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Physiological Aberrations in Panic Disorder

  • Wenzel SchichoEmail author
  • Oliver Pogarell
Chapter
Part of the Current Topics in Behavioral Neurosciences book series (CTBN, volume 21)

Abstract

Panic disorder is a frequent and clinically relevant medical entity with a high lifetime prevalence and significant impact on psychosocial stability and function. Regarding the clinical presentation, there are obvious similarities in paroxysmal neurological disorders such as seizures and focal epilepsies. In this context, the detection of EEG abnormalities during the attacks or in asymptomatic intervals, continuously or rhythmical, is of significant interest. Likewise, isolated epileptic discharges (IEDs) are important components of epilepsy. On the other hand, IEDs are also common in non-epileptic psychiatric patients. It is not known exactly which role IEDs play in the genesis of behavioural aberrations. In this chapter, attention is directed towards this issue and its relevance to managing psychiatric patients suffering from panic disorder (PD), as well as understanding the complex relationship between IEDs and the pathophysiology of PD. Two main conclusions are being proposed. First, patients suffering from PD may show a higher rate of unspecific EEG abnormalities and increased beta power, pointing to a state of hyperarousal. Secondly, if first-line treatment of PD fails, the use of antiepileptic drugs (AEDs) should be considered. There is enough evidence to suggest that IEDs play a significant role in the genesis of PD and that this relationship is far from clear, warranting more research in this field. This article gives an overview of the current literature on the pathophysiology of PD, including studies on altered microstates, coherence imaging and alpha asymmetry.

Keywords

Electroencephalography Epilepsy Isolated epileptic discharge (IED) Psychopathology Panic disorder Seizure disorder Synchronicity 

