A panic attack, characterized by an intense surge of fear that triggers severe physical reactions, is fundamentally a psychological event, while a seizure is a neurological event. A panic attack cannot cause a true epileptic seizure, but the intense stress of a panic attack can sometimes act as a trigger in individuals already prone to epilepsy. Panic attacks are not caused by abnormal electrical activity in the brain, which is the hallmark of a seizure. Instead, they arise from the body’s overreaction to perceived danger, leading to a cascade of physical symptoms that can be profoundly frightening.
Fundamental Differences Between Panic Attacks and Seizures
The primary distinction between a panic attack and a seizure lies in their origin. A panic attack is an anxiety-based response where the body’s “fight or flight” mechanism is activated without a genuine threat, involving the release of stress hormones. Seizures are caused by a sudden, uncontrolled surge of electrical activity within the brain’s neurons. This electrical misfiring temporarily disrupts normal communication between brain cells, leading to changes in behavior, movement, sensation, or consciousness.
The typical duration of each event also differs. A panic attack usually peaks in intensity within about ten minutes and then gradually subsides. Most epileptic seizures are much shorter, often lasting only between a few seconds and two minutes before resolving. A person experiencing a panic attack generally remains aware of their surroundings and responsive. During an epileptic seizure, however, a person often loses or has an altered level of consciousness and may not remember the event.
The Physiological Cascade of a Panic Attack
The intense physical symptoms of a panic attack are rooted in the body’s natural defense system going into overdrive. When the brain perceives a threat, it signals the sympathetic nervous system to initiate the stress response. This triggers the release of adrenaline and other stress hormones, causing the heart rate to accelerate, breathing to become rapid and shallow, and blood to be shunted to the larger muscles.
The rapid and deep breathing, known as hyperventilation, can mimic other serious medical conditions. Hyperventilation leads to a rapid exhalation of carbon dioxide, causing hypocapnia (low CO2 levels) and respiratory alkalosis. This chemical imbalance reduces the amount of free calcium ions in the blood. The drop in free calcium increases the excitability of peripheral nerves, causing common panic attack symptoms like tingling and numbness (paresthesia) in the hands, feet, and face. In severe cases, this can lead to muscle cramping and spasms, known as tetany, which may be mistaken for seizure-like convulsions.
The Neurological Basis of Seizure Activity
A true epileptic seizure stems from an imbalance between excitatory and inhibitory signals among neurons in the brain. The activity is characterized by an excessive, hypersynchronous electrical discharge of a population of neurons. Epilepsy is a neurological disorder defined by a predisposition to generate unprovoked seizures, often due to underlying structural abnormalities or genetic factors.
Seizures are broadly classified into two main categories: focal and generalized. Focal seizures start in one area of the brain, while generalized seizures involve both sides of the brain simultaneously. In individuals with epilepsy, extreme stress, including the kind caused by a panic attack, can act as a trigger by lowering the seizure threshold. Stress can make the brain more vulnerable to crossing that threshold, but the panic attack itself does not create the underlying neurological condition.
When Symptoms Overlap: Psychogenic Non-Epileptic Events
The question of whether a panic attack can lead to a seizure often arises because of Psychogenic Non-Epileptic Seizures (PNES), also referred to as functional seizures. These episodes physically resemble epileptic seizures, involving symptoms like shaking or loss of control, but they do not originate from abnormal electrical brain activity. PNES are classified as a functional neurological disorder, where the physical symptoms are a manifestation of underlying psychological distress, such as anxiety, trauma, or panic disorders.
The distinction between a true epileptic seizure and a PNES event is made through specialized testing. A definitive diagnosis often requires video-electroencephalogram (video-EEG) monitoring, which simultaneously records the patient’s physical movements and the electrical activity in their brain. During a PNES event, the video will show seizure-like behavior, but the EEG recording will remain normal, showing no signs of the excessive neuronal discharge characteristic of epilepsy. Management of PNES involves psychological treatments, such as cognitive-behavioral therapy, rather than the anti-seizure medications used for epilepsy.