Abstract
Objectives
Review interaction between epilepsy and anxiety
Acute anxiety or stress can precipitate seizures through undefined mechanisms
Chronic, low-grade anxiety is very common and may affect quality of life (QOL)
Phenomenology of anxiety include autonomic and motoric aspects
Mood Disorders (MD) are common in epilepsy (30–60%) and carry bi-directional import, affecting each other, for better or worse
Anti-seizure therapies – whether ASMs or other, impact on both seizures and MD
Methods
Review of apt Neuropsychologic and Epileptic therapeutic literature
Results
Various ASMs (pregabalin, clonazepam, clobazam) may be used as anxiolytics in monotherapy; other patients may need specific anxiolytics added; yet others may benefit from ASM plus anxiolytic plus Cognitive Behavioural Therapy (CBT)
Behavioral therapies for MD improve Quality of Life (QoL) and may improve seizure control
There is a much larger non-medication toolbox for treating MD, including Psychiatric care referral
All ASMs may affect mood – directly or indirectly – for better or worse
Conclusions
Enquiry into mood at every PWE review is warranted; especially with every alteration of medications
It is worthwhile treating anxiety along with epilepsy – improvements in either sphere seem to result in greater QOL improvements than either alone
Two issues remain unresolved: are anxiolytics or CBT as efficacious in PWE? Is there utility in their use in improving QOLIE and reducing suicidal risk?