References

  1. Adamaszek M, Olbrich S et al (2011) The diagnostic value of clinical EEG in detecting abnormal synchronicity in panic disorder. Clin EEG Neurosci 42(3):166–174PubMedCrossRefGoogle Scholar
  2. Alvarez-Silva S, Alvarez-Rodriguez J et al (2006) Panic and epilepsy. J Anxiety Disord 20(3):353–362PubMedCrossRefGoogle Scholar
  3. Asnaani A, Richey JA et al (2010) A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. J Nerv Ment Dis 198(8):551–555PubMedCentralPubMedCrossRefGoogle Scholar
  4. Avoli M, Louvel J et al (2005) Cellular and molecular mechanisms of epilepsy in the human brain. Prog Neurobiol 77(3):166–200PubMedCrossRefGoogle Scholar
  5. Bartolomei F, Trebuchon A et al (2005) Acute alteration of emotional behaviour in epileptic seizures is related to transient desynchrony in emotion-regulation networks. Clin Neurophysiol: Official J Int Fed Clin Neurophysiol 116(10):2473–2479CrossRefGoogle Scholar
  6. Beyenburg S, Mitchell AJ et al (2005) Anxiety in patients with epilepsy: systematic review and suggestions for clinical management. Epilepsy Behav: E&B 7(2):161–171CrossRefGoogle Scholar
  7. Boutros N (2009) Epileptiform discharges in psychiatric patients: a controversy in need of resurrection. Clin EEG Neurosci 40(4):239–244PubMedCrossRefGoogle Scholar
  8. Boutros NN (2010) Interictal spikes in psychiatric patients: a controversy in need for resurrection. J Clin Neurophysiol: Official Publ Am Electroencephalogr Soc 27(6):484–485 (Author reply 485)CrossRefGoogle Scholar
  9. Boutros NN, Galloway MP et al (2013a) Abnormal coherence imaging in panic disorder: a magnetoencephalography investigation. NeuroReport 24(9):487–491PubMedCrossRefGoogle Scholar
  10. Boutros NN, Gjini K et al (2013b) Panic versus epilepsy: a challenging differential diagnosis. Clin EEG Neurosci 44(4):313–318PubMedCrossRefGoogle Scholar
  11. Boutros NN, Kirollos SB et al (2014) Predictive value of isolated epileptiform discharges for a favorable therapeutic response to antiepileptic drugs in nonepileptic psychiatric patients. J Clin Neurophysiol: Official Publ Am Electroencephalogr Soc 31(1):21–30CrossRefGoogle Scholar
  12. Britz J, Van De Ville D et al (2010) BOLD correlates of EEG topography reveal rapid resting-state network dynamics. Neuroimage 52(4):1162–1170PubMedCrossRefGoogle Scholar
  13. Clark CR, Galletly CA et al (2009) Evidence-based medicine evaluation of electrophysiological studies of the anxiety disorders. Clin EEG Neurosci 40(2):84–112PubMedCrossRefGoogle Scholar
  14. Coburn KL, Lauterbach EC et al (2006) The value of quantitative electroencephalography in clinical psychiatry: a report by the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci 18(4):460–500PubMedCrossRefGoogle Scholar
  15. Deutsch SI, Rosse RB et al (2009) Temporal lobe epilepsy confused with panic disorder: implications for treatment. Clin Neuropharmacol 32(3):160–162PubMedCrossRefGoogle Scholar
  16. Dieler AC, Samann PG et al (2008) Independent component analysis applied to pharmacological magnetic resonance imaging (phMRI): new insights into the functional networks underlying panic attacks as induced by CCK-4. Curr Pharm Des 14(33):3492–3507PubMedCrossRefGoogle Scholar
  17. Doyle A, Pollack MH (2004) Long-term management of panic disorder. J Clin Psychiatry 65(Suppl 5):24–28PubMedGoogle Scholar
  18. Elisevich K, Shukla N et al (2011) An assessment of MEG coherence imaging in the study of temporal lobe epilepsy. Epilepsia 52(6):1110–1119PubMedCentralPubMedCrossRefGoogle Scholar
  19. Engelbregt HJKD, Promes VHL, Verhagen-Schouten S, Deijen JB (2012) In vivo EEG changes during a panic attack in a patient with specific phobia. J Med Cases 3(1):34–38Google Scholar
  20. Gallinat J, Hegerl U (1999) Limbic ictus as a condition for anxiety attacks. Der Nervenarzt 70(3):206–215PubMedCrossRefGoogle Scholar
  21. Gallinat J, Stotz-Ingenlath G et al (2003) Panic attacks, spike-wave activity, and limbic dysfunction. A case report. Pharmacopsychiatry 36(3):123–126PubMedCrossRefGoogle Scholar
  22. Gelowitz DL, Kokkinidis L (1999) Enhanced amygdala kindling after electrical stimulation of the ventral tegmental area: implications for fear and anxiety. J Neurosci: Official J Soc Neurosci 19(22): RC41Google Scholar
  23. Gerez M, Sada A et al (2011) Amygdalar hyperactivity, a fear-related link between panic disorder and mesiotemporal epilepsy. Clin EEG Neurosci 42(1):29–39PubMedCrossRefGoogle Scholar
  24. Gloor P, Olivier A et al (1982) The role of the limbic system in experiential phenomena of temporal lobe epilepsy. Ann Neurol 12(2):129–144PubMedCrossRefGoogle Scholar
  25. Gordon E, Palmer DM et al (2010) EEG alpha asymmetry in schizophrenia, depression, PTSD, panic disorder, ADHD and conduct disorder. Clin EEG Neurosci 41(4):178–183PubMedCrossRefGoogle Scholar
  26. Gorji A, Speckmann EJ (2009) Epileptiform EEG spikes and their functional significance. Clin EEG Neurosci 40(4):230–233PubMedCrossRefGoogle Scholar
  27. Ham P, Waters DB et al (2005) Treatment of panic disorder. Am Fam Physician 71(4):733–739PubMedGoogle Scholar
