Electroencephalographic (EEG) findings repeatedly reported abnormal synchronous or even epileptiform discharges in panic disorder. Although less frequently occurring in patients with panic disorder, these deviant EEG features during panic attacks were also observed in intracranial EEG. For this purpose, our article reviews the consideration of abnormal synchronous neuronal activity in different neurocircuits, particularly limbic, as a suggested condition of panic attacks. Therapeutic approaches of anticonvulsants have shown reductions of symptoms and frequency of attacks in numerous patients suffering from panic disorder, supporting the presumption of underlying abnormal synchronous neuronal activity. Thus, scalp EEG recordings are still recommended for discovering indications of abnormal synchronous neuronal activity in panic patients.
StrianF. Pathogenesis of psychic disorders - the paroxysmal anxiety (Pathogenese psychischer Störungen - die paroxysmale Angst). In: MöllerAAFröscherW, (eds). Psychische Störungen bei Epilepsie. Stuttgart, New York: Thieme; 1992.
4.
BeyenburgSMitchellAJSchmidtDElgerCEReuberM. Anxiety in patients with epilepsy: systematic review and suggestions for clinical management. Epilepsy Behav2005; 7(2): 161–171.
5.
MintzerSLopezF. Comorbidity of ictal fear and panic disorder. Epilepsy Behav2002; 3: 330–337.
6.
HenryTRFreyKASackellaresJCGilmanSKoeppeRABrunbergJA. In vivo cerebral metabolism and central benzodiazepine-receptor binding in temporal lobe epilepsy. Neurology1993; 43: 1998–2006.
7.
MacraeD. On the nature of fear with reference to its occurrence in epilepsy. J Nerv Ment Dis1954; 120: 385–393.
8.
PicardiADi GennaroGMeldolesiGNGrammaldoLGEspositoVQuaratoPP. Partial seizures due to sclerosis of the right amygdala presenting as panic disorder: on the importance of psychopathological assessment in differential diagnosis. Psychopath2007; 40: 178–183.
9.
SternTAMurrayGB. Complex partial seizures presenting as a psychiatric illness. J Nerv Ment Dis1984; 172: 625–627.
10.
NeumeisterABainENugentAC. Reduced serotonin type 1A receptor binding in panic disorder. J Neurosci2004; 24: 589–591.
11.
SazgarMCarlenPLWennbergR. Panic attack semiology in right temporal lobe epilepsy. Epileptic Disord2003; 5: 93–100.
12.
ToniCCassanoGBPerugiGMurriLMancinoMPetraccaA. Psychosensorial and related phenomena in panic disorder and in temporal lobe epilepsy. Compr Psychia1996; 37(2): 125–133.
13.
RayATaoJXHawes-EbersoleSEbersoleJS. Localizing value of scalp EEG spikes: a simultaneous scalp and intracranial study. Clin Neurophysiol2007; 118: 69–79.
14.
EngelJ. Seizures and Epilepsy. Philadelphia: FA Davis Company; 1989.
15.
PiazziniACaneviniMPMaggioriGCangerR. Depression and anxiety in patients with epilepsy. Epilepsy Behav2001; 2: 481–489.
16.
VazquezBDevinskyO. Epilepsy and anxiety. Epilepsy Behav2003; 4(suppl 4): S20-S25.
17.
WieserHG. Depth recorded limbic seizures and psychopathology. Neurosci Biobehav Rev1983; 7: 427–440.
JabourianAPErlichMDesvignesCel HadjamMBittonR. Panic attacks and 24-hour ambulatory EEG monitoring. Ann Med Psychol Paris1992; 150: 240–244.
26.
DevinskyOSatoSTheodoreWHPorterRJ. Fear episodes due to limbic seizures with normal ictal scalp EEG: a subdural electrographic study. J Clin Psychiatry1989; 50: 28–30.
27.
GloorPOlivierAQuesneyLFAndermannFHorowitzS. The role of the limbic system in experiential phenomena of temporal lobe epilepsy. Ann Neurol1982; 12: 129–144.
28.
QuesneyLFGloorP. Localization of epileptic foci. Electroencephalogr Clin Neurophysiol1985; (suppl)37: 165–200.
29.
EngelJ. Report of the ILAE Classification Core Group. Epilepsia2006; 47(9): 1558–1568.
30.
