Anxiety and epilepsy: what neurologists and epileptologists should know

Although there has been increasing recognition of psychiatric comorbidity in epilepsy, most research and attention in this area has focused on depression. However, comorbid anxiety in epilepsy is highly prevalent, affecting more than 40 % of patients in some reports. Many important outcomes are significantly impacted by anxiety in epilepsy, including quality of life, mortality, and seizure status. Recent evidence from epidemiologic studies suggests a bidirectional association of anxiety and epilepsy, and there is mounting evidence for possible common pathophysiology underlying anxiety and epilepsy. Despite this importance, anxiety is under-recognized and undertreated in clinical practice. A variety of anxiety symptoms are seen in epilepsy, including symptoms exclusively before, during or after seizures (peri-ictal anxiety), symptoms resembling primary anxiety disorders, and anxiety directly related to epilepsy or its treatment. Key therapeutic approaches include pharmacotherapy or cognitive behavioral therapy for most forms of interictal anxiety and better seizure control for peri-ictal anxiety.