Anxiety disorders
Anxiety, panic, and phobic symptoms can occur in people with epilepsy, especially those with limbic epilepsy. Limbic epilepsy is seizure foci arising in limbic brain areas; limbic areas are regions in the temporal and frontal lobes, which are involved with memory and emotion (1–4). Anxiety disorders may be more frequent in patients with left than in those with right TLE (2).
Treating anxiety
Supportive psychotherapy may help patients vent their feelings, dynamic (behavioral) therapy can identify provocative factors and help to target therapy, and cognitive behavioral therapies improve self-confidence and coping by reducing tension and avoidance. Meditation and biofeedback are also helpful.
Antianxiety medications that enhance serotonin activity (e.g., SSRIs) are usually effective and well tolerated. It is important to keep in mind that a dangerous cycle can develop when a benzodiazepine is used for the long-term treatment of anxiety or insomnia. Initially, the drug works well, but tolerance often develops and the dose needs to be increased. The cycle can repeat until a high dose is reached with cognitive and behavioral toxicity, but the role of the benzodiazepine may be overlooked because other factors also contribute.