Anxiety and Panic Symptoms in Cerebral Palsy Patients

Consult a physician?

Hello Dr.
Hsiao, I would like to ask for your advice.
I am a patient with cerebral palsy who has developed epilepsy, and I have a tendency to be easily startled.
I can be focused on something, and if there is a sudden noise nearby, I get startled.
This has been happening for about six months now, and I have been experiencing symptoms such as palpitations, anxiety, and chest tightness, feeling like I can't breathe.
Recently, I have noticed two symptoms that I am unsure if they indicate autonomic nervous system dysregulation:
1.
Whenever I get startled, I easily experience a sudden increase in heart rate and chest tightness, which has made me reluctant to go out.
The chest tightness can sometimes last for a while or even all day, and sometimes it can trigger an epileptic seizure.
I have undergone multiple ECGs, all of which have come back normal.
2.
If I fall or get startled suddenly, I can experience a blank mind for several seconds to minutes, sometimes even longer.
During these episodes, I forget what I was doing (for example, while chatting with a friend, I might suddenly not remember what I was supposed to reply) or I am unable to respond and can't process my thoughts.
I have discussed this with a neurologist and have undergone MRI scans, which showed only the congenital brain developmental defects causing the epileptic focus, and my EEG results have all been normal.
However, I frequently experience these situations, and I am unsure of the cause.
3.
Lastly, I would like to ask you, if I suddenly experience symptoms like chest tightness, how can I alleviate them? (Assuming that heart-related issues have been ruled out.) I am currently on a regular regimen of medication for epilepsy and anxiety, but I still feel uncomfortable at times.
Thank you for your assistance, Dr.
Hsiao.

ting, 20~29 year old female. Ask Date: 2018/12/31

Dr. Xiao Minghong reply Psychiatry

Dear Ms.
Ting,
Due to your unique constitution, some symptoms may require interdisciplinary evaluation.
Based on the information you provided, here are my responses:
1.
It is a normal physiological response for the heart rate to suddenly increase when startled.
However, some individuals who are more sensitive may overreact to bodily discomfort signals, sometimes feeling as if they are losing control, as if something frightening or dangerous is about to happen.
This can lead to anxiety or panic, making them afraid to go out.
I recommend that you visit a psychosomatic medicine clinic for further evaluation.
2.
Experiencing a sudden blank mind after an unexpected event can occur, although it is a rare symptom associated with certain psychiatric disorders.
It is essential to consider whether it could be related to epilepsy, such as an absence seizure.
I suggest discussing this symptom with your neurologist or undergoing further examinations.
3.
If your heart, lungs, and other physical examinations are normal, the cause may be psychological or psychiatric.
I recommend, as in point 1, that you visit a psychosomatic medicine clinic for further evaluation and discussion of a treatment plan.
I hope the above responses are helpful to you.
Wishing you all the best!
Sincerely,
Dr.
Hsiang Ming-Hong

Reply Date: 2018/12/31

More Info

Understanding anxiety and panic symptoms in patients with cerebral palsy, particularly those who also experience seizures, is a complex issue that requires a multifaceted approach. Your symptoms, including increased heart rate, chest tightness, and feelings of breathlessness, are common manifestations of anxiety, especially in individuals with a heightened sensitivity to stressors.
Cerebral palsy (CP) is a neurological condition that affects movement and muscle coordination, and it can also be associated with various comorbidities, including anxiety disorders. The interplay between CP and anxiety can exacerbate symptoms, leading to a cycle of fear and physical responses that may seem overwhelming.
1. Understanding Your Symptoms: The symptoms you describe, such as heart palpitations and chest tightness when startled, can be attributed to the body's fight-or-flight response, which is often heightened in individuals with anxiety. This response is mediated by the autonomic nervous system, which regulates involuntary bodily functions. When you experience a sudden scare or stressor, your body may react as if it is in danger, leading to an increase in heart rate and feelings of tightness in the chest. This reaction can be particularly pronounced in individuals with a history of seizures, as the brain's wiring may be more sensitive to stress.

2. Cognitive Effects: The episodes of feeling "blank" or unable to respond after a scare could be linked to a combination of anxiety and the neurological effects of cerebral palsy. Anxiety can impair cognitive function, making it difficult to concentrate or respond to stimuli. This can be exacerbated by the neurological challenges posed by CP, leading to moments of confusion or disorientation.

3. Managing Anxiety Symptoms: To alleviate the symptoms of anxiety, especially when they manifest as chest tightness or palpitations, consider the following strategies:
- Breathing Exercises: Practicing deep breathing techniques can help calm the nervous system. Inhale deeply through your nose, hold for a few seconds, and exhale slowly through your mouth. This can help reduce the immediate physical symptoms of anxiety.

- Mindfulness and Relaxation Techniques: Engaging in mindfulness meditation or progressive muscle relaxation can help you manage anxiety over time. These techniques encourage you to focus on the present moment and reduce the physiological symptoms of anxiety.

- Gradual Exposure: If certain situations trigger your anxiety, consider gradually exposing yourself to these situations in a controlled manner. This can help desensitize your response over time.

- Medication Management: Since you are already on medication for epilepsy and anxiety, it’s essential to maintain open communication with your healthcare provider. If you find that your current medication regimen is not adequately managing your symptoms, discuss potential adjustments or alternative treatments with your doctor.

4. Professional Support: Given the complexity of your condition, working with a mental health professional who understands both anxiety disorders and the implications of cerebral palsy can be beneficial. Cognitive-behavioral therapy (CBT) is particularly effective for anxiety and can help you develop coping strategies tailored to your unique situation.

5. Physical Health Monitoring: Since you have undergone multiple tests to rule out cardiac issues, it’s crucial to continue monitoring your physical health. Regular check-ups with your healthcare provider can help ensure that any new symptoms are addressed promptly.

In conclusion, your experiences are valid and reflect a common struggle among individuals with cerebral palsy who also deal with anxiety. By employing coping strategies, seeking professional support, and maintaining open communication with your healthcare providers, you can work towards managing your symptoms more effectively. Remember, you are not alone in this journey, and there are resources available to help you navigate these challenges.

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