Fear as the main feature of epileptic seizures

Objectives-There are circumstances in which partial seizures may be misdiag nosed as acute psychiatric disturbances. In particular, when fear is the pr ominent feature the patient may be considered for years as having panic att acks. Eight patients in whom fear was the main symptom of the seizures are reported on. Patients who had a proved lack of consciousness during the fit s and patients in whom fear was just fear of having a seizure were excluded . The ictal involvement of temporal limbic and frontal structures in those patients with fear of particular intensity was studied. Methods-The localisation of the epileptogenic zone was assessed by prolonge d interictal EEG recordings as well as ictal video-EEG recording of at leas t one seizure in every patient; five had ictal SPECT and four had chronic s tereotactic implantation of depth electrodes (SEEG). In six patients, a cor tical resection was performed with an Engel's class 1 outcome (minimum 28 m onths follow up, except for two patients). Results-Localisations of primary epileptogenic zones were right temporal in three patients, left temporal in three, bitemporal in one, and frontal in one. In all cases, diagnosis of epileptic seizures could be clinically evok ed because of the stereotypy of fits and of associated symptoms. The associ ation of a fear sensation, autonomic symptoms, and coordinated behaviour su ggests disturbance of a particular system. The SEEG data argue for temporol imbic and prefrontal lobe involvement in the expression of ictal fear. Conclusions-In intense ictal fear, with coordinated behaviour and autonomic features, the discharge may involve or interfere with a physiological comp lex information processing network. This network involves orbitoprefrontal, anterior cingulate, and temporal limbic cortices.