Sazgar Mona, Carlen Peter L, Wennberg Richard
Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
Epileptic Disord. 2003 Jun;5(2):93-100.
Panic attack semiology as a manifestation of epileptic seizures may lead to difficulties and delay in diagnosis. We present a case series to demonstrate the association of ictal panic and anxiety symptoms with partial seizures lateralized to the right temporal lobe.
From 112 consecutive patients with intractable temporal lobe epilepsy (59 right, 53 left) referred for video-EEG monitoring, five patients were identified whose seizures had been diagnosed as panic attacks in the past. Their ictal symptomatology included feelings of panic and impending doom, hyper-ventilation, palpitation, diaphoresis, shortness of breath and generalized paresthesiae. Ictal panic was not identified in 72 patients with extra temporal epilepsy investigated during the same period.
EEG documented a right anterior to mid-temporal focus in all five patients. Brain MRI or pathology showed right mesial temporal sclerosis in four and a right temporal ganglioglioma in one. Ictal tachycardia was documented with EEG-EKG recording in the latter patient, prior to right anterior temporal lobectomy and amygdalohippocampectomy. Reinvestigation of this patient five years later for recurrent seizures, no longer associated with panic symptomatology, showed right temporal ictal onsets with seizure spread to the left temporal lobe, now associated with ictal bradycardia.
Our case series provides further evidence to support a relationship between panic attack symptomatology and ictal involvement of the right mesial temporal region [Published with video sequences].
惊恐发作症状学作为癫痫发作的一种表现形式，可能会导致诊断困难和延误。我们呈现一组病例以证明发作期惊恐和焦虑症状与右侧颞叶局部发作之间的关联。
在112例连续接受视频脑电图监测的难治性颞叶癫痫患者（59例右侧，53例左侧）中，有5例患者过去曾被诊断为发作性惊恐。他们的发作期症状包括惊恐感和厄运将至感、过度换气、心悸、出汗、呼吸急促和全身感觉异常。同期调查的72例颞叶外癫痫患者未发现发作期惊恐。
脑电图显示所有5例患者右侧颞叶前部至中部有病灶。脑部磁共振成像或病理学检查显示，4例为右侧颞叶内侧硬化，1例为右侧颞叶节细胞胶质瘤。在后者患者进行右侧颞叶前部切除术和杏仁核海马切除术之前，脑电图-心电图记录显示发作期心动过速。5年后对该患者因癫痫复发进行复查，不再伴有惊恐症状，显示右侧颞叶发作起始并扩散至左侧颞叶，现伴有发作期心动过缓。
我们的病例系列提供了进一步的证据，支持惊恐发作症状学与右侧颞叶内侧区域发作期受累之间的关系[随视频序列发表]。