PegnaCPerriALentiC. Panic disorder or temporal lobe epilepsy: a diagnostic problem in an adolescent girl. Eur Child Adolesc Psych1999; 8: 237–239.
31.
ScaliseAPlacidiFDiomediMDe SimoneRGigliGL. Panic disorder or epilepsy? A case report. J Neurol Sci2006; 246(1–2): 173–175.
32.
BeauclairLFontaineR. Epileptiform abnormalities in panic disorder. Society of Biological Psychiatry, 41. Annual Convention1986; 96: 148.
33.
BystritskyAPontilloDPowersMSabbFWCraskeMGBookheimerSY. Functional MRI changes during panic anticipation and imagery exposure. Neuroreport2001; 12: 3953–3957.
34.
EdlundMJSwannACClothierJ. Patients with panic attacks and abnormal EEG results. Am J Psychiatry1987; 144: 508–509.
35.
KentJMCoplanJDMawlawiOMartinezJMBrowneSTSlifsteinM. Prediction of panic response to a respiratory stimulant by reduced orbitofrontal cerebral blood flow in panic disorder. Am J Psychiatry2005; 162: 1379–1381.
36.
McLachlanRSBlumeWT. Isolated fear in complex partial status epilepticus. Ann Neurol1980; 8: 639–641.
37.
SchülerPKalbR. Anxiety attacks and epileptic seizures: determining similarities based on a case report. Nervenarzt1994; 65: 411–414.
38.
SteinMBUhdeTW. Infrequent occurrence of EEG abnormalities in panic disorder. Am J Psychiatry1989; 146: 517–520.
39.
Van SwedenBRombautP. Panic attacks and EEG abnormalities. Am J Psychia1987; 144: 12.
40.
WeilburgJBSchachterSWorthJPollackMHSachsGSIvesJRSchomerDL. EEG abnormalities in patients with atypical panic attacks. J Clin Psychiatry1995; 56: 358–362.
41.
BystritskyALeuchterAFVapnikT. EEG abnormalities in nonmedicated panic disorder. J Nerv Ment Dis1999; 187: 113–114.
42.
HayashiKMakinoMHashizumeMNakanoKTsuboiK. Electroencephalogram abnormalities in panic disorder patients: a study of symptom characteristics and pathology. Biopsychosoc Med2010; 4: 9.
43.
AndrewsGHobbsMJBorkovecTDBeesdoKCraskeMGHeimbergRG. Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V. Depress Anxiety2010; 27(2): 134–147.
44.
NormanNC. A review of EEG biofeedback treatment of anxiety disorders. Clin Electroencephalogr2000; 31(1): 1–6.
DantendorferKAmeringMBaischerWBergerPSteinbergerKWindhaberJKatschnigH. Is there a pathophysiological and therapeutic link between panic disorder and epilepsy?Acta Psychiatr Scand1995; 91: 430–432.
49.
BartolomeilFGuyeMWendlingFGavaretMRégisJChauvelP. Fear, anger and compulsive behavior during seizure: involvement of large scale fronto-temporal neural networks. Epileptic Disorder2002; 4(4): 235–241.
GloorP. Contributions of electroencephalography and electrocorticography to the neurosurgical treatment of the epilepsies. Adv Neurol1975; 8: 59–105.
52.
AdamecRE. Amygdala kindling and anxiety in the rat. Neuroreport1990; 1: 255–258.
53.
FishDRGloorPQuesneyFLOlivierA. Clinical responses to electrical brain stimulation of the temporal and frontal lobes in patients with epilepsy: pathophysiological implications. Brain1993; 116: 397–414.
54.
PenfieldW. Functional localization in temporal and deep sylvian areas. Research Publications: Association of Research in Nervous and Mental Disease1958; 36: 210–226.
55.
UrsinHKaadaBR. Functional localization within the amygdaloid complex in the cat. Electroencephalogr Clin Neurophysiol1960; 12: 1–20.
56.
WiestGLehner-BaumgartnerEBaumgartnerC. Panic Attacks in an individual with bilateral selective lesions of the amygdala. Arch Neurol2006; 63: 1798–1801.
57.
RogersRDRamnaniNMackayCWilsonJLJezzardPCarterCS. Distinct portions of anterior cingulated cortex and medial prefrontal cortex are activated by reward processing in separable phases of decision-making condition. Biol Psychiatry2004; 55: 594–602.
58.
