Abstracts

RATIONALE: Psychiatric disorders are common in epilepsy, but associations may be limited to particular sub-groups of patients, since epilepsy is a heterogeneous disease. We sought to determine the prevalence of psychiatric conditions, particularly panic disorder, in focal epilepsy patients with a fear aura.
METHODS: A consecutive series of 12 patients with ictal fear underwent psychiatric evaluation, either via formal consultation with a psychiatrist, or via standardized interview using the Mini International Neuropsychiatric Interview (MINI), an instrument which allows rapid diagnosis of Axis I disorders according to strict DSM-IV criteria. An addendum was made to the MINI to create an instrument specifically for use in epilepsy patients (MINI-Epi) by adding questions to clarify areas of potential diagnostic confusion in this population (e.g. schizophrenia vs. post-ictal psychosis, panic attack vs. partial seizure).
RESULTS: Four of the 12 patients (33%) with ictal fear had a co-morbid diagnosis of panic disorder. One of these developed panic attacks only after epilepsy surgery, and another worsened after surgery, while in the other two panic attacks were not related to any surgical procedure. Two patients had other anxiety disorders. Eight patients (67%) had current or past depression; this did not appear to be related to the presence of panic disorder. All patients were able to clearly distinguish subjectively between their seizures and their panic attacks.
CONCLUSIONS: A specific co-morbidity exists between focal epilepsy with ictal fear and panic disorder. The prevalence of panic disorder in this group is far higher than the 3.5% lifetime prevalence seen in the general population (1) or the 5-10% prevalence seen in unselected epilepsy patients (2,3). The predisposition to panic disorder in these patients may be exacerbated by anterior temporal lobectomy. Involvement of the amygdala in both temporal lobe epilepsy and panic disorder may underlie the association between these two conditions. Physicians should be aware of the common co-occurrence of these disorders so as to avoid diagnostic confusion and provide appropriate treatment for each.
1. Kessler RC, McGonagle KA, Zhao S, Nelson, CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey, Arch Gen Psychiatry1994;51:8-19.
2. Perini GI, Tosin C, Carraro C, Bernasconi G, Canevini MP, Canger R, Pellegrini A, Testa G. Interictal mood and personality disorders in temporal lobe epilepsy and juvenile myoclonic epilepsy. J Neurol Neurosurg Psychiatry 1996;61:601-5.
3. Swinkels WAM, Kuyk J, de Graaf EH, van Dyck R, Spinhoven Ph. Prevalence of psychopathology in Dutch epilepsy inpatients: a comparative study. Epilepsy and Behavior 2001;2:441-7.
[Supported by: Dr. Mintzer was supported in this work by both the Merritt-Putnam award of the Epilepsy Foundation (sponsored by Parke-Davis) and the National Epifellows Foundation.]