Differentiating ictal panic with low-grade temporal lobe tumors from psychogenic panic attacks

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Indolent low-grade temporal lobe tumors can manifest as ictal panic, often misdiagnosed as psychogenic panic attacks.
• This diagnostic challenge can delay appropriate treatment for temporal lobe epilepsy.

Purpose of the Study:

• To differentiate ictal panic seizures originating from low-grade temporal lobe tumors from psychogenic panic attacks.
• To aid clinicians in developing a diagnostic paradigm for these conditions.

Main Methods:

• Retrospective review of 43 patients who underwent temporal lobectomy for low-grade neoplasms causing epilepsy.
• Detailed analysis of 10 patients with ictal panic misdiagnosed as psychogenic panic attacks.

Main Results:

• Tumor pathologies included pleomorphic xanthoastrocytoma, ganglioglioma, oligodendroglioma, and dysembryoplastic neuroepithelial tumors.
• Patients experienced prolonged symptoms (mean 9.8 years) with unprovoked ictal panic and occasional associated symptoms like nausea and déjà vu.
• Surgical resection of tumors led to seizure outcome improvement in all cases.

Conclusions:

• Ictal panic and psychogenic panic attacks are distinct clinical entities requiring different treatment approaches.
• A thorough patient history is key to distinguishing between these conditions.
• Neuroimaging is essential for identifying patients with tumor-related ictal panic.