Anxiety and Epilepsy: What Neurologists and Epileptologists Should Know

Overview

Journal Curr Neurol Neurosci Rep

Specialty Neurology

Date 2014 Mar 22

PMID 24652453

Citations 7

Authors

Heidi M Munger Clary

Affiliations

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Abstract

Although there has been increasing recognition of psychiatric comorbidity in epilepsy, most research and attention in this area has focused on depression. However, comorbid anxiety in epilepsy is highly prevalent, affecting more than 40 % of patients in some reports. Many important outcomes are significantly impacted by anxiety in epilepsy, including quality of life, mortality, and seizure status. Recent evidence from epidemiologic studies suggests a bidirectional association of anxiety and epilepsy, and there is mounting evidence for possible common pathophysiology underlying anxiety and epilepsy. Despite this importance, anxiety is under-recognized and undertreated in clinical practice. A variety of anxiety symptoms are seen in epilepsy, including symptoms exclusively before, during or after seizures (peri-ictal anxiety), symptoms resembling primary anxiety disorders, and anxiety directly related to epilepsy or its treatment. Key therapeutic approaches include pharmacotherapy or cognitive behavioral therapy for most forms of interictal anxiety and better seizure control for peri-ictal anxiety.

Citing Articles

Panic disorder in epilepsy.

Redecker T, Jeung-Maarse H, Brandt C Epilepsy Behav Rep. 2024; 25:100646.

PMID: 38299123 PMC: 10828572. DOI: 10.1016/j.ebr.2024.100646.

Afraid to go out: Poor quality of life with phobic anxiety in a large cross-sectional adult epilepsy center sample.

Munger Clary H, Giambarberi L, Floyd W, Hamberger M Epilepsy Res. 2023; 190:107092.

PMID: 36701931 PMC: 10167591. DOI: 10.1016/j.eplepsyres.2023.107092.

Virtual Reality Therapy for People With Epilepsy and Related Anxiety: Protocol for a 3-Phase Pilot Clinical Trial.

Gray H, Tchao D, Lewis-Fung S, Pardini S, Harris L, Appel L JMIR Res Protoc. 2023; 12:e41523.

PMID: 36692939 PMC: 9906303. DOI: 10.2196/41523.

Anxiety-like features and spatial memory problems as a consequence of hippocampal SV2A expression.

Serrano M, Bartholome O, Van Den Ackerveken P, Ferrara A, Rogister B, Plenevaux A PLoS One. 2019; 14(6):e0217882.

PMID: 31166988 PMC: 6550411. DOI: 10.1371/journal.pone.0217882.

Should adult neurologists play a role in the management of the most common psychiatric comorbidities? Practical considerations.

Munger Clary H, Salpekar J Epilepsy Behav. 2018; 98(Pt B):309-313.

PMID: 30471892 PMC: 6614011. DOI: 10.1016/j.yebeh.2018.10.020.

References

Hitiris N, Mohanraj R, Norrie J, Sills G, Brodie M . Predictors of pharmacoresistant epilepsy. Epilepsy Res. 2007; 75(2-3):192-6. DOI: 10.1016/j.eplepsyres.2007.06.003. View

Alwash R, Hussein M, Matloub F . Symptoms of anxiety and depression among adolescents with seizures in Irbid, Northern Jordan. Seizure. 2000; 9(6):412-6. DOI: 10.1053/seiz.2000.0427. View

Haut S, Hall C, Masur J, Lipton R . Seizure occurrence: precipitants and prediction. Neurology. 2007; 69(20):1905-10. DOI: 10.1212/01.wnl.0000278112.48285.84. View

Isaacs K, Philbeck J, Barr W, Devinsky O, Alper K . Obsessive-compulsive symptoms in patients with temporal lobe epilepsy. Epilepsy Behav. 2004; 5(4):569-74. DOI: 10.1016/j.yebeh.2004.04.009. View

Sazgar M, Carlen P, Wennberg R . Panic attack semiology in right temporal lobe epilepsy. Epileptic Disord. 2003; 5(2):93-100. View

