SHM Converge Scientific Abstract ePoster Gallery-When Anxiety Is Epileptic: Temporal Lobe Seizures Imitating Panic Disorder

Pdf Summary

This case describes a 34-year-old man with asthma, depression, and anxiety who initially presented after a motor vehicle accident preceded by anxiety and loss of awareness. He had no clear traumatic injuries, normal labs, and sinus bradycardia on ECG. He was discharged with concern for panic attack versus syncope, and his antidepressant was changed from fluoxetine to bupropion.<br /><br />Four days later, he was found minimally responsive at home. Again, routine evaluation was unrevealing: CBC, BMP, thyroid studies, magnesium, MRI brain, echocardiogram, and a short EEG were all normal. He reported symptoms he believed were panic attacks, including déjà vu, chest tightness, diaphoresis, palpitations, and nausea.<br /><br />A continuous EEG later revealed electroclinical seizures arising from the right temporal lobe. He was treated with levetiracetam, after which the episodes stopped. Bupropion was discontinued because it can lower seizure threshold.<br /><br />The article emphasizes that temporal lobe epilepsy can mimic panic disorder because seizures from this region may produce fear, anxiety, derealization, autonomic symptoms, and even altered awareness. While panic attacks commonly involve chest tightness, palpitations, nausea, and sweating, loss of consciousness or altered mental status is less typical and should prompt further workup.<br /><br />The key conclusion is that new, atypical, or severe “panic attacks,” especially those involving altered consciousness, should raise suspicion for focal seizures. Epilepsy and anxiety disorders can coexist, so both diagnoses may need to be considered rather than assuming symptoms are purely psychiatric.

Asset Subtitle

Kayleigh K. Butler

Meta Tag

Author List Alexis R. Cole, Anna Kolchinski, Kayleigh K. Butler

Category Clinical Vignettes

Concept Temporal Lobe Epilepsy

Concept Panic Disorder

Concept Panic Attack

Concept Focal Seizure

Concept Electroencephalography

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Kayleigh K. Butler

Track Adult

Keywords

temporal lobe epilepsy

panic attacks

focal seizures

altered awareness

anxiety disorder

electroclinical seizures

right temporal lobe

bupropion

levetiracetam

syncope

Temporal Lobe Epilepsy

Panic Disorder

Panic Attack

Focal Seizure

Electroencephalography