Editor—Thompson et al highlighted the considerable challenge in differentiating partial seizures from panic disorder and the considerable overlap that exists between the two disorders.1 Patients with these disorders often present to old age psychiatry services and, perhaps not surprisingly, show slightly different psychopathology from that reported by Thompson et al.
In a series of 69 elderly patients identified through the Salford case register presenting to the old age psychiatry service with epilepsy (42 women), both generalised anxiety disorder (18) and depression (18) were common. Thirty three of these patients had partial seizures, nine of whom (seven women) presented with panic attacks. The frequency of these attacks was less than reported by Thompson et al, and five had fewer than one attack every three months. This no doubt contributed to the delay in diagnosis.
As well as symptoms of panic, these nine patients all had overt psychotic symptoms and behavioural disturbance. Three patients had delusions (paranoid, grandiose, and of reference), which were central to the clinical picture. Hallucinations were seen in seven patients (olfactory (three patients), auditory (two), and visual (two)), and several patients had a complex mixture of both delusional and hallucinatory psychopathology. Six patients described an aura, and three were noted to have automatisms. In three patients the original referral was precipitated by verbal and physical aggression, and this group presented particular management difficulties. The initial electroencephalogram showed epileptiform changes in five of the nine cases, with abnormalities being mainly on the right side (four cases). Three patients met ICD-10 criteria for depressive disorder, and three patients had a dementia illness (Alzheimer's, vascular, and alcohol related).
The complex relation between partial seizures and panic not only reflects the direct association between the two but also the independent relations that exist between both conditions and the diagnosis of depression, dementia, and alcohol misuse. Clinicians need to be alerted to this association not only in the clinical settings highlighted by Thompson but also in patients with more overt behavioural and psychological disturbances, as these features are common and seem to make diagnosis of partial seizures more difficult.
References
- 1.Thompson SA, Duncan JS, Smith SJM. Partial seizures presenting as panic attacks. BMJ. 2000;321:1002–1003. doi: 10.1136/bmj.321.7267.1002. . (21 October.) [DOI] [PMC free article] [PubMed] [Google Scholar]