Lesional Temporal Lobe Epilepsy: Beware the Deceitful “Panic Attack”

Publication date: March 2018
Source:World Neurosurgery, Volume 111
Author(s): Kay O. Kulason, Julia R. Schneider, Ralph Rahme, Bidyut Pramanik, Derek Chong, John A. Boockvar
BackgroundGanglioglioma is a rare, benign, intraaxial glioneuronal tumor but a relatively common cause of pharmacoresistant temporal lobe epilepsy (TLE). Given its often nonspecific neuropsychiatric manifestations and frequently negative electroencephalographic workup, TLE can be easily misdiagnosed as a psychiatric disorder, particularly panic attacks.Case DescriptionWe present a case of a 17-year-old boy who was found to have lesional TLE secondary to a left temporal ganglioglioma, 5 years after having been misdiagnosed with panic disorder and having undergone ineffective and unnecessary psychotherapy. He was successfully cured by surgery. Although a few similar cases of TLE masquerading as a panic disorder have been previously reported in the literature, this is the youngest and only pediatric patient described to date.ConclusionThis report underscores the challenges in making an accurate clinical diagnosis of TLE and the importance of timely brain imaging whenever an atypical or medically refractory panic disorder is encountered.



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