#AHT: Addressing anxiety in people with epilepsy: The power of the neurologist

Studies estimate that some form of anxiety disorder affects at least 25% of people with epilepsy, yet anxiety is underdiagnosed and undertreated. More attention often is paid to depression, possibly because of the risk for suicide. However, anxiety disorders also can increase risk for suicide, said Coraline Hingray, Pôle Universitaire du Grand Nancy and Centre Psychothérapique de Nancy, France, during a session at the American Epilepsy Society (AES) Annual Meeting in 2021. Also, said Hingray, anxiety in people with epilepsy is a stronger influence on quality of life than either depression or seizure frequency. And it is associated with poorer epilepsy outcomes.
A recent study found that among people with newly diagnosed epilepsy, those screening positive for both anxiety and depression had 7 times the risk of recurrent seizures, despite treatment with anti-seizure medications (ASMs), compared with those who screened negative for both conditions.

Types of anxiety

A 2011 consensus statement from the ILAE states that it’s essential to establish the relationship, if any, between the anxiety and the epilepsy. Anxiety can be any of several types, and many people experience more than one type:
An interictal (between-seizures) anxiety disorder is the most common and is independent of seizure occurrence. It includes generalized anxiety disorder, panic disorder, and others.
A side effect of anti-seizure medication or a new development after epilepsy surgery
Peri-ictal anxiety, which can occur up to 3 days before a seizure, during a seizure (aura), or up to 5 days after a seizure. This type is often underrecognized. Improved seizure control will reduce these anxiety symptoms.
Anxiety also can be associated with fear of seizure recurrence (seizure phobia), or a reaction to the diagnosis of epilepsy and the limitations associated with it.

Screening for anxiety: A first step and a conversation starter
Many neurologists cite time constraints as a barrier to screening. The GAD-7 screening tool takes only a few minutes and can be completed in the waiting room. It’s used in the general population to screen for anxiety and has been validated in people with epilepsy.

Soon, our hospital GAD-7 screening tool will begin assessing the anxiety of patients with epilepsy to improve their quality of life.