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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by S.D. Guy on May 1, 2000, at 4:44:43
There seems to be nothing written about a biological connection between epilepsy and social phobia.
Have you heard of anything like this?There are journal articles that talk about socialization problems in people with epilepsy, but they all seem to think it's always psychological effects of the experience of living with epilepsy.
The best example may be this article from 1999 in the journal Seizure:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10486296&dopt=Abstract
I think this is a clue that is being overlooked. The first and more obvious clue for me was that benzodiazepine anticonvulsants (e.g. clonazepam) can treat social phobia.Clobazam is supposedly a similar benzo without as much cognitive side effects - ever take it for social anxiety?
Recently, non-benzo anticonvulsants with GABA-ergic effects, such as gabapentin, pregabalin and vigabatrin may have been suggested or used for social phobia.
I know these are used for bipolar disorder, but has anyone been prescribed any of these for social phobia?
My father began having what were probably Complex Partial Seizures when he was a little older than me. I just found out that my brother, who is 2 years oldr than me, had a grand mal seizure recently with no prior history. We are all 3 of us shy but in my case it is crippling full-on social phobia.
I'm not sure yet what to do with this information. I haven't had any seizures myself so I guess consulting a neurologist would be premature, but a neurologist might have more knowledge of all the anticonvulsant drugs. It's likely to be weeks before I can hear from my pdoc again. I just quit Paxil after it made me puke 2 nights in a row on an extra-low starting dose of 10mg. Normally I'd stick it out longer but I can't really handle alot of disruptive sideFX right now. Clonazepam was next on the list anyway and with this epilepsy connection dawning on me I feel it, or maybe some other GABA-affecting med, is the best hope.
peace and health
Posted by SLS on May 1, 2000, at 9:55:49
In reply to Social Phobia-Epilepsy Connection? (some rambling), posted by S.D. Guy on May 1, 2000, at 4:44:43
> There seems to be nothing written about a biological connection between epilepsy and social phobia.
> Have you heard of anything like this?
There seems to be a connection between temporal lobe epilepsy and psychiatric disturbances, particularly depression and anxiety. The left temporal lobe is thought to be most often responsible for these. Psychiatric disturbances often result from injury or lesions (tumors) to the left temporal lobe as well. Disturbances attributed to temporal lobe epilepsy/injury include:- depression
- anxiety disorders
- panic attacks
- agoraphobia
- decreased socialization
- derealizationThere is often great difficulty in differentiating between various anxiety disorders and the anxiety syndromes associated with temporal lobe epilepsy. There need not be any convulsions. Paroxysmal anxiety and panic attacks occur as episodes representing an ictal event. Chronic states of depression or anxiety occur interictally.
Do you experience brief intense episodes or are your anxiety/phobic states more chronic?
Anyway, you can start digging around for more information by using "temporal lobe" as a search keyword. Please post if you find anything interesting, especially if it is consistent with your suspicions.
Thanks.
* From your citation:"The patients with epilepsy showed significantly higher scores on the basic coping styles MBHI Inhibition style and MBHI Sensitivity style, and lower scores on the MBHI Sociability and the MBHI Confidence"
Q: What does a higher score versus a lower score indicate?
I included some abstracts below. One of them also addresses complex partial epilepsy.
- Scott
-----------------------------------------------------: J Neurol Neurosurg Psychiatry 1996 Dec;61(6):601-5 Related Articles, Books, LinkOut
Interictal mood and personality disorders in temporal lobe epilepsy and juvenile myoclonic epilepsy.Perini GI, Tosin C, Carraro C, Bernasconi G, Canevini MP, Canger R, Pellegrini A, Testa G
Department of Neurological and Psychiatric Sciences, University of Padova, Italy.
BACKGROUND: Mood disorders have been described as the commonest psychiatric disorders in patients with temporal lobe epilepsy. Secondary depression in temporal lobe epilepsy could be interpreted either as an adjustment reaction to a chronic disease or as a limbic dysfunction. To clarify this issue, a controlled study of psychiatric disorders was conducted in different forms of epileptic and non-epileptic chronic conditions. METHODS: Twenty outpatients with temporal lobe epilepsy, 18 outpatients with juvenile myoclonic epilepsy--a primary generalised seizure disorder--20 matched type I diabetic patients, and 20 matched normal controls were assessed by a structured interview (SADS) and by self rating scales (Beck depression inventory (BDI) and the state and trait anxiety scales STAIX1 and STAIX2). RESULTS: Sixteen (80%) patients with temporal lobe epilepsy fulfilled the criteria for a psychiatric diagnosis at the SADS interview with a significantly higher frequency than patients with juvenile myoclonic epilepsy (22%) and diabetic patients (10%) (P < 0.0001). The most frequent disorder in temporal lobe epilepsy was a mood disorder: 11 (55%) patients with temporal lobe epilepsy had depression compared with three patients with juvenile myoclonic epilepsy and two diabetic patients (P < 0.001). Eight patients with temporal lobe epilepsy with an affective disorder also had a comorbid personality or anxiety disorder. Patients with temporal lobe epilepsy scored significantly higher on BDI, STAIX1, and STAIX2 than the three control groups (P < 0.001, P < 0.01, P < 0.001). CONCLUSIONS: Patients with temporal lobe epilepsy have a higher incidence of affective and personality disorders, often in comorbidity, than patients with juvenile myoclonic epilepsy and diabetic patients suggesting that these psychiatric disorders are not an adjustment reaction to a chronic disease but rather reflect a limbic dysfunction.
