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Salpekar JA, Ma GJ, Mietchen J, Mani J, Jones JE. Treatment of Comorbid Anxiety and Epilepsy. J Neuropsychiatry Clin Neurosci 2023; 35:218-227. [PMID: 36785943 DOI: 10.1176/appi.neuropsych.20220116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Objective: Anxiety is among the most common psychiatric illnesses, and it commonly co-occurs with epilepsy. This review of the existing literature on anxiety comorbid with epilepsy aims to generate new insights into strategies for assessment and treatment. Methods: The authors conducted a narrative literature review to select key publications that help clarify the phenomenology and management of comorbid anxiety and epilepsy. Results: Anxiety symptoms may be relevant even if the criteria for a diagnosis of an anxiety disorder are not met. Associating specific seizure types or seizure localization with anxiety symptoms remains difficult; however, the amygdala is a brain region commonly associated with seizure foci and panic or fear sensations. The hypothalamic-pituitary-adrenal axis may also be relevant for anxiety symptoms, particularly for the selection of treatments. Nonpharmacological treatment is appropriate for anxiety comorbid with epilepsy, particularly because relaxation techniques may reduce hypersympathetic states, which improve symptoms. Medication options include antidepressants and anticonvulsants that may have efficacy for anxiety symptoms. Benzodiazepines are a good choice to address this comorbid condition, although side effects may limit utility. Conclusions: Ultimately, there are numerous treatment options, and although there is a limited evidence base, quality of life may be improved with appropriate treatment for individuals experiencing comorbid anxiety and epilepsy.
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Affiliation(s)
- Jay A Salpekar
- Johns Hopkins University School of Medicine, Baltimore (Salpekar); Department of Psychiatry, Brigham and Women's Hospital, Boston (Ma); Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison (Mietchen, Jones); Howard University College of Medicine, Washington, D.C. (Mani)
| | - Grace J Ma
- Johns Hopkins University School of Medicine, Baltimore (Salpekar); Department of Psychiatry, Brigham and Women's Hospital, Boston (Ma); Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison (Mietchen, Jones); Howard University College of Medicine, Washington, D.C. (Mani)
| | - Jonathan Mietchen
- Johns Hopkins University School of Medicine, Baltimore (Salpekar); Department of Psychiatry, Brigham and Women's Hospital, Boston (Ma); Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison (Mietchen, Jones); Howard University College of Medicine, Washington, D.C. (Mani)
| | - Jeremy Mani
- Johns Hopkins University School of Medicine, Baltimore (Salpekar); Department of Psychiatry, Brigham and Women's Hospital, Boston (Ma); Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison (Mietchen, Jones); Howard University College of Medicine, Washington, D.C. (Mani)
| | - Jana E Jones
- Johns Hopkins University School of Medicine, Baltimore (Salpekar); Department of Psychiatry, Brigham and Women's Hospital, Boston (Ma); Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison (Mietchen, Jones); Howard University College of Medicine, Washington, D.C. (Mani)
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Ibáñez A, García AM, Esteves S, Yoris A, Muñoz E, Reynaldo L, Pietto ML, Adolfi F, Manes F. Social neuroscience: undoing the schism between neurology and psychiatry. Soc Neurosci 2018; 13:1-39. [PMID: 27707008 PMCID: PMC11177280 DOI: 10.1080/17470919.2016.1245214] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multiple disorders once jointly conceived as "nervous diseases" became segregated by the distinct institutional traditions forged in neurology and psychiatry. As a result, each field specialized in the study and treatment of a subset of such conditions. Here we propose new avenues for interdisciplinary interaction through a triangulation of both fields with social neuroscience. To this end, we review evidence from five relevant domains (facial emotion recognition, empathy, theory of mind, moral cognition, and social context assessment), highlighting their common disturbances across neurological and psychiatric conditions and discussing their multiple pathophysiological mechanisms. Our proposal is anchored in multidimensional evidence, including behavioral, neurocognitive, and genetic findings. From a clinical perspective, this work paves the way for dimensional and transdiagnostic approaches, new pharmacological treatments, and educational innovations rooted in a combined neuropsychiatric training. Research-wise, it fosters new models of the social brain and a novel platform to explore the interplay of cognitive and social functions. Finally, we identify new challenges for this synergistic framework.
