Patients with seizure of frontal lobe origin can present with bizarre behavior. At times, this bizarre behavior can be unrecognized or confused with seizure of other origin with nonepileptic events or with psychiatric disorder.
I recently saw a patient who began to experience events that were characterized by terrible fear which was followed by irritability. It was as if she could not stand in place where she was at and felt like running away. She was referred to a psychiatrist who diagnosed her to have panic disorder. She was subsequently treated for panic disorder. Her symptoms did not improve; therefore, she came to see me for a second opinion. Upon asking, the patient reported that the episodes were always the same and that they lasted approximately seconds to minutes. Due to the stereotypicity of the event and a normal routine electroencephalography (EEG), we requested that she would undergo a 24-hour video-monitoring EEG. Stereotypicity can help the physician in the differential diagnosis of psychiatric disorder versus a seizure disorder. During 24-hour video-monitoring EEG, she experienced several of these events. Also, a computer tomography scan was performed, which showed a small meningioma in the orbital frontal region.