A patient with partial seizures manifested as panic attacks and auditory hallucination

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We report a case of a 51-year-old man presenting anxiety and autonomic symptoms of panic-like attacks and simultaneous auditory hallucination. No abnormalities were evident in a physical examination but his cognitive function was impaired. Thus panic disorder or non-specific dementia with psychosis was initially suspected. Brain MRI was almost normal, except for an old right basal ganglia infarction and mild frontal atrophy. Neuroimaging studies showed reduced glucose metabolism over bilateral frontal, right temporal and right parietal regions. When a panic-like attack occurred, EEG documented ictal discharges in the right frontal and temporal areas. After successful treatment with carbamazepine, cognitive dysfunction and abnormal findings on brain imaging were improved. This case suggests that epilepsy should be suspected in a patients presenting with anxiety symptoms of panic-like attacks and hallucinations.