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Affiliation(s)
- Agustín Ibáñez
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
- b National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
- c Center for Social and Cognitive Neuroscience (CSCN), School of Psychology , Universidad Adolfo Ibáñez , Santiago de Chile , Chile
- d Universidad Autónoma del Caribe , Barranquilla , Colombia
- e Centre of Excellence in Cognition and its Disorders , Australian Research Council (ACR) , Sydney , Australia
| | - Adolfo M García
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
- b National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
- f Faculty of Elementary and Special Education (FEEyE) , National University of Cuyo (UNCuyo) , Mendoza , Argentina
| | - Sol Esteves
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
| | - Adrián Yoris
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
- b National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
| | - Edinson Muñoz
- g Departamento de Lingüística y Literatura, Facultad de Humanidades , Universidad de Santiago de Chile , Santiago , Chile
| | - Lucila Reynaldo
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
| | | | - Federico Adolfi
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
| | - Facundo Manes
- a Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation , Favaloro University , Buenos Aires , Argentina
- b National Scientific and Technical Research Council (CONICET) , Buenos Aires , Argentina
- e Centre of Excellence in Cognition and its Disorders , Australian Research Council (ACR) , Sydney , Australia
- i Department of Experimental Psychology , University of South Carolina , Columbia , SC , USA
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Chaudhary UJ, Duncan JS, Lemieux L. A dialogue with historical concepts of epilepsy from the Babylonians to Hughlings Jackson: persistent beliefs. Epilepsy Behav 2011; 21:109-14. [PMID: 21550316 DOI: 10.1016/j.yebeh.2011.03.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 03/21/2011] [Accepted: 03/22/2011] [Indexed: 10/18/2022]
Abstract
Epilepsy is one of the few neurological disorders to be recognized in Antiquity. The etiology of epilepsy has evolved from affliction of evil spirits and bad omens to an organic disease of the brain. Geographically separate cultures have recognized the diverse symptomatology of epilepsy from vigorous convulsions to spontaneous localized jerking since times immemorial. Similarly, the diagnostic procedures and treatment options have varied in different milieus. In this review we have followed the course of history chronologically from Babylonians to Hughlings Jackson, mapping the conceptual development of epilepsy and the origin of some of the positive and negative attitudes inherited into today's epileptology. Original writings, such as Hughlings Jackson's letters, and English translations of early Latin work, where available, were used as primary sources of information. Where primary sources were not accessible, we consulted research articles, books, and commentaries by eminent historians and epileptologists.
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Affiliation(s)
- Umair J Chaudhary
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK
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Abstract
Neurology, in the modern sense, did not exist in ancient Egypt, where medicine was a compound of natural, magical and religious elements, with different practitioners for each form of healing. Nevertheless, Egyptian doctors made careful observations of illness and injury, some of which involved the nervous system. Modern scholars have three sources of information about Egyptian medicine: papyri, inscriptions, and mummified remains. These tell us that the Egyptians had words for the skull, brain, vertebrae, spinal fluid and meninges, though they do not say if they assigned any function to them. They described unconsciousness, quadriparesis, hemiparesis and dementia. We can recognize neurological injuries, such as traumatic hemiparesis and cervical dislocation with paraplegia, in the well known Edwin Smith surgical papyrus. Similarly recognizable in the Ebers papyrus is a description of migraine. An inscription from the tomb of the vizier Weshptah, dated c. 2455 BCE, seems to describe stroke, and Herodotus describes epilepsy in Hellenistic Egypt. We have very little understanding of how Egyptian physicians organized these observations, but we may learn something of Egyptian culture by examining them. At the same time, modern physicians feel some connection to Egyptian physicians and can plausibly claim to be filling a similar societal role.
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Affiliation(s)
- George K York
- Department of Neurology, University of California at Davis, CA, USA.
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