Panic attacks in the differential diagnosis and treatment of resistant epilepsy

Abstract

The authors present four patients displaying panic disorder and a history of epileptic seizures to illustrate difficulties regarding differential diagnosis between epileptic seizures and panic attacks. The cases describe the aversive properties of epileptic seizures, the role of visual seizure-triggering stimuli as phobic cues, and the effectiveness and safety of clomipramine treatment of panic attacks as an adjunct to concurrent antiepileptic medication.

Seizures Initially Diagnosed as Panic Attacks: Case Series

“…Anxiety may occur as a pre-ictal psychological reaction to symptoms that alert the patient to seizure onset, as a feature of the post-ictal state or as a distinct interictal behaviour [20]. Patients with epilepsy have a higher incidence of comorbid non-seizure panic attacks or anxiety disorders than the general population [18, 21, 22], and these may be misdiagnosed as seizures [23]. Anxiety or panic may be a feature of PNES in patients with or without co-existent epilepsy, where the differential diagnosis may be particularly difficult [24].…”

Anxiety Disorders in Epilepsy

“…Postictal anxiety symptoms similar to those in panic attacks can be observed in temporal lobe epilepsy and less frequently in extratemporal lobe epilepsies (Beyenburg et al, 2005). The differential diagnosis of seizure-related events is sometimes problematic for the clinicians since such events may be misled by panic attacks that present like complex partial seizures (Bernik et al, 2002). Differentiating symptoms that are more suggestive of a seizure include motor automatisms, alterations in consciousness, the possible presence of an aura and postictal confusion (Vasquez & Devinsky 2003;Scicutella & Ettinger, 2002).…”

Evaluation of the quality of life of patients with epilepsy and patients with physchogenic non-epileptic seizures

“…Болесници у на-паду панике имају акутан страх да ће умрети или изгубити контролу, што је обично праћено израженим соматским, односно, вегетативним симптомима (лупање срца, знојење, отежано дисање и др.) (166).…”