Clinical Review

Partial seizures presenting as panic attacks

BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7267.1002 (Published 21 October 2000) Cite this as: BMJ 2000;321:1002
  1. Siân A Thompson, senior house officer (SianAT@aol.com),
  2. John S Duncan, professor,
  3. Shelagh J M Smith, consultant clinical neurophysiologist
  1. National Hospital for Neurology and Neurosurgery, London WC1N 3BG
  1. Correspondence to: S A Thompson, Medical Research Council Cognition and Brain Sciences Unit, Cambridge CB2 2EF
  • Accepted 21 January 2000

Partial seizures should be considered in the differential diagnosis of refractory or atypical panic attacks

The diagnosis of partial epileptic seizures is often challenging. The problem is considerable; the lifetime prevalence of epilepsy is 3-4%, and 60% of those affected have simple or complex partial seizures. 1 2 Panic disorder has a lifetime prevalence of about 1.5% and is characterised by discrete episodes of unexpected, sudden, overwhelming terror accompanied by a variety of physical, cognitive, and behavioural symptoms.3

Panic disorder and some partial seizures may have similar symptoms. Patients with epilepsy may have prodromal symptoms of tension, anxiety, and depression. Temporal lobe seizures commonly include affective symptoms, fear, and autonomic features, including changes in skin colour, blood pressure, and heart rate.4 In comparison, for panic attack to be diagnosed (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) patients must have at least four of 13 symptoms, including physical symptoms (palpitations, sweating, trembling, sensation of breathlessness, chest pain, feeling of choking, nausea, faintness, chills or flushes, and paraesthesiae) and affective symptoms, including fear of losing control, fear of dying, and derealisation or depersonalisation. 3 5 There is, therefore, considerable overlap of symptoms between the two disorders, and a definitive diagnosis may be difficult. We describe three patients with partial seizures that were suggestive of panic disorder.

Case reports

Case 1

A 68 year old man presented with a four year history of stereotyped attacks that occurred 10 to 14 times daily. These began with the sensation of pins and needles in his head, spreading to his torso and limbs. His breathing became rapid, and he …

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