March 18, 2008

Epilepsy and the Problem of Anxiety...

Anxiety is common to lots of folks. It isn't unusual for any of us to suffer from it, and in various ways. Still, for epileptics, like myself, anxiety can be a complication or symptom of our epilepsy, and it is something frequently misperceived by others.

Jerry Federspiel created this expressive graphic titled "Anxiety". I thought it it represented something common to the experience of many epilepsy experiences. Federspiel has a double degree in computer science and psychology from Wisconsin, and I am certain both areas of study have informed his imagery here.

According to Orrin Devinsky, M.D.:
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).

Researchers surmise "up to 50-60% of patients with epilepsy may develop psychiatric complications, in particular depression, anxiety, and psychotic disorders."
They aslo readily admit difficulties and a lack of understanding of how best to treat these incidences when they do occur.

Anxiety is related to epilepsy in specific ways. Elana R. Pulver has written: "It can occur not only as a reaction to the diagnosis, but also as a symptom of the epilepsy, and, in some cases, as a side effect of seizure medicines. When considering a diagnosis of epilepsy, it is very important to distinguish it correctly from other disorders. Some people with high levels of anxiety can experience panic attacks, which are characterized by intense feelings of nervousness, fear, and the sudden appearance of bodily symptoms such as sweating, hyperventilation, accelerated heartbeat, and flushing of the skin. In some cases, panic attacks have been misdiagnosed as epilepsy, and epilepsy has even been misdiagnosed as panic attacks! Because these symptoms of anxiety can be present during a seizure, in many cases the two are hard to differentiate. In extreme cases, hyperventilation caused by anxiety can trigger a convulsion, which can further complicate the diagnosis. Also, because the panic attacks occur suddenly and without warning, they are extremely frightening; the person usually believes that they represent a serious medical condition. Because panic attacks and seizures can be so similar, it is important to use techniques such as MRI and EEG to differentiate between them".

And then there are the other instances, like Ms. Pulver points out, when E. is misdiagnosed as "panic attack" or "anxiety". Sometimes this happens because the differential diagnoses is difficult to make. Sometimes it happens because there are mitigating factors, e.g. cultural sentiments against a diagnoses of E., that color a diagnoses of E...

While I was in college, I knew a young man. Very intelligent, good guy. He went on a trip with the honors society and when he came home. he told us that he had some kind of event. He was alone, in a hallway of the hotel in which he was staying. He found himself waking up, on the floor and discovering that he had chipped his teeth. He couldn't say what had happened to him, but after submitting to his doctor, he came back to say he had been diagnosed with "anxiety". Hmmmmmm.

I suppose I could have been happy with that if he had not chipped his teeth. The chipped teeth suggested to me something more like a tonic-clonic or convulsive event. But, I am not the doctor...

In line with earlier reports, a recent paper, to be published in Journal of Anxiety Disorders (available online 13 June 2005) posits the existence of a subgroup of panic attacks with the clinical features of the epileptic aura, and so must be considered and diagnosed as simple partial seizures (SPSs) with a psychic content. In the paper, research is presented to support a hypothesis that panic attacks, when they have the same clinical signs as the epileptic consciousness, should be diagnosed as partial seizures with a psychic content.

After setting out the four clinical signs defining it (suddenness, automatic nature, great intensity and strangeness), the authors made an extensive review of the literature in search of scientific information to support the hypothesis, which reveals a wealth of concurring scientific evidence, at both the clinical and preclinical levels, to support the hypothesis presented in this paper. The authors conclude by saying that panic attacks observed clinically with the features of suddenness, strangeness, great intensity and automatic nature should be interpreted as SPSs. (http://www.medindia.net/news/view_news_main.asp?str=2&x=5388)

The last bit was especially helpful to me when I came across it. Now, when someone insinuates that my anxiety has nothing to do with my E., I can reply back that it well may be a part of the kinds of seizures I suffer. It isn't something external to my condition, but rather something integral to it.



1. Perini G, Mendius R. Depression and anxiety in complex partial seizures. J Nerv Ment Dis 1984;172:287–90.
2. Altshuler LL, Devinsky O, Post RM, Theodore W. Depression, anxiety and temporal lobe epilepsy: laterality of focus and symptomatology. Arch Neurol 1990;47:284–8.
3. Vazquez B, Devinsky O, Luciano D, Alper K, Perrine K. Juvenile myoclonic epilepsy: clinical features and factors related to misdiagnosis. J Epilepsy 1993;6:233–8.
4. Cutting S, Lauchheimer A, Barr W, Devinsky O. Adult-onset idiopathic generalized epilepsy: clinical and behavioral features. Epilepsia 2001;42:1395–8.

3 comments:

jason said...

Nice one. A very well-written post on methods to attack anxiety.I came across a very good wesbite that has guides regarding anxiety attacks. Thought I might share it with you at www.attackanxiety.org.

Rycharde Manne said...

Interesting... I had a panic attack some 8 years ago when presenting a lecture at a conference. My pre-syncope symptoms are very similar to that!

Back to my differential diagnosis! What has been interesting is trying to dredge up from memory things that may be important pointers to my own condition. With hindsight it is easy to see how seemingly transient conditions may have been warning signs.

One thing you may look at is hypnotherapy. But worth spending time finding a therapist you trust, best to look for a trained analytical hypnotherapist as they have better training than just the standard therapies to stop smoking, lose weight etc.

Rych

James Marzilli said...

The psychological symptoms of anxiety disorder mainly include uneasiness, fear of losing control, behavioral problems, sleep problems, nightmares, insecurity, restlessness, confusion, avoidance, nervousness, constant fear, hypervigilance, escapism and self-consciousness. The associated physical symptoms of anxiety disorder include sweating, shortness of breath, flushing, palpitation, dry mouth, nausea, hot flashes, chills, cold and numbness in feet and hands, muscle pain, joint pain, tremors, twitches, chest pain, headache, stomach pains, queasiness, diarrhea, frequent urination, dizziness and fatigue. http://www.xanax-effects.com/