Anxiety disorders constitute important, though for a long time, neglected comorbidities of epilepsy. They deserve attention, because they are frequent and negatively impact the quality of life of persons with epilepsy. This chapter covers aspects of the neurobiological and pathophysiological correlates of anxiety and anxiety disorders, classification and differential diagnosis of epilepsy-related anxiety, epidemiology, the relationship between anxiety and different forms of epilepsy, and the influence of epilepsy surgery on concomitant anxiety. The bidirectional relationship between epilepsy and anxiety deserves broad attention, as this extends to the different levels of this comorbidity from animal models (for instance, GAERS rats may show increased levels of anxiety when compared to healthy controls, already before the onset of epilepsy) to epidemiology (anxiety may be detected up to 3 years before epilepsy diagnosis). Treatment (drugs, psychotherapy, alternative treatments) is also covered. Selective serotonin-reuptake inhibitors and serotonin-noradrenalin reuptake inhibitors are established in the treatment of anxiety disorders. It would be of value in persons with epilepsy and a comorbid anxiety disorder to treat both conditions with a single drug, which leads to the issue of anxiolytic properties of antiepileptic drugs (AEDs). Strong evidence has been demonstrated for pregabalin in social phobia and generalized anxiety disorder, lamotrigine in posttraumatic stress disorder, and gabapentin in social anxiety. Anxiety may also be a side effect of AEDs. Case vignettes at the end of the chapter illustrate the issue.


Epilepsy Anxiety Epidemiology Prevalence Bidirectional Relationship Antiepileptic Drugs Pregabalin Animal Models Quality Of Life 



I would like to thank Michael Frauenheim, MD, and Kirsten Labudda, PhD, my co-heads at the ward for behavior medicine and psychotherapy in epileptology at Bethel Epilepsy Centre, for their valuable contributions to the pathophysiology part of the chapter and to the case reports.


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© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of General EpileptologyBethel Epilepsy CentreBielefeldGermany

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