HopkinsDAHolstegeG. Amygdaloid projections to the mesencephalon, pons and medulla oblongata in the cat. Exp Brain Res1978; 32: 529–547.
59.
GoddardC. Long term alteration following amygdala stimulation. In: EleftheriouB, (ed). Neurobiology of the Amygdala. New York: Plenum; 1972.
60.
MorrellF. Secondary epileptogenesis in man. Arch Neurol1985; 42: 318–335.
61.
SmallJGMilsteinVSmallIFSharpleyPH. Does ECT produce kindling?Biol Psychiatry1981; 16: 773–778.
62.
SramkaMSedlakPNadvornikP. Observation of kindling phenomenon in treatment of pain by stimulation in thalamus. In: SweetWHObradorSMartin-RodriguezJG, (eds). Neurosurgical Treatment in Psychiatry, Pain and Epilepsy. Baltimore MD: University Park Press; 1977: 651–654.
63.
PinelJPTreitDRovnerLI. Temporal lobe aggression in rats. Science1977; 197: 1088–1089.
64.
StevensJRLivermoreA. Kindling of the mesolimbic dopamine system: animal model of psychosis. Neurology1978; 28: 36–46.
65.
KohlerCGCarranMABilkerWO'ConnorMJSperlingMR. Association of fear auras with mood and anxiety disorders after temporal lobectomy. Epilepsia2001; 42(5): 647–681.
66.
MonroeRR. Episodic Behavioral Disorders. Cambridge MS: Harvard University Press; 1970.
67.
SchmutzM. Relevance of kindling and related processes to human epileptogenesis. Prog Neuropsychopharmacol Biol Psychiatry1987; 11: 505–525.
68.
Aroniadou-AnderjaskaVQashuFBragaMF. Mechanisms regulating GABAergic inhibitory transmission in the basolateral mygdale: implications for epilepsy and anxiety disorders. Amino Acids2007; 32: 305–315.
69.
BirabenATaussigDThomasPEvenCVignalJPScarabinJM. Fear as the main feature of epileptic seizures. J Neurol Neurosurg Psychia2001; 70: 186–191.
70.
ChuganiHTChuganiDC. Imaging of serotonin mechanisms in epilepsy. Epilepsy Curr2005; 5: 201–206.
71.
MaronEShlikJ. Serotonin function in panic disorder: important, but why?Neuropsychopharmocology2006; 31: 1–11.
72.
NashJRSargentPARabinerEA. Altered 5HT1A binding in panic disorder demonstrated by positrone emission tomography. Eur Neuropsychopharmocol2004; 14: 322–323.
73.
GoddardAWMasonGFAppelMRothmanDLGueorguievaRBeharKL. Impaired GABA neuronal response to acute benzodiazepine administration in panic disorder. Am J Psychiatry2004; 161: 2186–2193.
74.
Roy-ByrnePP. The GABA-benzodiazepine receptor complex: structure, function and role in anxiety. J Clin Psychiatry2005; 66: 14–20.
75.
FontaineRBretonGDeryRFontaineSElieR. Temporal lobe abnormalities in panic disorder: an MRI study. Biol Psychiatry1990; 27: 304–310.
76.
KaschkaWFeistelHEbertD. Reduced benzodiazepine receptor binding in panic disorders measured by iomazenil SPECT. J Psychiatr Res1995; 29: 427–434.
77.
ByrnePP RoyWardNGDonnellyPJ. Valproate in anxiety and withdrawal syndromes. J Clin Psychiatry1989; 50(suppl): 44–48.
78.
GrunwaldFHufnagelAElgerCEBiersackHJ. Single-photon, emission-computed tomography (SPECT) in the diagnosis of epilepsy. Radiologe1993; 33: 198–203.
79.
MassanaGSerra-GrabulosaJMSalgado-PinedaPGastóCJunquéCMassanaC. Amygdalar atrophy in panic disorder patients detected by volumetric magnetic resonance imaging. Neuroimage2003; 19(1): 80–90.
80.
MeyerMAZimmermannAWMillerCA. Temporal lobe epilepsy presenting as panic attacks: detection of interictal hypometabolism with positron emission tomography. J Neuroimaging2000; 10: 120–122.
81.
ReimanEMRaichleMEButlerFKHerscovitchPRobinsE. A focal brain abnormality in panic disorder, a severe form of anxiety. Nature1984; 310: 683–685.
82.
