Epilepsy and mental health disorders: current challenges and potential solutions

Abstract:

Epilepsy affects similar to 50 million people worldwide and is associated with increased psychiatric comorbidities, including depression, anxiety, psychosis and suicidality. Despite this, current epilepsy management primarily focusses on seizure control, potentially overlooking mental health concerns. This article explores the challenges of integrating psychiatric care into epilepsy treatment and proposes solutions for a more holistic approach. Using a consensus development panel method, a multidisciplinary team of neurologists, psychiatrists and a lived-experience expert identified key challenges to optimising the mental health of people living with epilepsy, such as healthcare system fragmentation, underdiagnosis of mental health conditions and inadequate resources. Among the proposed solutions, the need for routine mental health screening, interdisciplinary support and collaboration, and increased research into the neuropsychiatric aspects of epilepsy were highlighted. A shift from a seizure-centric model to a patient-centred approach is advocated, emphasising biopsychosocial care and improved access to psychiatric services. We also discuss prospective practical strategies to tackle the issues identified, including collaborative care models, structured decision trees and AI-driven screening tools, to enhance diagnosis and treatment. Addressing these challenges through systemic change, research investment and service innovation should significantly improve the care and quality of life for individuals with an epilepsy and co-occurring mental health disorders. (Summary); Cipriani, A (corresponding author), Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford, England.;Cipriani, A (corresponding author), Warneford Hosp, Oxford Hlth NHS Fdn Trust, Oxford, England.;Cipriani, A (corresponding author), NIHR Oxford Hlth Biomed Res Ctr, Oxford Precis Psychiat Lab, Oxford, England.;Cipriani, A (corresponding author), Warneford Hosp, NIHR Oxford Hlth Clin Res Facil, Oxford, England. (Author of contact); De Giorgi, Riccardo, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, United Kingdom, Warneford Hospital, Oxford, Oxfordshire, United Kingdom; Lomax, Tessa, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, United Kingdom, Warneford Hospital, Oxford, Oxfordshire, United Kingdom; Moreno, Carmen, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Madrid, Spain; Van Assche, Evelien V., Department of Psychiatry, University of Münster, Munster, Nordrhein-Westfalen, Germany; Osimo, Emanuele Felice, Department of Psychiatry, Cambridge, Cambridgeshire, United Kingdom, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; Bajorek, Tomasz, Department of Psychological Medicine, John Radcliffe Hospital, Oxford, Oxfordshire, United Kingdom; Sen, Arjune, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, United Kingdom, Centre for Global Epilepsy, Wolfson College Oxford, Oxford, Oxfordshire, United Kingdom; Fazel, Seena B., University of Oxford Medical Sciences Division, Oxford, Oxfordshire, United Kingdom, Warneford Hospital, Oxford, Oxfordshire, United Kingdom; Baune, Bernhard T., Department of Psychiatry, University of Münster, Munster, Nordrhein-Westfalen, Germany, Department of Psychiatry, Melbourne, VIC, Australia, University of Melbourne, Melbourne, VIC, Australia; Kandasamy, Rohan Oliver, Department of Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom; Yu, Rongqin, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, United Kingdom; Peña-Ceballos, Javier, Department of Neurology, Beaumont Hospital, Dublin, Ireland; Lattanzi, Simona, Neurological Clinic, Università Politecnica delle Marche, Ancona, AN, Italy; Camazón, Pablo Andrés, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Madrid, Spain; del Rincon, Celia Romero, Epilepsy Unit, Blua Sanitas Valdebebas Hospital, Madrid, Madrid, Spain; Yogarajah, Mahinda, Department of Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom, Chalfont Centre for Epilepsy, Buckingham, Bucks, UK, United Kingdom, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Assenza, Giovanni, Operative Research Unit of Neurology, University Hospital Foundation, Rome, Italy, Neurophysiology and Neurobiology, University of Rome, Rome, Italy; Robinson, Torie, Epilepsy Sparks, London, United Kingdom; Aledo-Serrano, Angel, Epilepsy Unit, Blua Sanitas Valdebebas Hospital, Madrid, Madrid, Spain; Cipriani, Andrea S., University of Oxford Medical Sciences Division, Oxford, Oxfordshire, United Kingdom, Warneford Hospital, Oxford, Oxfordshire, United Kingdom, NIHR Oxford Health Biomedical Research Centre, Oxford, Oxfordshire, United Kingdom, Warneford Hospital, Oxford, Oxfordshire, United Kingdom (Authors with Filk); R.D.G. is supported by the National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre (grant NIHR203316). T.L. is supported by the NIHR (Award number: ACF-2021-13-010). R.Y. is supported by John Fell Fund (no. 0013538). A.C. is supported by the NIHR Oxford Cognitive Health Clinical Research Facility, by an NIHR Research Professorship (grant RP-2017-08-ST2-006), by the NIHR Oxford and Thames Valley Applied Research Collaboration, by the NIHR Oxford Health Biomedical Research Centre (grant NIHR203316) and by the Wellcome Trust (GALENOS Project). The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR or the UK Department of Health and Social Care. C.M. is supported by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (ISCIII, PI21/01929), CIBER (Consorcio Centro de Investigaci\u00F3n Biom\u00E9dica en Red) (CB/07/09/0023), co-financed by the European Union (EU) and European Regional Development Fund from the European Commission, \u2018A way of making Europe\u2019, financed by the European Union \u2013 Next Generation EU (PMP21/00051), Madrid Regional Government (B2017/BMD-3740 AGES-CM-2), European Union Structural Funds, EU Seventh Framework Program, H2020 Program under the Innovative Medicines Initiative 2 Joint Undertaking: Project c4c (Grant agreement No. 777389), Horizon Europe (FAMILY: HORIZON-HLTH-2021-STAYHLTH-01-02 No. 101057529; Psych-STRATA: HORIZON-HLTH-2021-STAYHLTH-01-02 No. 101057454; Bootstrap: HORIZON-HLTH-2022-STAYHLTH-01-01-two-stage No. 101080238), National Institute of Mental Health of the National Institutes of Health, Fundaci\u00F3n Familia Alonso and Fundaci\u00F3n Alicia Koplowitz. (Notes)