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Research project

Epilepsy and anxiety: targeting a vicious cycle

How effective is eye movement desensitization and reprocessing therapy in targeting epilepsy-related anxiety?

Karin van der Hiele

Stichting Epilepsie Instellingen Nederland (SEIN)
University of Amsterdam, Academic Centre for Dentistry Amsterdam, Department of Social Dentistry and Behavioral Sciences

Anxiety disorders occur in about 14-25% of people with epilepsy and have an adverse impact on health-related quality life (Johnson, Jones, Seidenberg, & Hermann, 2004). You can imagine that the unpredictable and uncontrollable nature of epilepsy may result in anxiety, especially in relation to seizures.

Emotional states, such as stress, fear, anxiety and agitation are often mentioned as seizure triggers by people with epilepsy (Michaelis, Schonfeld, & Elsas, 2012). In addition, uncertainty about when the next seizure will occur may lead to heightened anxiety. This forms the basis of a vicious cycle in which seizures lead to heightened anxiety and vice versa. Psychological interventions may be beneficial to break this vicious cycle.

A recent review of 24 randomized controlled trials of psychological treatments in epilepsy, reported moderate-quality evidence that psychological and self-management interventions improve quality of life and emotional well-being and reduce fatigue in adults with epilepsy (Michaelis et al., 2017). Most of these treatments are focused on seizure reduction, whereas the mediating effects of anxiety and stress reduction are often not studied (Novakova, Harris, Ponnusamy, & Reuber, 2013). Furthermore, eye movement desensitization and reprocessing (EMDR) therapy has not yet been studied as a treatment for relieving anxiety in adults with epilepsy, but may be a very promising tool. In a case series study of seizure-related anxiety in five children with epilepsy, EMDR therapy appeared to be a potentially successful, quick and safe psychological treatment for relieving anxiety (Chen et al., 2014; Dautovic, de Roos, van Rood, Dommerholt, & Rodenburg, 2016).

The current study aims to examine the effectiveness of EMDR therapy in a case series study of 10 adult patients with anxiety related to their epilepsy. We expect that EMDR therapy will significantly reduce anxiety and that this will indirectly reduce the number of seizures and improve quality of life. The case series study is currently being performed at Stichting Epilepsie Instellingen Nederland (SEIN). Additional funding will be requested for a randomized controlled trial to further study the effectiveness and efficiency of EMDR therapy in relieving epilepsy-related anxiety. 

Literature references

Beyenburg, S., Mitchell, A.J., Schmidt, D., Elger, C.E., & Reuber, M. (2005). Anxiety in patients with epilepsy: systematic review and suggestions for clinical management. Epilepsy Behav, 7(2), 161-171. doi:10.1016/j.yebeh.2005.05.014

Chen, Y.R., Hung, K.W., Tsai, J.C., Chu, H., Chung, M.H., Chen, S.R., . . . Chou, K.R. (2014). Efficacy of eye-movement desensitization and reprocessing for patients with posttraumatic-stress disorder: a meta-analysis of randomized controlled trials. PLoS One, 9(8), e103676. doi:10.1371/journal.pone.0103676

Dautovic, E., De Roos, C., Van Rood, Y., Dommerholt, A., & Rodenburg, R. (2016). Pediatric seizure-related posttraumatic stress and anxiety symptoms treated with EMDR: a case series. Eur J Psychotraumatol, 7, 30123. doi:10.3402/ejpt.v7.30123

Johnson, E.K., Jones, J.E., Seidenberg, M., & Hermann, B.P. (2004). The relative impact of anxiety, depression, and clinical seizure features on health-related quality of life in epilepsy. Epilepsia, 45(5), 544-550. doi:10.1111/j.0013-9580.2004.47003.x

Michaelis, R., Schonfeld, W., & Elsas, S.M. (2012). Trigger self-control and seizure arrest in the Andrews/Reiter behavioral approach to epilepsy: a retrospective analysis of seizure frequency. Epilepsy Behav, 23(3), 266-271. doi:10.1016/j.yebeh.2011.11.023

Michaelis, R., Tang, V., Wagner, J.L., Modi, A.C., LaFrance, W.C., Jr., Goldstein, L.H., . . . Reuber, M. (2017). Psychological treatments for people with epilepsy. Cochrane Database Syst Rev, 10, CD012081. doi:10.1002/14651858.CD012081.pub2

Novakova, B., Harris, P.R., Ponnusamy, A., & Reuber, M. (2013). The role of stress as a trigger for epileptic seizures: A narrative review of evidence from human and animal studies. Epilepsia, 54(11), 1866-1876. doi:10.1111/epi.12377

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