CendesFAndermannFGloorPGambardellaALopesCendes IWatsonC. Relationship between atrophy of the amygdala and ictal fear in temporal lobe epilepsy. Brain1994; 117: 739–746.
83.
EngelJBrownWJKuhlDEPhelpsMEMazziottaJCCrandallP. Pathological findings underlying focal temporal lobe hypometabolism in partial epilepsy. Ann Neurol1982; 12: 518–528.
84.
MulderDWDalyD. Psychiatric symptoms associated with lesions of temporal lobe. J Am Med Assoc1952; 150: 173–176.
85.
OntiverosAFontaineRBretonGElieRFontaineSDeryR. Correlation of severity of panic disorder and neuroanatomical changes on magnetic resonance imaging. J Neuropsychiatry Clin Neurosci1989; 1: 404–408.
86.
EngelJKuhlDEPhelpsME. Patterns of human local cerebral glucose metabolism during epileptic seizures. Science1982; 218: 64–66.
87.
LeeYSHwangJKimSJ. Decreased blood flow of temporal regions of the brain in subjects with panic disorder. J Psychiatr Res2006; 40: 828–834.
88.
ReimanEMRaichleMERobinsEButlerFKHerscovitchPFoxPPerlmutterJ. The application of positron emission tomography to the study of panic disorder. Am J Psychiatry1986; 143: 469–477.
89.
NordahlTESempleWEGrossMMellmanTASteinMBGoyerP. Cerebral glucose metabolic differences in patients with panic disorder. Neuropsychopharmacology1990; 3: 261–272.
90.
ThomasKMDrevetsWCDahlRERyanNDBirmaherBEccardCH. Amygdala response to fearful faces in anxious and depressed children. Arch Gen Psychia2001; 58: 1057–1063.
91.
EngelJCrandallPRauschHR. The partial epilepsies. In: RosenbergRNGrossmanRGSchochetSHeinzeERWillisWD, (eds). The Clinical Neurosciences. New York: Churchill-Livingstone; 1983: 1349–1380.
92.
RoweCCBerkovicSFAustinMCMcKayWJBladinPF. Patterns of postictal cerebral blood flow in temporal lobe epilepsy: qualitative and quantitative analysis. Neurology1991; 41: 1096–1103.
93.
SpencerSS. The relative contributions of MRI, SPECT, and PET imaging in epilepsy. Epilepsia1994; 35(suppl 6): S72–89.
94.
SakaiYKumanoHNishikawaM. Cerebral glucose metabolism associated with a fear network in panic disorder. Neuroreport2005; 16: 927–931.
95.
CharneyDSNestlerEJ. Neurobiology of mental illness. In: CharneyDSBremnerJD, (eds). The Neurobiology of Anxiety Disorders (2nd ed), New York: Oxford University Press; 2004.
96.
TassoneDMBoyceEGuyerJNuzumD. Pregabalin: a novel gamma-aminobutyric acid analogue in the treatment of neuropathic pain, partial-onset seizures, and anxiety disorders. Clin Ther2007; 29(1): 26–48.
97.
ShearMKHouckPGreenoCMastersS. Emotion-focused psychotherapy for patients with panic disorder. Am J Psychiatry2001; 158: 193–198.
98.
BakkerAvan BalkomAJSpinhovenP. SSRIs vs. TCAs in the treatment of panic disorder: a meta-analysis. Acta Psychiatr Scand2002; 106: 163–167.
99.
OttoMWTubyKSGouldRAMcLeanRYPollackMH. An effect-size analysis of the relative efficacy and tolerability of serotonin selective reup-take inhibitors for panic disorder. Am J Psychiatry2001; 158: 1989–1992.
100.
Van AmeringenMManciniCPipeBBennetM. Antiepileptic drugs in the treatment of anxiety disordes: role in therapy. Drugs2004; 64(19): 2199–2220.
101.
NiedermeyerEda SilvaFL. Electroencephalography: Basic Principles, Clinical Applications and Related Fields. 5th ed.Hagerstown MD: Lippincott, Williams and Wilkins, United States; 2004.
102.
TondoLBurraiCScamonattiLToccafondiFPoddigheAMinnaiG. Carbamazepine in panic disorder [letter]. Am J Psychiatry1989; 146: 558–559.
103.
