Exploring Anticipatory Anxiety of Seizures in Patients with Epilepsy
Abstract number :
3.247
Submission category :
6. Cormorbidity (Somatic and Psychiatric)
Year :
2023
Submission ID :
596
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Andres Kanner, MD – Comprehensive Epilepsy Center, University of Miami Miller School of Medicine, Miami, FL
Enrique Carrazana, MD – Neurelis, Inc., San Diego, CA; John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; Heidi Munger Clary, MD, MPH – Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC; Adrian Rabinowicz, MD – Neurelis, Inc., San Diego, CA; Edward Faught, MD – Emory Epilepsy Program, Emory University School of Medicine, Atlanta, GA
Rationale:
With the diagnosis of epilepsy, patients and their families experience loss of predictability, which may contribute to fear of whether and when future seizures might occur. This fear of seizures may persist despite the passage of time. A subset of patients with epilepsy (PWE) may experience a pathological fear of having a seizure and may limit their daily activities by engaging in avoidant behaviors. This pathological fear has been called anticipatory anxiety of seizures (AAS; also known as seizure phobia) and may be underappreciated clinically.
Methods:
We reviewed published data on clinical manifestations of AAS and potential pathological mechanisms. In addition, we explored possible tools to screen for AAS and therapeutic interventions for the clinical setting.
Results:
In the few available studies, the variables most relevant to AAS were history of mood and anxiety disorders, history of traumatic events, avoidance behavior, and family psychiatric history. Additionally, panic disorders, agoraphobia, and cannabis use were identified concurrently with AAS. Epilepsy-related variables associated with the development of AAS included shorter history of epilepsy, longer duration of individual ictal events, unsafe feeling during seizures, and the presence of peri-ictal psychiatric symptoms. Although anxiety and depression have been associated with increased emergency room use, an association between seizure emergencies and AAS has not been established. PWE perception of low control over their lives (locus of control) may contribute to AAS because the unpredictability of seizures may be associated with belief in an external locus of control influenced by uncontrollable outside forces or chance. Regarding screening for AAS, there is currently no validated tool. However, a ten question subset of questions from the Epilepsy Anxiety Survey Instrument has been proposed as a screener that may be applicable for AAS. Additionally, a single question about seizure worry in everyday life may be useful in time-constrained clinics. Potential therapeutic interventions include pharmacotherapy targeting AAS symptoms, cognitive behavioral therapy, use of rescue seizure medication that might reduce seizure worry, and development of a seizure action plan to enhance sense of control.
Conclusions:
AAS has been explored as a distinct psychiatric entity characterized by a pathological process that includes fear of having seizures and associated avoidance behaviors. Because AAS can be a disruptive force in the lives of PWE and their families, clinicians should screen for psychiatric comorbidities of epilepsy at the time of diagnosis and subsequent visits. Recognition and treatment of AAS may be integral to comprehensive management of PWE, and further investigation is needed.
Funding:
Neurelis, Inc.
Cormorbidity (Somatic and Psychiatric)