Fear as the only clinical expression of affective focal status epilepticus

Affective seizures consist of fear, depression, joy, and (rarely) anger. A correct diagnosis is often delayed as the behavioral features, like fear, are interpreted as psychiatric disorders. We describe a patient with affective focal status epilepticus (AFSE) in which fear was the only clinical manifestation. We present electroencephalographic correlates and discuss the diagnostic difficulties that can be encountered in similar cases. AFSE with fear as the only clinical expression may represent a diagnostic challenge. When fear is the only or the prominent behavioral feature, seizures may be diagnosed as panic attacks, leading to erroneous therapy. In such situations, electroencephalography is an essential tool in differentiating between psychiatric disorders and epileptic events.