PerugiGFrareFToniCTusiniGVannucchiGAkiskalHS. Adjunctive Valproat in panic disorder patients with comorbid bipolar disorder or otherwise resistant to standard antidepressants: a 3-year “open” follow-up study. Eur Arch Psychiatry Clin Neurosci2010; 260(7): 553–560.
104.
KeckPEJr.McElroySLFriedmanLM. Valproate and carbamazepine in the treatment of panic and posttraumatic stress disorders, withdrawal states, and behavioral dyscontrol syndromes. J Clin Psychopharmacol1992; 12: 36S–41S.
105.
PrimeauFFontaineR. GABAergic agents and panic disorder. Biol Psychiatry1988; 24: 941–960.
LumMFontaineRElieROntiverosA. Divalproex Sodium's antipanic effect in panic disorder: a placebo-controlled study. Biol Psychiatry1990; 27: 164a–165a.
108.
KeckPEJr.TaylorVETugrulKCMcElroySLBennettJA. Valproate treatment of panic disorder and lactate-induced panic attacks. Biol Psychiatry1993; 33: 542–546.
109.
MulaMPiniSCassanoPG. The role of anticonvulsant drugs in anxiety disorders: a critical review of the evidence. J Clin Pharmacol2007; 27(3): 263–272.
110.
PandeACFeltnerDEJeffersonJWDavidsonJRPollackMSteinMB. Efficacy of the novel anxiolytic pregabalin in social anxiety disorder: a placebo-controlled multicenter study. J Clin Psychopharmacol2004; 24(2): 141–149.
111.
MuralidharanABhagwagarZ. Potential of levetiracetam in mood disorder: a preliminary review. CNS drugs2006; 20(12): 969–979.
112.
GruenerD. Tiagabine as an augmenting agent for the treatment of anxiety. 22nd Conference of the Anxiety Disorders Association of America, Austin, TX; 2002: 21–24.
HenriksenGF. Status epilepticus partialis with fear as clinical expression: report of a case and ictal EEG findings. Epilepsia1973; 14: 39–46.
116.
McNamaraE. Absence seizures associated with panic attacks initially misdiagnosed as temporal lobe epilepsy: the importance of prolonged EEG monitoring in diagnosis. J Psychiatr Neurosci1992; 18(1): 46–49.
117.
KellettJKokkinidisL. Extinction deficit and fear reinstatement after electrical stimulation of the amygdala: implications for kindling-associated fear and anxiety. Neuroscience2004; 127: 277–287.
118.
BarnesSJPinelJP. Conditioned effects of kindling. Neurosci Biobehav Rev2001; 25: 745–751.
119.
KalynchukLE. Long-term amygdala kindling in rats as a model for the study of interictal emotionality in temporal lobe epilepsy. Neurosci Biobehav Rev2000; 24: 691–704.
120.
Le DouxJE. Emotion circuits in the brain. Annu Rev Neurosci2000; 23: 155–184.
121.
HannessonDKPollockMSHowlandJGMohapelPWallaceAECorcoranME. Amygdaloid kindling is anxiogenic but fails to alter object recognition or spatial working memory in rats. Epilepsy Behav2008; 13: 52–61.
122.
RainnieDAsprodiniEShinnick-GallagherP. Kindling-induced long-lasting changes in synaptic transmission in the basolateral amygdala. J Neurophysiol1992; 67: 443–454.
123.
ParientePDLepineJPLellouchJ. Lifetime history of panic attacks and epilepsy: an association from a general population survey [letter]. J Clin Psychiatry1991; 52: 88–89.
124.
NeckelmannDAmzicaFSteriadeM. Spike-wave complexes and fast components of cortically generated seizures. III. Synchronizing Mechanisms. J Neurophysiol1998; 80(39): 1480–1494.
125.
SchindlerKLeungHElgerCELehnertzK. Assessing seizure dynamics by analysing the correlation structure of multichannel intracranial EEG. Brain2007; 130(Pt 1): 65–77.
126.
JacobsJLeVanPChanderRHallJDubeauFGotmanJ. Interictal high-frequency oscillations (80–500 Hz) are an indicator of seizure onset areas independent of spikes in the human epileptic brain. Epilepsia2008; 49: 1893–1907.
127.
JacobsJLeVanPMoellerFBoorRStephaniU. Hemodynamic changes preceding the interictal EEG spike in patients with focal epilepsy investigated using simultaneous EEG-fMRI. Neuroimage2009; 45: 1220–1223.
