Anxiety in epilepsy

Seizures arising from the limbic network, including the amygdala, may produce fear-related symptoms (there are commonly other symptoms related to temporal lobe seizure accompanying this symptom, such as déjà vu, epigastric rising sensation, or olfactory hallucination (Hingray et al, 2019)

Types of anxiety specific to patients with epilepsy (Hingray et al, 2019)

• Peri-ictal anxiety
  • Preictal, preceding the seizure (prodromes, 5 minutes – 48 hours before)
  • Ictal, part of the seizure (including auras – 5 minutes – a few seconds preceding, as well as ictal fear)
  • Postictal, occurring within 72 hours of the seizure (often accompanied by dysphoria)
• Interictal anxiety occurring independent of seizures
  • Anticipatory anxiety of epileptic seizures – excessive fear of having a seizure
  • Seizure phobia – excessive fears of seizures, often associated with avoidance surrounding circumstances associated with previous seizures
  • Epileptic social phobia – fear of being seen by others while having a seizure
  • Epileptic panic disorder – specific panic disorder associated with agoraphobia
• Iatrogenic
  • Medication side-effects (levetiracetam, topiramate, perampanel, zonisamide)
  • Withdrawal of medication (pregabalin, benzodiazepines, gabapentin, divalproex)
  • Antiepileptic medication inducing metabolism

Differentiating panic attack vs ictal fear: (Hingray et al, 2019)

References

Hingray, C., McGonigal, A., Kotwas, I. & Micoulaud-Franchi, J.-A. The Relationship Between Epilepsy and Anxiety Disorders. Curr. Psychiatry Rep. 21, 40 (2019). https://pubmed.ncbi.nlm.nih.gov/31037466/