Comorbidity of panic disorder and seizures: Affinity or artifact?

Abstract

Case reports of the co-occurence of panic attacks and seizures in the same individuals have prompted speculation about a shared neuropathophysiology. We investigated the association of a history of panic disorder and of seizures using community data from the Epidemiologic Catchment Area (ECA) studies, a multisite, population-based survey of psychiatric disorders. At one site (New Haven) post hoc data inspection disclosed a strong association between lifetime prevalence of panic disorder and of seizures (OR=15), which persisted in controlled analyses. The adjusted odds of persons with panic disorder reporting a seizure history was 5.9-fold (95% CI, 2.2–15.5) that of persons with no lifetime psychiatric disorder and 5.5-fold (95% CI, 2.0–15.3) that of persons with other psychiatric disorders. This association was also found in a second, independent sample, comprising the other four ECA sites, using a different measure of seizure history. In this second sample, the corresponding odds ratios were 5.1 (95% CI, 3.0–8.5) and 1.9 (95% CI, 1.1–3.3), respectively. These findings must be interpreted with extreme caution, since they were not hypothesized at study inception and may arise from several spurious and artifactual causes. For example, subjects with panic disorder may mistakenly label their attacks as seizures. Additionally, this association appears to characterize panic disorder only when complicated by other psychiatric conditions. Nonetheless, these suggestive results argue for further controlled investigations of this question.