Pharmacoresistant partial-onset epilepsy misdiagnosed as panic disorder: a case report

Area of Science:

• Neurology
• Epileptology
• Psychiatry

Background:

• Clinical differentiation between simple partial seizures and panic attacks is challenging due to overlapping symptomatology.
• Both conditions share common pathophysiological and anatomical substrates within the limbic system, particularly the amygdala.

Purpose of the Study:

• To present a case study illustrating the diagnostic challenges in distinguishing temporal lobe epilepsy from panic attacks.
• To emphasize the importance of considering epilepsy in atypical or treatment-resistant cases initially diagnosed as panic attacks.

Main Methods:

• Detailed patient history, including spousal input, and clinical evaluation.
• Long-term video-electroencephalography (EEG) monitoring to detect seizure activity.
• Magnetic Resonance Imaging (MRI) to identify structural brain abnormalities.
• Presurgical evaluation and subsequent surgical removal of the epileptic focus.

Main Results:

• The patient, initially diagnosed with panic attacks, was confirmed to have simple partial seizures with secondary generalization via video-EEG.
• An MRI revealed right-sided mesial temporal sclerosis, a sequela of childhood febrile seizures.
• Surgical resection of the right anterior temporal lobe focus resulted in complete seizure freedom and resolution of presumed panic attack symptoms.

Conclusions:

• This case underscores the diagnostic difficulty between simple partial seizures and psychiatric conditions like panic attacks.
• Physicians, particularly psychiatrists, must maintain vigilance for atypical presentations or treatment-resistant cases of panic attacks that may warrant further neurological investigation.
• Early and accurate diagnosis through comprehensive evaluation, including neurophysiological testing, is crucial for effective management of conditions mimicking psychiatric disorders.