Sudden arousals from slow wave sleep and panic disorder: successful treatment with anticonvulsants--a case report

We report on a patient who suffered from treatment-resistant sudden arousals from sleep for 30 years and eventually developed daytime panic attacks. Polysomnography recorded three sudden arousals from sleep stage 4, with intense anxiety that was not associated with confusion or dream recall. While resting wakeful electroencephalogram (EEG) was normal, sleep-deprived EEG revealed increased left temporal theta activity and brain magnetic resonance imaging showed left hemispheric atrophy. Complete remission of symptoms could be obtained only with a combination therapy of carbamazepine and clonazepam. Relations between atypical sleep disorders, panic disorder and ictal brain activity are discussed. We conclude that in patients with atypical sleep and anxiety disorders anticonvulsants could be a successful treatment approach.