PMID: 8971108, UI: 97126184
-----------------------------------------------------
Psychosensorial and related phenomena in panic disorder and in temporal lobe epilepsy.Toni C, Cassano GB, Perugi G, Murri L, Mancino M, Petracca A, Akiskal H, Roth SM
Institute of Psychiatry, University of Pisa, Italy.
Since Cullen coined the term "neurosis" in the 18th century, medical investigators have searched the neural substrates of conditions we now classify as anxiety disorders. Harper and Roth in 1962 hypothesized that the temporal lobes might represent one such substrate for phobic-anxious patients with depersonalization-derealization (DD); the association between the presumed temporal lobe feature and phobic anxiety was so compelling that Roth (in 1959) described the condition as "phobic-anxiety-depersonalization" syndrome. Introduced into our current nosology as panic disorder-agoraphobia (PDA), this seemingly neuropsychiatric condition is nonetheless distinct from complex partial epilepsy (CPE), from which it is conventionally differentiated through clinical and anamnestic evaluation. Yet increasingly there are clinical-and laboratory-hints of certain overlap between manifestations of the two disorders, hitherto based largely on evaluation of psychosensorial phenomena in PDA or affective phenomena in CPE. We located only one systematic study that monitored 24-hour electroencephalogram (EEG) abnormalities in PDA. Finally, recent epidemiologic data suggest a significantly greater than chance association between PDA and a history of seizures. To further explore these intriguing links, the present study directly compared a group of 91 PDA outpatients with a group of 41 CPE outpatients with respect to DD and other psychosensorial symptoms. The broad similarities discovered between psychosensorial and related phenomena provide further support for the hypothesis that there may be a common neurophysiological substrate linking CPE phenomena with PDA.
-----------------------------------------------------
: Seizure 1999 Apr;8(2):116-9 Related Articles, Books
Emotional status after right vs. left temporal lobectomy.Burton LA, Labar D
Fordham University Psychology Department, Cornell University Medical College, Cornell, USA.
Nineteen temporal lobectomy patients with epilepsy were evaluated (11 right and 8 left) with a brief questionnaire that addressed: (1) General Happiness; (2) Depression; (3) Anxiety; (4) Impulse Control; and (5) Socialization. The patients with left temporal lobectomy reported increases in depression and decreases in socialization compared with the right temporal lobectomy patients after surgery. Furthermore although the right temporal lobectomy patients reported increases in general happiness, no changes in general happiness were reported by the left temporal lobectomy patients. The present study supported the idea that an increased negative affect is associated with left rather than right temporal lobectomy. This is consistent with a model of negative emotional valence when the right hemisphere dominates awareness. Copyright 1999 British Epilepsy Association.
Posted by Kim on May 1, 2000, at 16:14:34
In reply to Re: Social Phobia-Epilepsy Connection?, posted by SLS on May 1, 2000, at 9:55:49
S.D.,
An EEG can show if you have a lowered seizure threshold even if you haven't had any seizures. A lowered threshold means you have a greater-than-average possibility of a seizure. The EEG can't predict if you will actually have a seizure or how severe it will be if you do have one. The EEG can also identify some possible triggers for seizures, such as a photic (flashing lights) response.
Kim
Posted by JohnB on May 3, 2000, at 4:25:30
In reply to Social Phobia-Epilepsy Connection? (some rambling), posted by S.D. Guy on May 1, 2000, at 4:44:43
gabapentin (Neurontin) is has been used a lot recently for social phobia.
Posted by DC on May 4, 2000, at 0:47:23
In reply to Re: Social Phobia-Epilepsy Connection? (some rambl, posted by JohnB on May 3, 2000, at 4:25:30
> gabapentin (Neurontin) is has been used a lot recently for social phobia.
S.D. Guy, I currently take neurontin and have found it quite helpful for social anxiety. I think your suspicions regarding epilepsy and social phobia are correct. Pregabablin is the next drug. Nardil works, of course, but with a lot of side effects.
