Anxiety, panic, and phobic symptoms can occur in people with epilepsy, especially those with limbic epilepsy. Limbic epilepsy is seizure foci arising in limbic brain areas; limbic areas are regions in the temporal and frontal lobes, which are involved with memory and emotion (1–4). Anxiety disorders may be more frequent in patients with left than in those with right TLE (2).

Treating anxiety

Supportive psychotherapy may help patients vent their feelings, dynamic (behavioral) therapy can identify provocative factors and help to target therapy, and cognitive behavioral therapies improve self-confidence and coping by reducing tension and avoidance. Meditation and biofeedback are also helpful.

Antianxiety medications that enhance serotonin activity (e.g., SSRIs) are usually effective and well tolerated. It is important to keep in mind that a dangerous cycle can develop when a benzodiazepine is used for the long-term treatment of anxiety or insomnia. Initially, the drug works well, but tolerance often develops and the dose needs to be increased. The cycle can repeat until a high dose is reached with cognitive and behavioral toxicity, but the role of the benzodiazepine may be overlooked because other factors also contribute.

References

1. Perini G, Mendius R. Depression and anxiety in complex partial seizures. J Nerv Ment Dis 1984;172:287–90.
2. Altshuler LL, Devinsky O, Post RM, Theodore W. Depression, anxiety and temporal lobe epilepsy: laterality of focus and symptomatology. Arch Neurol 1990;47:284–8.
3. Vazquez B, Devinsky O, Luciano D, Alper K, Perrine K. Juvenile myoclonic epilepsy: clinical features and factors related to misdiagnosis. J Epilepsy 1993;6:233–8.
4. Cutting S, Lauchheimer A, Barr W, Devinsky O. Adult-onset idiopathic generalized epilepsy: clinical and behavioral features. Epilepsia 2001;42:1395–8.

Reproduced and adapted with permission from Orrin Devinsky, M.D. and Epilepsia.

Topic Editor: Steven C. Schachter, M.D.
Last Reviewed: 12/15/06