A panic attack is a sudden, intense surge of fear or discomfort that peaks within minutes, involving physical symptoms like heart palpitations, sweating, and shortness of breath. A seizure, in contrast, is caused by abnormal, excessive electrical discharges in the brain, often leading to changes in behavior, movements, or consciousness. The direct answer is that a panic attack generally cannot cause a true epileptic seizure. However, the extreme physiological response during a severe panic attack can closely mimic seizure activity or trigger a related event that appears similar to an observer.
The Acute Physiological Overlap
A severe panic attack activates the body’s fight-or-flight response, often leading to hyperventilation (rapid, shallow breathing). This excessive breathing causes a significant drop in carbon dioxide levels in the blood. The resulting chemical imbalance, known as respiratory alkalosis, profoundly affects the nervous system.
Consequences include lightheadedness, dizziness, and intense tingling sensations (paresthesia), particularly in the hands, feet, and around the mouth. This altered state can also trigger muscle spasms, such as carpopedal spasm, where the hands and feet involuntarily contract. These movements are not seizures but can be misinterpreted as convulsive activity. Intense hyperventilation can also lead to fainting (syncope), sometimes accompanied by brief, disorganized jerking movements known as convulsive syncope. This transient motor activity results from a temporary lack of blood flow to the brain, not abnormal electrical firing.
Defining Non-Epileptic Seizure Events
The confusion between panic and seizures is complicated by Psychogenic Non-Epileptic Seizures (PNES), sometimes called functional seizures. PNES are episodes that look like epileptic seizures but lack the uncontrolled electrical discharges characteristic of epilepsy. Instead, these events are physical manifestations of underlying psychological distress, such as severe anxiety or panic disorder.
PNES is classified as a functional neurological disorder, where brain function is temporarily disrupted without structural damage. These events are genuine and involuntary, rooted in the brain’s stress response system, and triggered by emotional distress. Diagnosis is complex because symptoms closely resemble true epilepsy. However, an electroencephalogram (EEG) conducted during a PNES event shows normal brain electrical activity. This condition requires a distinct treatment approach focused on the psychological origin rather than anti-epileptic medications.
Key Differences in Symptom Presentation
Distinguishing a true epileptic seizure from a severe panic attack or a PNES event requires careful observation.
Onset and Duration
A true epileptic seizure often has an abrupt onset, beginning without warning or with only a brief aura. Conversely, panic attacks and most PNES events tend to have a more gradual build-up, often following increasing stress. Most generalized epileptic seizures last only a few seconds to a few minutes. Panic attacks typically peak within ten minutes but can last significantly longer, sometimes continuing for 20 to 30 minutes.
Post-Event State and Movement
The post-event state is a major difference. Epileptic seizures are commonly followed by deep confusion, extreme sleepiness, or disorientation known as the post-ictal phase. In contrast, a person recovering from a panic attack or PNES typically returns to full awareness rapidly, often recalling the event in detail.
The physical movements also differ:
- Epileptic seizures involve rhythmic, synchronized jerking movements of the limbs.
- PNES movements are often asynchronous, fluctuating in intensity, and may involve side-to-side head shaking or pelvic thrusting.
- Loss of bladder or bowel control is common during a generalized epileptic seizure but is rare during a panic attack or PNES event.
When Professional Assessment is Necessary
Any event involving loss of consciousness, uncontrolled movements, or confusion should prompt an immediate medical evaluation. Only a qualified healthcare professional can accurately determine the underlying cause of a seizure-like episode. The gold standard for definitive diagnosis is video-electroencephalography (video-EEG) monitoring.
This procedure simultaneously records brain electrical activity and a video of the patient’s physical symptoms during an episode. If the video shows a seizure-like event while the EEG recording remains normal, it points strongly to a non-epileptic cause like PNES or a severe panic reaction. Neurologists specialize in treating true epileptic seizures, while psychiatrists and psychologists handle PNES and panic disorders. Treatment for confirmed epilepsy involves anti-epileptic medications to stabilize brain electrical activity. For PNES and severe panic attacks, treatment centers on psychotherapy, particularly Cognitive Behavioral Therapy (CBT), and stress management techniques. Addressing the psychological roots of the symptoms is necessary to reduce their frequency and severity.