Posted by Rick on May 4, 2000, at 14:33:49
In reply to Social Phobia-Epilepsy Connection? (some rambling), posted by S.D. Guy on May 1, 2000, at 4:44:43
There is an interesting discussion I ran across in which Social Phobia experts theorize on possible links between Social Phobia and Parkinsonism...not just that the two disorders might share a dopiminergic genesis, but that Social Phobia might actually be an early reflection of Parkinsonism. It's at:
http://www.psychiatrist.com/supplenet/59s17/59s17n1d.htm
NOTE: If an i.d. and password are requested, you should go to the homepage and register first. It's free. Just click on the link at the top of the homepage and fill out the brief form. The homepage address is:
http://www.psychiatrist.com
Posted by SD on May 8, 2000, at 16:20:14
In reply to Re: Social Phobia-Epilepsy Connection?, posted by SLS on May 1, 2000, at 9:55:49
... Paroxysmal anxiety and panic attacks occur as episodes representing an ictal event. Chronic states of depression or anxiety occur interictally.
>
> Do you experience brief intense episodes or are your anxiety/phobic states more chronic?Chronic. (Since pretty much forever.) Your classic generalized social phobia (social anxiety disorder).
BTW what do ictal and interictal mean?
> * From your citation:
>
> "The patients with epilepsy showed significantly higher scores on the basic coping styles MBHI Inhibition style and MBHI Sensitivity style, and lower scores on the MBHI Sociability and the MBHI Confidence"
>
> Q: What does a higher score versus a lower score indicate?
>The names of the 'coping styles' are pretty much self-descriptive and I guess could be called 'personality traits' or whatever. Higher score --> more of a fit with that 'style'. So the results reported would be what you'd expect from people with generalized social phobia or chronic severe shyness.
Peace and health,
SD
Posted by Noa on May 8, 2000, at 17:05:26
In reply to thankyouthankyouthankyou (Re: S.P.-Epilepsy conn.), posted by SD on May 8, 2000, at 16:20:14
What do you all make of this?
One of my nephews, 22 y.o., has had epilepsy since around age 10 or 11. First symptoms were absence seizures, followed later by grand-mal, or full tonic-clonic seizures. He also reported other types of seizures in which he did not lose consciousness or have clonic spasms. He has always been quite shy and somewhat anxious. About a month ago, he emailed me to ask if I could help him figure out what was going on with him now. BTW, his seizure activity has become less frequent in the past 2 years or so, and he does not currently take anticonvulsants. Anyway, he now reports that when he is engaged in any lengthy conversations, after a while, he experiences a tremor in his voice and in his legs. He says he doesn't feel anxious about the situation, and it appears to be unrelated to the age or gender of the person with whom he is speaking. My advice to him was first to run it by his neurologist. I also told him that he might benefit from biofeedback training. But it isn't clear to me what is going on.
Another BTW is that my grandmother, his great-grandmother, suffered from Parkinsons and died at a relatively young age because of it. Her sister, my great-aunt, had a life-long seizure disorder of unknown origin (btw, she also had some mental impairment, perhaps mild retardation or severe learning disabilities, and at least in later life had psychiatric problems, such as paranoia--she had to keep moving because there were always people inside the walls, etc.-- and apparently had a lifelong imaginary friend).
Anyway, here is a case of a young man with epilepsy and chronic shyness who complains of tremors when in social situations, and has a positive family history of parkinsons and epilepsy. Any ideas?
Posted by Liz on May 9, 2000, at 13:09:32
In reply to Re: Epilepsy-Social Phobia-Parkinsons , posted by Noa on May 8, 2000, at 17:05:26
> Anyway, here is a case of a young man with epilepsy and chronic shyness who complains of tremors when in social situations, and has a positive family history of parkinsons and epilepsy. Any ideas?It sounds more like Essential tremor or possibly dystonia although you don't mention whether his tremor is resting (hands in lap) or when hands are outstretched (postural tremor) or holding objects like a glass of water (action tremor). Parkinson's is generally a resting tremor which improves when holding objects. Essential tremor is the most common movement disorder and is increased by anxiety.
You're right, he needs to ask his neuro.
Posted by SLS on May 11, 2000, at 16:53:55
In reply to thankyouthankyouthankyou (Re: S.P.-Epilepsy conn.), posted by SD on May 8, 2000, at 16:20:14
> ... Paroxysmal anxiety and panic attacks occur as episodes representing an ictal event. Chronic states of depression or anxiety occur interictally.
>
> BTW what do ictal and interictal mean?
The word "ictal" refers to the seizure event. "Interictal" refers to the period between ictal events.So, what have you come up with?
Your thoughts as to whether the efficacy of Neurontin in the treatment of social anxiety disorders indicates that there may be some overlap with the epilepsy-induced anxiety are very interesting. I think they deserve a good look at. I don't doubt that the temporal lobe(s) are involved in both scenarios.
- Scott
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