Lesional Temporal Lobe Epilepsy: Beware the Deceitful "Panic Attack"

World Neurosurg. 2018 Mar:111:197-200. doi: 10.1016/j.wneu.2017.12.124. Epub 2017 Dec 28.

Abstract

Background: Ganglioglioma 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 description: We 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.

Conclusion: This 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.

Keywords: Dysembryoplastic neuroepithelial tumor; Ganglioglioma; Panic attack; Panic disorder; Seizure; Temporal lobe epilepsy.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Brain Neoplasms / complications*
  • Brain Neoplasms / diagnosis
  • Diagnostic Errors*
  • Epilepsy, Temporal Lobe / diagnosis
  • Epilepsy, Temporal Lobe / etiology*
  • Ganglioglioma / complications*
  • Ganglioglioma / diagnosis
  • Humans
  • Male
  • Panic Disorder / diagnosis
  • Panic Disorder / etiology*