Anxiety is a core emotion that many people experience at certain points in life. Anxiety can become a disorder, however, if it gets out of hand, causing a constant feeling of nervousness, distress, and unease for no apparent reason. How is anxiety related to epilepsy? Anxiety can be quite significant in the life of a person with epilepsy. In any medical illness, people may become anxious after the diagnosis of their condition. But anxiety is also related to epilepsy in more specific ways. 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. Anxiety as a reaction to the diagnosis of epilepsy People often develop anxiety after epilepsy is diagnosed, or after they experiencing a seizure for the first time. In fact, one common cause of anxiety in epilepsy is the fear of having a seizure. The knowledge that a seizure can occur at any time and place without very much warning is a major point of anxiety for many people. Some also become anxious about social rejection due to their condition, particularly during adolescence. Social support is therefore an important element in the life of a person with epilepsy. Anxiety as a symptom of epilepsy Anxiety is not a purely psychological or psychosocial phenomenon; it also can occur as a direct result of neurobiological factors like abnormal brain function and seizures. In fact, some factors that are responsible for seizures may also be responsible for anxiety, which can manifest itself in various ways in epilepsy. For instance, many people report feelings and symptoms of anxiety as part of their "aura," the distinctive sensation that some people with epilepsy experience just before having a seizure. Some components of anxiety, such as obsessiveness and agitation, may be seen in people with epilepsy-related psychosis. Similar anxiety can be seen in brain-damaged people. Therefore, although the exact relationship between brain abnormalities and anxiety is extremely complex and not very well understood, it is clear that there is a relationship. Both psychological and biological components of anxiety are particularly apparent in people with seizures. Can panic attacks and seizures be confused? 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. Treatment of anxiety in people with epilepsy The treatment of anxiety in a person with epilepsy should be based on a thorough investigation. Once a clear picture of the situation has emerged, possible treatments can be examined. Some people do well with counseling. Others need more structured psychotherapy to reduce their experiences of anxiety. Behavior therapy, a common form of treatment used for anxiety, is based on teaching patients specific methods and skills that they can use to reduce anxiety. Behavior therapy for anxiety is advantageous in that it equips the person with tools for self-reliance and self-control. In some cases, anti-anxiety medications are used. The danger is that the person may become dependent on the medication. This is more likely to happen to people with epilepsy than to others because some medications that are used to lessen anxiety also suppress seizures, and vice versa. Thus the person can become even more dependent on the medication and have considerable difficulty in discontinuing it. For people with both epilepsy and anxiety, the neurologist nevertheless may recommend seizure medicines that also have anti-anxiety effects. Panic disorder may coexist with epilepsy and be a significant source of distress or disability. An aura of anxiety or fearfulness (ictal fear) may be confused with panic attacks. Recent studies have reported evidence, demonstrated by positron emission tomography and magnetic resonance imaging, suggesting that the lesion in panic disorder may be in temporal lobes. The findings lend additional support to the idea that these illnesses may be related. 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.