Panic attacks, spike-wave activity, and limbic dysfunction. A case report.
INTRODUCTION: Several lines of evidence indicate that an increased neuronal excitability of the corpus amygdaloideum and hippocampus may be one pathophysiological condition of panic attacks. METHODS: In this report, we will describe the case of a 54-year-old female patient with a depressive syndrome who first experienced very rapid atypical panic attacks with dizziness, trance-like and distorted optical perception, but without clear epileptic symptoms. RESULTS: Several EEG recordings showed temporal sharp-waves and spike-wave patterns. Magnetic resonance imaging (MRI) revealed a hypodense area near left mesial temporal structures. Brain imaging with SPECT showed a hypoperfusion of the basal temporal cortical structures on the left side. Treatment with antidepressants had no effect, but the addition of valproic acid led to an attenuation of the panic attacks and epileptic potentials on the EEG. DISCUSSION: A clinical trial using anti-epileptics could be successful in patients not responding to antidepressants or in the presence of epileptiform EEG activity. In this article, we will review the literature concerning the complex relationship between panic attacks and ictal activity of limbic structures and discuss the difficult diagnostic classification of atypical cases.