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Panic attacks, spike-wave activity, and limbic dysfunction. A case report.

J Gallinat, G Stotz-Ingenlath, U E Lang

    Pharmacopsychiatry
    |June 14, 2003
    PubMed
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    Atypical panic attacks in a patient with depression were linked to temporal sharp-wave activity and left temporal hypoperfusion. Valproic acid, an anti-epileptic, effectively reduced panic attacks and EEG abnormalities.

    Area of Science:

    • Neuroscience
    • Neurology
    • Psychiatry

    Background:

    • Increased neuronal excitability in the amygdala and hippocampus is implicated in panic attacks.
    • Atypical panic attacks can present with complex perceptual disturbances and without clear epileptic symptoms.

    Observation:

    • A 54-year-old female with depression experienced atypical panic attacks with dizziness and distorted visual perception.
    • Electroencephalogram (EEG) revealed temporal sharp-wave and spike-wave patterns.
    • Magnetic resonance imaging (MRI) showed a hypodense area near left mesial temporal structures, and SPECT imaging indicated left basal temporal hypoperfusion.

    Findings:

    • Standard antidepressant treatment was ineffective.
    • The addition of valproic acid, an anti-epileptic drug, led to a reduction in panic attack frequency and severity.

    Related Experiment Videos

  • Valproic acid also decreased the epileptiform potentials observed on EEG.

    • Implications:

    • Anti-epileptic treatment may be beneficial for patients with panic disorder who do not respond to antidepressants, especially if epileptiform EEG activity is present.
    • This case highlights the complex relationship between limbic ictal activity and panic attacks, underscoring diagnostic challenges in atypical presentations.
    • Further clinical trials exploring anti-epileptics for refractory panic disorder are warranted.