PSYCHOSENSORIAL AND RELATED PHENOMENA IN PANIC DISORDER AND IN TEMPORAL-LOBE EPILEPSY

Since Cullen coined the term ''neurosis'' in the 18th century, medical investigators have searched the neural substrates of conditions we no w classify as anxiety disorders. Harper and Roth in 1962 hypothesized that the temporal lobes might represent one such substrate for phobic- anxious patients with depersonalization-derealization (DD); the associ ation between the presumed temporal lobe feature and phobic anxiety wa s so compelling that Roth (in 1959) described the condition as ''phobi c-anxiety-depersonalization'' syndrome. Introduced into our current no sology as panic disorder-agoraphobia (PDA), this seemingly neuropsychi atric condition is nonetheless distinct from complex partial epilepsy (CPE), from which it is conventionally differentiated through clinical and anamnestic evaluation. Yet increasingly there are clinical-and la boratory-hints of certain overlap between manifestations of the two di sorders, hitherto based largely on evaluation of psychosensorial pheno mena in PDA or affective phenomena in CPE. We located only one systema tic study that monitored 24-hour electroencephalogram (EEG) abnormalit ies in PDA. Finally, recent epidemiologic data suggest a significantly greater than chance association between PDA and a history of seizures . To further explore these intriguing links, the present study directl y compared a group of 91 PDA outpatients with a group of 41 CPE outpat ients with respect to DD and other psychosensorial symptoms. The broad similarities discovered between psychosensorial and related phenomena provide further support for the hypothesis that there may be a common neurophysiological substrate linking CPE phenomena with PDA. Copyrigh t (C) 1996 by W.B. Saunders Company