Temporal lobe epilepsy and comorbid anxiety disorders

The incidence of anxiety disorders in patients with temporal lobe epilepsy (TLE) is higher than in the general population. Studies on anxiety disorders and their correction in patients with temporal lobe epilepsy are not so numerous, and their results are somewhat contradictory. A drug for the correction of anxiety disorders prescribed to patients with epilepsy should have a high efficiency, favourable tolerability profile and minimal side effects. Many studies have shown that gamma-aminobutyric acid (GABA) plays a key role in the regulation of neuronal excitability. Decreased inhibitory GABAergic transmission in the central nervous system is crucial for the development of anxiety. Enhancement of the inhibitory action of GABA leads to a decrease in neuronal hyperactivity, allowing the symptoms of anxiety to be reduced. Benzodiazepines are among the most effective drugs for the treatment of anxiety disorders. Enhancement of the inhibitory action of GABA leads to sedative, anxiolytic and myorelaxant effects. Long-term use of benzodiazepines may lead to tolerance requiring dose adjustment, increases the risk of potential dependence, marked sedation and cognitive impairment are observed. In this regard, it seems relevant to use drugs that target the GABA receptor, but with a smaller spectrum of undesirable effects. Etifoxin, a non-benzodiazepine drug of the benzoxazine family, has anxiolytic action due to a dual mechanism of action on GABA-receptors, so that GABA-ergic transmission is improved. Two clinical observations of mesial temporal sclerosis (hippocampal sclerosis) with the development of anxiety disorders are presented. In addition to antiepileptic therapy, the patients were prescribed etifoxine (Strezam) 50 mg 1 capsule 3 times a day. At the repeated examination after 21 days the general well-being of the patients improved, regression of emotional tension and anxiety disorders was noted. Given the high efficiency of etifoxin in the correction of anxiety disorders and its favorable tolerability profile, as well as additional effects such as anticonvulsant, neuroplastic, neurotrophic and neuroprotective effects, its use should be recommended in the complex treatment of patients with temporal lobe epilepsy.