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Castellana F, D’Onofrio G, Ciccone F, Di Claudio MT, Pugliatti M, Popolizio T, d’Orsi G. Ictal Fear or Panic Attack, This Is the Question-A Video-EEG Study. Brain Sci 2024; 14:594. [PMID: 38928594 PMCID: PMC11201740 DOI: 10.3390/brainsci14060594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Panic disorder (PD) and focal epilepsy, in particular, temporal lobe epilepsy, often present diagnostic challenges due to overlapping clinical manifestations. This article describes the case of a 25-year-old female, misdiagnosed with PD for 15 years, whose recurring episodes of sudden fear, palpitations, and nausea were later identified as manifestations of focal epilepsy. Initially unresponsive to conventional anti-anxiety medications, the patient's correct diagnosis was only established through comprehensive electro-clinical, neuropsychological, and neuroimaging evaluations during her admission to our research hospital. Long-term video-EEG monitoring (LTVEM) played a pivotal role in identifying the epileptic nature of her episodes, which were characterized by paroxysmal activity in the right temporal and zygomatic regions, consistent with the location of a dysplastic lesion in the right amygdala, as revealed by high-resolution magnetic resonance imaging. These findings underline the importance of considering focal epilepsy in the differential diagnosis of PD, especially in cases refractory to standard psychiatric treatments. The misdiagnosis of epilepsy as PD can lead to significant delays in appropriate treatment, potentially exacerbating the patient's condition and affecting their quality of life. This case emphasizes the necessity of a multidisciplinary approach and the utilization of advanced diagnostic tools like LTVEM in elucidating the underlying causes of paroxysmal psychiatric symptoms.
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Affiliation(s)
- Francesco Castellana
- Neurology Unit, Epilepsy Center, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy; (F.C.); (M.T.D.C.); (G.d.)
- Unit of Clinical Neurology, Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy;
| | - Grazia D’Onofrio
- Clinical Psychology Service, Health Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Filomena Ciccone
- Clinical Psychology Service, Health Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Maria Teresa Di Claudio
- Neurology Unit, Epilepsy Center, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy; (F.C.); (M.T.D.C.); (G.d.)
| | - Maura Pugliatti
- Unit of Clinical Neurology, Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy;
| | - Teresa Popolizio
- Complex Unit of Radiology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Giuseppe d’Orsi
- Neurology Unit, Epilepsy Center, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy; (F.C.); (M.T.D.C.); (G.d.)
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Alyami H. Response: Video-EEG Monitoring and Cerebral Imaging are Mandatory in Patients with Functional Seizures. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:78-79. [PMID: 38362095 PMCID: PMC10866386 DOI: 10.4103/sjmms.sjmms_509_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Hussain Alyami
- Department of Internal Medicine, College of Medicine, Taif University, Taif, Saudi Arabia
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Finsterer J. Video-electroencephalography Monitoring and Cerebral Imaging are Mandatory in Patients with Functional Seizures. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:76-77. [PMID: 38362092 PMCID: PMC10866381 DOI: 10.4103/sjmms.sjmms_413_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 02/17/2024]
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