

Main results: 

We included two randomised controlled trials assessing psychological interventions for people with newly diagnosed epilepsy. One study assessed a cognitive behavioural intervention (CBI) in an adolescent population. This study was rated as low quality. One study assessed a specialist nurse intervention in an adult population. This study was rating as very low quality.

We rated one study as having unclear risk of bias and one study as having high risk of bias.

The CBI study indicated that this intervention could significantly reduce depressive symptoms in people with subthreshold depressive disorder. However, the study assessing the effectiveness of a nurse intervention found no significant benefit for depressive symptoms,but did find that in individuals with the least knowledge of epilepsy, a nurse intervention could increase their knowledge of epilepsy scores.

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