Panic versus epilepsy: a challenging differential diagnosis

The differential diagnosis of panic attacks (PAs) from temporal lobe epilepsy is important and challenging. Despite advances in understanding the neural basis of psychiatric disorders, current practice strongly emphasizes dichotomous thinking of either "functional" PAs of psychiatric etiology or a seizure disorder. We present a case with PA features strongly suggestive of a seizure disorder. An extensive workup failed to resolve the dichotomy between functional and neurological. The possibility is raised that there may be degrees of abnormal hyperexcitability, leading to the emergence of symptoms, but not enough to generate large potentials that can be detected at the scalp.