# Temporal Lobe Epilepsy Masquerading as Panic Attacks: A Case Report

## TL;DR

A case shows how temporal lobe epilepsy can look like panic attacks, leading to years of wrong treatment until proper diagnosis and therapy improve outcomes.

## Contribution

This case report highlights the under-recognized possibility of temporal lobe epilepsy masquerading as panic attacks, even in patients with known generalized epilepsy.

## Key findings

- A 46-year-old woman with refractory panic-like episodes was found to have temporal lobe epilepsy through video-EEG monitoring.
- Transitioning to anti-seizure therapy targeting focal seizures led to reduced panic symptoms and improved clinical outcomes.
- The case underscores the importance of neurological evaluation in refractory psychiatric-like symptoms to avoid misdiagnosis.

## Abstract

What are the main findings?
Temporal lobe epilepsy may mimic panic attacks, and misdiagnosis can lead to years of ineffective treatment and decreased quality of life.Atypical or refractory panic-like episodes could prompt neurology consultation and video-EEG evaluation, as correct diagnosis and targeted therapy markedly improve prognosis.

Temporal lobe epilepsy may mimic panic attacks, and misdiagnosis can lead to years of ineffective treatment and decreased quality of life.

Atypical or refractory panic-like episodes could prompt neurology consultation and video-EEG evaluation, as correct diagnosis and targeted therapy markedly improve prognosis.

What are the implications of the main findings?
Clinicians should maintain a high index of suspicion for neurological etiologies such as temporal lobe epilepsy when encountering panic-like symptoms, even in patients with generalized epilepsy currently under treatment.Early referral for neurological assessment can allow for accurate diagnosis and implementation of targeted anti-seizure therapy, resulting in improved clinical outcomes and quality of life.

Clinicians should maintain a high index of suspicion for neurological etiologies such as temporal lobe epilepsy when encountering panic-like symptoms, even in patients with generalized epilepsy currently under treatment.

Early referral for neurological assessment can allow for accurate diagnosis and implementation of targeted anti-seizure therapy, resulting in improved clinical outcomes and quality of life.

Background: The clinical presentation of temporal lobe epilepsy (TLE) and panic disorder can sometimes overlap, particularly when the seizure symptoms include paroxysmal episodes of intense fear and autonomic symptoms. As a result, patients with TLE can be misdiagnosed with a primary psychiatric illness, which leads to inappropriate treatment, worsening of the underlying condition and decreased function and quality of life. Clinical case: We present the case of a 46-year-old woman, known for a 20-year history of generalized epilepsy and major depressive disorder with panic attacks that were refractory and persistent despite trials of SSRIs, benzodiazepines and cognitive behavioral therapy (CBT). While hospitalized for video-EEG monitoring in the context of worsening epilepsy, she was found to have TLE seizures presenting as what the patient had described as panic attacks, and that sometimes progressed to secondarily generalized seizures. Following a transition from a medication regimen targeting generalized epilepsy to one more appropriate for focal seizures, the patient experienced clinical improvement with a decrease in the magnitude and frequency of panic symptoms. Conclusions: This case, in combination with other case reports in the literature, demonstrates the need for clinical suspicion of TLE in patients presenting with atypical panic-like episodes or a refractory panic disorder, especially in cases known for epilepsy or having risk factors for seizure disorder. It also highlights the importance of comprehensive diagnostic evaluation in neuropsychiatric presentations, including EEG and brain imaging, to ensure accurate diagnosis and appropriate management.