Anxiety in epilepsy--based on two case reports.
There are a great number of psychopathological symptoms which manifest themselves in 70-75% of epileptic patients but most of them remain unrecognised and untreated. These symptoms may affect the patients' quality of life more negatively than the epileptic seizures themselves. Anxiety is one of the most frequently occurring interictal psychopathological symptom. A number of specialists agree that chronic epilepsy causes the amplification of endogenic seizure suppressing mechanisms which hinder the epileptic seizures and are responsible for the development of interictal psychopathological symptoms. However the physiological effects of the interictal psychopathological conditions (e.g. anxiety) have epileptogenic effect as well. There is a high chance that the conditions of epilepsy and anxiety will mutually create a destructive vicious circle and it will be illustrated by our two case reports. In our experience, before modifying the pharmacotherapy of a patient suffering from chronic epilepsy with increased frequency of seizures, the anxiety level should be defined; and if it is high it should be treated first. From our perspective, the so-called "rational bitherapy" is very effective when a high potential antiepileptic drug is combined with an anxiety reducing method. The latter can be drug related or consists only of psychotherapy. We need more controlled clinical research to prove that inside epilepsy there are risk groups as well as conditions of high risk when the connection between anxiety and epilepsy is more than evident. The described cases seem to indicate that the existence of periictal anxiety can be a risk factor in developing later interictal anxiety.
Baran
Brigitta
B
Semmelweis Egyetem, Altalános Orvosi Kar, Pszichiátriai és Pszichoterápiás Klinika, Budapest. baran@psych.sote.hu
Farkas
Márta
M
Rajna
Péter
P
D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects; D001007:Anxiety / Q000139:chemically induced / Q000209:etiology* / Q000503:physiopathology; D004827:Epilepsy / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D012307:Risk Factors
D000927:Anticonvulsants