Panic Attack vs Seizure: How to Tell the Difference — A Neurologist Explains

A patient arrives convinced they have epilepsy. Their episodes include sudden heart pounding, chest tightness, shortness of breath, tingling in the hands, dizziness, a feeling of unreality, and intense fear that they are about to die — lasting 10–20 minutes and then resolving completely. Their EEG is normal. They have been given anti-epileptic medication by a local clinic. The actual diagnosis: panic disorder.

The reverse also happens: a patient with absence epilepsy or temporal lobe epilepsy is treated for anxiety for years before the correct diagnosis is made. Getting this distinction right matters enormously for treatment.

Overlapping Features

Both panic attacks and seizures can produce: palpitations, chest tightness, shortness of breath, dizziness, a sense of unreality (derealization/depersonalization), fear, tingling (paraesthesias), and a feeling that something terrible is happening. Both can cause the person to lose what they were doing temporarily.

Features That Favour Panic Attack

• Duration of 5–20 minutes — gradually builds and then slowly resolves
• The person remains fully conscious and remembers the entire episode
• Tingling is typically bilateral (both hands and around the mouth) from hyperventilation
• Triggered by specific situations, stressors, or perceived threats
• Strong family or personal history of anxiety
• Relief with controlled breathing
• Normal EEG (though EEG can be normal in some epilepsy types too)

Features That Favour Seizure

• Loss of consciousness (person is completely unaware during the event)
• Amnesia for the event — person does not remember anything that happened during the episode
• Post-ictal confusion or sleep (deep drowsiness after the event lasting minutes to hours)
• Tongue biting — especially on the lateral aspect of the tongue
• Incontinence during the episode
• Stereotyped aura: always the same sensation before every episode (specific smell, visual disturbance, déjà vu)
• Jerking movements — though not all seizures cause jerking

Diagnosis

A standard EEG captures only 50% of epilepsy cases — a normal EEG does not exclude epilepsy. A 24-hour ambulatory EEG or video-EEG monitoring during a typical episode is the gold standard. For panic disorder, the diagnosis is clinical — based on history, examination, ruling out cardiac causes (ECG, Holter monitor), and thyroid function (hyperthyroidism produces palpitation-dominant presentations).

For epilepsy and anxiety assessment: Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.