Neuropsychiatric Symptoms of Epilepsy

Chapter 4
Anxiety
Christian Brandt
Abstract Anxiety disorders constitute important, though for a long time, neglected
comorbidities of epilepsy. They deserve attention, because they are frequent and
negatively impact the quality of life of persons with epilepsy. This chapter covers
aspects of the neurobiological and pathophysiological correlates of anxiety and
anxiety disorders, classification and differential diagnosis of epilepsy-related anxiety,
epidemiology, the relationship between anxiety and different forms of epilepsy,
and the influence of epilepsy surgery on concomitant anxiety. The bidirectional
relationship between epilepsy and anxiety deserves broad attention, as this extends
to the different levels of this comorbidity from animal models (for instance, GAERS
rats may show increased levels of anxiety when compared to healthy controls,
already before the onset of epilepsy) to epidemiology (anxiety may be detected up
to 3 years before epilepsy diagnosis). Treatment (drugs, psychotherapy, alternative
treatments) is also covered. Selective serotonin-reuptake inhibitors and serotoninnoradrenalin
reuptake inhibitors are established in the treatment of anxiety disorders.
It would be of value in persons with epilepsy and a comorbid anxiety disorder
to treat both conditions with a single drug, which leads to the issue of anxiolytic
properties of antiepileptic drugs (AEDs). Strong evidence has been demonstrated
for pregabalin in social phobia and generalized anxiety disorder, lamotrigine in
posttraumatic stress disorder, and gabapentin in social anxiety. Anxiety may also be
a side effect of AEDs. Case vignettes at the end of the chapter illustrate the issue.
Keywords Epilepsy • Anxiety • Epidemiology • Prevalence • Bidirectional
Relationship • Antiepileptic Drugs • Pregabalin • Animal Models • Quality Of Life
C. Brandt , MD
Department of General Epileptology , Bethel Epilepsy Centre ,
Maraweg 21 , Bielefeld 33617 , Germany
e-mail: christian.brandt@mara.de
© Springer International Publishing Switzerland 2016
M. Mula (ed.), Neuropsychiatric Symptoms of Epilepsy, Neuropsychiatric
Symptoms of Neurological Disease, DOI 10.1007/978-3-319-22159-5_4
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