Patients with epilepsy and anxiety disorders. Diagnosis and treatment

Up to 50-60% of patients with epilepsy may develop psychiatric complications, in particular depression, anxiety, and psychotic disorders. Although this comorbidity has received a great deal of attention in recent years, the anxiety spectrum of psychiatric disturbances in epilepsy patients has not been extensively studied, although tjhis comorbidity has a significant effect on the medical management and quality of life. The etiology is multifactorial, including neurobiological and shared pathophysiological mechanisms as well as psychosocial and iatrogenic factors (e.g., influence of antiepileptic drugs, epilepsy surgery). Despite the high prevalence of comorbid anxiety in epilepsy, very little is known about optimal treatment strategies. This article reviews the complex interrelationships between anxiety disorders and epilepsy from a clinical point of view. The evaluation of anxiety relative to ictal, peri-ictal, and postictal states is described, and medical treatment options for anxiety disorders in patients with epilepsy are discussed, illustrating that their treatment extends far beyond seizure control.