Ettinger A, Copeland L, Zeber J, Van Cott A, Pugh M . Are psychiatric disorders independent risk factors for new-onset epilepsy in older individuals?. Epilepsy Behav. 2009; 17(1):70-4. DOI: 10.1016/j.yebeh.2009.10.010. View

Feltner D, Wittchen H, Kavoussi R, Brock J, Baldinetti F, Pande A . Long-term efficacy of pregabalin in generalized anxiety disorder. Int Clin Psychopharmacol. 2007; 23(1):18-28. DOI: 10.1097/YIC.0b013e3282f0f0d7. View

Maschio M, Dinapoli L, Sperati F, Pace A, Fabi A, Vidiri A . Effect of pregabalin add-on treatment on seizure control, quality of life, and anxiety in patients with brain tumour-related epilepsy: a pilot study. Epileptic Disord. 2012; 14(4):388-97. DOI: 10.1684/epd.2012.0542. View

Brandt C, Schoendienst M, Trentowska M, Schrecke M, Fueratsch N, Witte-Boelt K . Efficacy and safety of pregabalin in refractory focal epilepsy with and without comorbid anxiety disorders - results of an open-label, parallel group, investigator-initiated, proof-of-concept study. Epilepsy Behav. 2013; 29(2):298-304. DOI: 10.1016/j.yebeh.2013.08.004. View

10.

Au A, Chan F, Li K, Leung P, Li P, Chan J . Cognitive-behavioral group treatment program for adults with epilepsy in Hong Kong. Epilepsy Behav. 2003; 4(4):441-6. DOI: 10.1016/s1525-5050(03)00149-5. View

11.

Kanner A . Psychiatric issues in epilepsy: the complex relation of mood, anxiety disorders, and epilepsy. Epilepsy Behav. 2009; 15(1):83-7. DOI: 10.1016/j.yebeh.2009.02.034. View

12.

Van Paesschen W, King M, Duncan J, Connelly A . The amygdala and temporal lobe simple partial seizures: a prospective and quantitative MRI study. Epilepsia. 2001; 42(7):857-62. DOI: 10.1046/j.1528-1157.2001.042007857.x. View

13.

Kanner A . Psychiatric comorbidities and epilepsy: is it the old story of the chicken and the egg?. Ann Neurol. 2012; 72(2):153-5. DOI: 10.1002/ana.23679. View

14.

Spina E, Trifiro G, Caraci F . Clinically significant drug interactions with newer antidepressants. CNS Drugs. 2011; 26(1):39-67. DOI: 10.2165/11594710-000000000-00000. View

15.

Brandt C, Schoendienst M, Trentowska M, May T, Pohlmann-Eden B, Tuschen-Caffier B . Prevalence of anxiety disorders in patients with refractory focal epilepsy--a prospective clinic based survey. Epilepsy Behav. 2010; 17(2):259-63. DOI: 10.1016/j.yebeh.2009.12.009. View

16.

Kaplan P . Epilepsy and obsessive-compulsive disorder. Dialogues Clin Neurosci. 2010; 12(2):241-8. PMC: 3181953. View

17.

VanCott A, Cramer J, Copeland L, Zeber J, Steinman M, Dersh J . Suicide-related behaviors in older patients with new anti-epileptic drug use: data from the VA hospital system. BMC Med. 2010; 8:4. PMC: 2823654. DOI: 10.1186/1741-7015-8-4. View

18.

Kobau R, Gilliam F, Thurman D . Prevalence of self-reported epilepsy or seizure disorder and its associations with self-reported depression and anxiety: results from the 2004 HealthStyles Survey. Epilepsia. 2006; 47(11):1915-21. DOI: 10.1111/j.1528-1167.2006.00612.x. View

19.

Kimiskidis V, Valeta T . Epilepsy and anxiety: epidemiology, classification, aetiology, and treatment. Epileptic Disord. 2012; 14(3):248-56. DOI: 10.1684/epd.2012.0524. View

20.

Park S, Song H, Hwang Y, Lee H, Suh C, Kwon S . Differential effects of seizure control and affective symptoms on quality of life in people with epilepsy. Epilepsy Behav. 2010; 18(4):455-9. DOI: 10.1016/j.yebeh.2010.05.021. View