Ictal Fear or Panic Attack, This Is the Question-A Video-EEG Study
Francesco Castellana1,2, Grazia D'Onofrio3, Filomena Ciccone3
1Neurology Unit, Epilepsy Center, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy.
Focal epilepsy can mimic panic disorder (PD), leading to misdiagnosis. Advanced diagnostics like long-term video-EEG monitoring are crucial for accurate diagnosis and timely treatment of epilepsy presenting as psychiatric symptoms.
Area of Science:
- Neurology
- Psychiatry
- Epileptology
Background:
- Panic disorder (PD) and focal epilepsy share overlapping symptoms, complicating diagnosis.
- Misdiagnosis of epilepsy as PD can delay appropriate treatment and impact patient outcomes.
Observation:
- A 25-year-old female was misdiagnosed with PD for 15 years.
- Her symptoms of sudden fear, palpitations, and nausea were unresponsive to anti-anxiety medications.
Findings:
- Comprehensive evaluations, including long-term video-EEG monitoring (LTVEM), identified focal epilepsy.
- Episodic paroxysmal activity in the right temporal/zygomatic regions correlated with a right amygdala dysplastic lesion.
Implications:
- Highlights the importance of considering focal epilepsy in PD differential diagnosis, especially for treatment-refractory cases.
- Emphasizes the need for multidisciplinary approaches and advanced tools like LTVEM for accurate diagnosis of paroxysmal psychiatric symptoms.
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