Ictal Fear Presenting As Panic Attacks
Nor Asyikin Fadzil, Norili Farhana Ahmad Saberi, Maruzairi Husain, Zahiruddin Othman
Abstract: Introduction: Ictal fear is the most frequent type of simple partial seizure and accounts for 60% of all psychiatric aura. Thus, it is not infrequent to be treated as panic attacks (PA). Additionally, the two conditions often co-occur, making differential diagnosis even more difficult.
Objective: A 54-year-old man who presented with depression and PA was studied. The symptomatology will be discussed.
Result: The patient had features that suggest the panic attack was actually ictal fear. The depression responded to mirtazapine 45 mg nocte, however, the panic attacks worsened. The diagnosis of complex partial seizure (CPS) was finally made about 18 months after the initial presentation. His condition greatly improved with sodium valproate 1,500 mg nocte.
Conclusion: Differentiating CPS from panic attacks can be difficult at the initial presentation of the illness. Particular attention should be given to clinical features commonly associated with ictal panic. Otherwise, postictal and interictal panic will become increasingly similar to typical panic attacks.