Your heart is racing. Your chest feels tight. For a second, you wonder, “Is it anxiety — or something more serious, like a seizure?”

It’s a fair question. Panic attacks and epileptic seizures can sometimes have similar symptoms. Both may involve a rapid heartbeat, sweating, and intense fear.

Panic attacks don’t directly cause epileptic seizures. Panic attacks and epileptic seizures are different events with different underlying causes. But the overlap in symptoms is real.

For people who already live with epilepsy, stress and anxiety may also be linked with seizure activity. Stress is commonly reported as a seizure trigger. Here’s what separates the two conditions, where they overlap, and when it’s worth talking to a doctor.

Can Panic Attacks Directly Cause Seizures?

Panic attacks usually don’t directly cause epileptic seizures. However, in some people with epilepsy, breathing changes during a panic attack may occasionally trigger a seizure.

Panic attacks come from the body’s fear and stress response. Epileptic seizures come from abnormal electrical activity in the brain.

In some people, though, intense psychological distress can trigger seizurelike episodes that aren’t epilepsy at all.

How Panic Attacks and Seizures Differ

A panic attack is a sudden episode of intense fear or discomfort that can happen even when there’s no clear danger or trigger. It activates the body’s survival response, sometimes described as the fight-or-flight response.

During an episode, you may experience a rapid heartbeat, sweating, trembling, dizziness, lightheadedness, and shortness of breath. Chest pain, nausea, numbness, or tingling can also occur.

Panic disorder is an anxiety disorder marked by repeated panic attacks. It often comes with ongoing worry about future attacks. It can also lead to avoidance behaviors, like avoiding places where an attack happened before.

An epileptic seizure works differently. It happens when there’s a sudden burst of abnormal electrical activity in the brain. This can affect movement, sensation, emotions, behavior, or awareness.

Seizures vary widely. Tonic-clonic seizures involve convulsions and a loss of consciousness. Absence seizures cause brief lapses in awareness, often with little noticeable movement.

The two conditions can look a lot alike. Because of this, panic disorder is one of the conditions most frequently mistaken for a seizure disorder.

What Are Psychogenic Nonepileptic Seizures?

Psychogenic nonepileptic seizures (PNES) sit in an important middle ground. They’re often referred to by doctors as functional seizures. These seizurelike episodes can include shaking, unresponsiveness, or loss of consciousness.

But PNES aren’t caused by abnormal electrical activity in the brain. Instead, they fall under functional neurological disorder (FND). This means they occur when intense psychological distress or anxiety triggers the physical episode.

PNES can look just like an epileptic seizure. Because of this, doctors often use video electroencephalogram (EEG) monitoring to tell them apart.

An EEG records the brain’s electrical activity. During a PNES episode, the EEG doesn’t show the epileptic electrical activity associated with an epileptic seizure.

Treatment for PNES usually centers on psychotherapy. Cognitive behavioral therapy (CBT), a type of talk therapy, is a common approach. It helps people understand and manage the thought patterns and behaviors that contribute to the episodes.

Anti-seizure medications typically aren’t part of the plan. That’s because PNES isn’t caused by abnormal brain activity.

How Can You Tell a Panic Attack From a Seizure?

A few patterns can help. They separate a panic attack from a seizure, even though the two share symptoms.

• Duration — Seizures usually last just seconds up to a few minutes. Panic attacks tend to last longer, often between five and 20 minutes.
• Pattern — Seizures tend to look nearly the same each time. Panic attacks can vary more from one episode to the next.
• Automatisms — Repetitive movements, like chewing, swallowing, or picking at clothing, point toward a seizure.
• Awareness and memory — Panic attacks usually leave memory and alertness intact. Seizures may be followed by a temporary period of confusion or grogginess afterward, sometimes called a postictal state.
• Hyperventilation — Panic attacks can sometimes involve rapid, deep breathing. In some people, especially children with absence epilepsy, hyperventilation can also trigger a seizure.

None of these signs are foolproof on their own. That’s why the overlap can make an accurate diagnosis hard to pin down.

When Seizures Look Like Panic Attacks — and Vice Versa

Sometimes the overlap goes the other way. A seizure can look so much like a panic attack that it gets overlooked.

How Seizure Auras Can Mimic Panic Attacks

Seizures may start in a part of the brain called the temporal lobe. These often begin with a warning sign called an aura.

A temporal lobe aura can bring on sudden fear. It can also cause a sense of unreality called derealization, plus heart palpitations and other bodywide symptoms. This mix can look a lot like a panic attack.

Because of this overlap, some people are first diagnosed with panic disorder. Later, they learn their episodes were actually caused by epilepsy.

Video EEG monitoring often sorts out which condition is really happening. Doctors sometimes pair it with an MRI scan of the brain. A neurologist is typically the specialist who makes this assessment.

If You Already Have Epilepsy: Stress and Seizure Risk

Stress is commonly reported as a seizure trigger in people with epilepsy, and anxiety may also be linked with seizure activity. Intense psychological distress can lower your seizure threshold. This can make a breakthrough seizure more likely.

Panic attacks don’t cause epilepsy. However, panic attacks and epilepsy can occur in the same person. Plus, anxiety can sometimes affect seizure frequency in people who already have epilepsy.

If you already have a seizure disorder, managing anxiety can help too. It’s one more piece, alongside anti-seizure medications and other treatments your neurologist may recommend.

When Should You Talk to Your Doctor?

A few signs suggest an episode may not be a typical panic attack. These are worth bringing up with a doctor or neurologist.

• New-onset episodes that start after age 45, which is unusual for a first panic attack
• A family member or caregiver noticing repetitive movements, like chewing or plucking at clothing, during an episode
• A childhood history of seizures with fever
• No improvement despite standard anxiety treatment, like psychotherapy or anti-anxiety medications
• Loss of consciousness or confusion that lingers after the episode ends

A seizure lasting five minutes or longer is a medical emergency. So is a set of repeated seizures without full recovery in between them. If this happens, call emergency services right away.

Getting the right diagnosis matters. Treatment differs across panic disorder, epilepsy, and PNES.

Panic disorder can be treated with psychotherapy, including CBT. Antidepressants like selective serotonin reuptake inhibitors (SSRIs) may also help. So can other anti-anxiety medications, such as benzodiazepines.

Epilepsy is typically treated with anti-seizure medications.

Your Action Plan

Panic attacks and epileptic seizures have different underlying causes. However, they can share many overlapping physical symptoms.

A rapid heartbeat, dizziness, difficulty breathing, and intense fear can occur in both conditions. That’s why one condition may sometimes be mistaken for the other, leading to a misdiagnosis.

If you’re dealing with unexplained episodes, keeping a simple log can help. Note how long each one lasted, what it felt like, and whether you felt confused or tired afterward. Bring it to your next appointment.

If anything about your episodes feels unusual, ask your doctor about it. They may refer you to a neurologist or recommend an EEG for further evaluation. Getting the right diagnosis is the first step toward the right treatment.

Whichever condition turns out to be the underlying cause of your symptoms, effective treatment is available. This might mean psychotherapy, medication, or a combination of both. Receiving an accurate diagnosis and working with your healthcare team can help you find an effective path forward.

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What specific signs help you tell the difference between a panic attack and a seizure? Let others know in the comments below.