  28. Hirschfeld RM (1996) Panic disorder: diagnosis, epidemiology, and clinical course. J Clin Psychiatry 57(Suppl 10):3–8 (Discussion 9–10)Google Scholar
  29. Hurley RA, Fisher R et al (2006) Sudden onset panic: epileptic aura or panic disorder? J Neuropsychiatry Clin Neurosci 18(4):436–443PubMedCrossRefGoogle Scholar
  30. Jabourian AP, Erlich M et al (1992) Panic attacks and 24-hour ambulatory EEG monitoring. Ann Med Psychol 150(2–3):240–244 (Discussion 245)Google Scholar
  31. Jacobi F, Wittchen HU et al (2004) Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 34(4):597–611PubMedCrossRefGoogle Scholar
  32. Jacobs J, Levan P et al (2009) Hemodynamic changes preceding the interictal EEG spike in patients with focal epilepsy investigated using simultaneous EEG-fMRI. Neuroimage 45(4):1220–1231PubMedCrossRefGoogle Scholar
  33. Kalynchuk LE (2000) Long-term amygdala kindling in rats as a model for the study of interictal emotionality in temporal lobe epilepsy. Neurosci Biobehav Rev 24(7):691–704PubMedCrossRefGoogle Scholar
  34. Kanner AM (2011) Ictal panic and interictal panic attacks: diagnostic and therapeutic principles. Neurol Clin 29(1):163–175 (ix)Google Scholar
  35. Keele NB (2005) The role of serotonin in impulsive and aggressive behaviors associated with epilepsy-like neuronal hyperexcitability in the amygdala. Epilepsy Behav: E&B 7(3):325–335CrossRefGoogle Scholar
  36. Kellett J, Kokkinidis L (2004) Extinction deficit and fear reinstatement after electrical stimulation of the amygdala: implications for kindling-associated fear and anxiety. Neuroscience 127(2):277–287PubMedCrossRefGoogle Scholar
  37. Kikuchi M, Koenig T et al (2011) EEG microstate analysis in drug-naive patients with panic disorder. PLoS ONE 6(7):e22912PubMedCentralPubMedCrossRefGoogle Scholar
  38. Lanteaume L, Khalfa S et al (2007) Emotion induction after direct intracerebral stimulations of human amygdala. Cereb Cortex 17(6):1307–1313PubMedCrossRefGoogle Scholar
  39. Lewine JD, Andrews R et al (1999) Magnetoencephalographic patterns of epileptiform activity in children with regressive autism spectrum disorders. Pediatrics 104(3 Pt 1):405–418PubMedCrossRefGoogle Scholar
  40. Lin YY, Shih YH et al (2003) Magnetoencephalographic yield of interictal spikes in temporal lobe epilepsy. Comparison with scalp EEG recordings. Neuroimage 19(3):1115–1126PubMedCrossRefGoogle Scholar
  41. Meletti S, Tassi L et al (2006) Emotions induced by intracerebral electrical stimulation of the temporal lobe. Epilepsia 47(Suppl 5):47–51PubMedCrossRefGoogle Scholar
  42. Mintzer S, Lopez F (2002) Comorbidity of ictal fear and panic disorder. Epilepsy Behav: E&B 3(4):330–337CrossRefGoogle Scholar
  43. Nguyen DK, Nguyen DB et al (2009) Insular cortex epilepsy: an overview. Can J Neurol Sci (Le journal canadien des sciences neurologiques) 36(Suppl 2):S58–S562Google Scholar
  44. Ray A, Tao JX et al (2007) Localizing value of scalp EEG spikes: a simultaneous scalp and intracranial study. Clin Neurophysiol: Official J Int Fed Clin Neurophysiol 118(1):69–79CrossRefGoogle Scholar
  45. Sazgar M, Carlen PL et al (2003) Panic attack semiology in right temporal lobe epilepsy. Epileptic Dis: Int Epilepsy J Videotape 5(2):93–100Google Scholar
  46. Skapinakis P, Lewis G et al (2011) Panic disorder and subthreshold panic in the UK general population: epidemiology, comorbidity and functional limitation. Eur Psychiatry: J Assoc Eur Psychiatrists 26(6):354–362CrossRefGoogle Scholar
  47. Toni C, Cassano GB et al (1996) Psychosensorial and related phenomena in panic disorder and in temporal lobe epilepsy. Compr Psychiatry 37(2):125–133PubMedCrossRefGoogle Scholar
  48. Towle VL, Carder RK et al (1999) Electrocorticographic coherence patterns. J Clin Neurophysiol: Official Publ Am Electroencephalogr Soc 16(6):528–547CrossRefGoogle Scholar
  49. Vaaler AE, Morken G et al (2009) Symptoms of epilepsy and organic brain dysfunctions in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department. BMC Psychiatry 9:63PubMedCentralPubMedCrossRefGoogle Scholar
  50. Van de Ville D, Britz J et al (2010) EEG microstate sequences in healthy humans at rest reveal scale-free dynamics. Proc Natl Acad Sci USA 107(42):18179–18184PubMedCrossRefGoogle Scholar
  51. Weilburg JB, Schachter S et al (1993) Focal paroxysmal EEG changes during atypical panic attacks. J Neuropsychiatry Clin Neurosci 5(1):50–55PubMedGoogle Scholar
  52. Weilburg JB, Schachter S et al (1995) EEG abnormalities in patients with atypical panic attacks. J Clin Psychiatry 56(8):358–362PubMedGoogle Scholar
  53. Wieser HG (1983) Depth recorded limbic seizures and psychopathology. Neurosci Biobehav Rev 7(3):427–440PubMedCrossRefGoogle Scholar
  54. Young GB, Chandarana PC et al (1995) Mesial temporal lobe seizures presenting as anxiety disorders. J Neuropsychiatry Clin Neurosci 7(3):352–357PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of Psychiatry and PsychotherapyUniversity of MunichMunichGermany

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