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Panic, Ictal Fear, and Hyperventilation 

Panic, Ictal Fear, and Hyperventilation
Panic, Ictal Fear, and Hyperventilation

Martin Schöndienst

and Katrin Lindemann

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date: 03 December 2021

This chapter begins with an examination of Gowers’ attempt to describe “vagal and vaso-vagal attacks” – panic attacks in today’s diagnostic classifications – and his difficulties with concisely delineating a condition, which is now thought of as a “mental” disorder. Given that the interrelations between panic, hyperventilation and ictal fear are diverse and have to be explored clinically on a case-by-case basis, we then use several case reports to demonstrate how diagnostic access can be gained and how this relates to therapeutic dimensions. In the borderland of these conditions, every patient represents a ‘special scenario’ with idiosyncratic transitions between anxiety and epilepsy and sometimes hyperventilation, making it indispensable to consider every patient’s individual subjective symptoms. We illustrate this approach by working with short extracts from doctor-patient interactions. Patients’ own descriptions of their subjective experiences usually allow a clear definition of the idiosyncratic aspects of their condition. We then discuss the pathophysiological mechanisms of the different disorders. Further case reports highlight situations in which panic and hyperventilation are tightly interwoven with epileptic seizures. Our chapter concludes with suggestions for the management of this clinical scenario.

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