Left parieto-occipital lesion with epilepsy mimicking panic disorder

Occipital Lobe Epilepsy With Ictal Fear: Evidence From a Stereo-Electroencephalography (sEEG) Case

Ictal fear—a relatively rare phenomenon—is a semiological characteristic of epilepsy. Most patients with epilepsy with ictal fear have an epileptic zone in the mesial temporal lobe, which is the classical brain area involved in emotion processing. Herein, we report a case of epilepsy with ictal fear as the first manifestation in a 10-year-old boy. All noninvasive evaluation including scalp video electroencephalography (EEG), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET-CT) suggested a possible lesion in the left posterior brain region. Stereo-electroencephalography (sEEG) results showed high frequency direct current shift in the left occipital lobe 1 s before the fear manifestation which preceded in 12 s the discharge in the amygdala. This case highlights the epileptic network hypothesis which suggested occipital cortex may play an important role in the early emotional network independently of amygdala activation.

Occipital lobe epilepsy with fear as leading ictal symptom

Ictal fear is a semiological feature which is commonly associated with mesial temporal lobe epilepsy. Here, we describe fear as a leading symptom in cryptogenic occipital lobe epilepsy. In a patient with negative MRI findings, intracranial EEG recordings documented a strict correlation between habitual ictal anxiety attacks and both spontaneous and stimulation-induced epileptic activity in a right occipital epileptogenic area with subsequent spreading to the symptomatogenic zone in the amygdala. Circumscribed occipital topectomy led to seizure freedom. Episodes of non-epileptic fear ceased shortly afterwards. This report provides insight into pathways of propagation of epileptic activity, illustrates different etiologies of pathologic fear and underlines the importance of ictal EEG recordings.