Assessment of Anxiety in Patients With Epilepsy: A Literature Review

Rauh, Raphael Benjamin; Schulze‐Bonhage, Andreas; Metternich, Birgitta

doi:10.3389/fneur.2022.836321

Cited by 17 publications

(9 citation statements)

References 52 publications

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“…S2A), which is consistent with other epileptic zebrafish models (25). Approximately 20% of individuals with epilepsy suffer from anxiety (26, 27), thus we tested the “wall-hugging” thigmotaxis behavior of our zebrafish mutants, a validated measure of anxiety in animals and humans (28–30). We exposed the 5 dpf larvae to 6 minutes of light and 4 minutes of darkness, and measured the distance they travelled and time they spent close to the wall, i.e ., in the outer well zone (Fig.…”

Section: Resultsmentioning

confidence: 99%

Epileptic phenotypes inslc13a5loss-of-function zebrafish are rescued by blocking NMDA receptor signaling

Dogra,

Phan,

Gavrilovici

et al. 2024

Preprint

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SLC13A5 encodes a citrate transporter highly expressed in the brain important for regulating intra- and extracellular citrate levels. Mutations in this gene cause a rare infantile epilepsy characterized by lifelong seizures, developmental delays, behavioral deficits, poor motor progression, and language impairments. SLC13A5 individuals respond poorly to treatment options; yet drug discovery programs are limited due to a paucity of animal models that phenocopy human symptoms. Here, we used CRISPR/Cas9 to create loss-of-function mutations in slc13a5a and slc13a5b, the zebrafish paralogs to human SLC13A5. slc13a5 mutant larvae showed cognitive dysfunction and sleep disturbances, consistent with SLC13A5 individuals. These mutants also exhibited fewer neurons and a concomitant increase in apoptosis across the optic tectum, a region important for sensory processing. slc13a5 mutants displayed hallmark features of epilepsy, including an imbalance in glutamatergic and GABAergic excitatory-inhibitory gene expression, disrupted neurometabolism, and neuronal hyperexcitation as measured in vivo by extracellular field recordings and live calcium imaging. Mechanistically, we tested the involvement of NMDA signaling in slc13a5 mutant epilepsy-like phenotypes. Slc13a5 protein co-localizes with excitatory NMDA receptors in wild-type zebrafish and blocking NMDA receptors in slc13a5 mutant larvae rescued bioenergetics, hyperexcitable calcium events, and behavioral defects. These data provide empirical evidence in support of the hypothesis that excess extracellular citrate over-chelates the ions needed to regulate NMDA receptor function, leading to sustained channel opening and an exaggerated excitatory response that manifests as seizures. These data show the utility of slc13a5 mutant zebrafish for studying SLC13A5 epilepsy and open new avenues for drug discovery.

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Section: Resultsmentioning

confidence: 99%

Epileptic phenotypes inslc13a5loss-of-function zebrafish are rescued by blocking NMDA receptor signaling

Dogra,

Phan,

Gavrilovici

et al. 2024

Preprint

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“…Epilepsy is associated with excess mortality due to Sudden Unexpected Death in Epilepsy (SUDEP) [25]. What is reported much less is the subjectively experienced fear of death around seizures [26], which is rarely routinely screened for in clinical practice [27]. Almost all people in our sample reported intense fear and anxiety before, during, or after the seizures.…”

Section: Resultsmentioning

confidence: 99%

Seizures as a Struggle between Life and Death: An Existential Approach to the Psychosocial Impact of Seizures in Candidates for Epilepsy Surgery

et al. 2023

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Introduction: Mental health comorbidities such as depression and anxiety are common in epilepsy, especially among people with pharmacoresistant epilepsy who are candidates for epilepsy surgery. The Psychology Task Force of the International League Against Epilepsy advised that psychological interventions should be integrated into comprehensive epilepsy care. Methods: To better understand the psychological impact of epilepsy and epileptic seizures in epilepsy surgery candidates, we analysed interviews with this subgroup of patients using Karl Jaspers’ concept of limit situations, which are characterised by a confrontation with the limits and challenges of life. These are especially chance, randomness, and unpredictability, death and finitude of life, struggle and self-assertion, guilt, failure, and falling short of one’s aspirations. Results: In 43 interviews conducted with 15 people with drug-resistant epilepsy who were candidates for epilepsy surgery, we found that these themes are recurrent and have a large psychosocial impact, which can result in depression and anxiety. For some people, epileptic seizures appear to meet the criteria for traumatic events. Conclusion: Understanding epilepsy and seizures as existential challenges complements the neurobiological explanations for psychological comorbidities and can help tailor psychological interventions to the specific needs of people with epilepsy, especially those who are candidates for surgical treatment.

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“…Research estimates that anxiety disorders are more than twice as likely in patients with epilepsy compared to the general population, and paresthesia is reported in up to 72% of epilepsy cases ( 26 ). Due to the similar features and high comorbidity, panic is one of the most prevalent condition that requires differentiation from seizure disorders ( 271 , 272 ). However, there is research that attempts to delineate the two disorders.…”

Section: Paresthesiamentioning

confidence: 99%

Biobehavioral approach to distinguishing panic symptoms from medical illness

Tunnell,

Corner,

Roque

et al. 2024

Front. Psychiatry

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Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.

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Assessment of Anxiety in Patients With Epilepsy: A Literature Review

Cited by 17 publications

References 52 publications

Epileptic phenotypes inslc13a5loss-of-function zebrafish are rescued by blocking NMDA receptor signaling

Epileptic phenotypes inslc13a5loss-of-function zebrafish are rescued by blocking NMDA receptor signaling

Seizures as a Struggle between Life and Death: An Existential Approach to the Psychosocial Impact of Seizures in Candidates for Epilepsy Surgery

Biobehavioral approach to distinguishing panic symptoms from medical illness

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