Neural correlates of spontaneous panic attacks.

In this report, we present two anxiety disorder patients who spontaneously experienced a panic attack during an fMRI examination and subsequently aborted the measurement. We analyzed the functional data gathered up to that point in relation to the patients' subsequent verbal reports of the course of the panic attacks. Within prominent structures of the fear network (amygdala, insula, prefrontal cortex) neural dynamics mirrored the description of the attack very well for one of the patients. For the other patient who experienced a less intense attack and who was treated pharmacologically at the time of measurement, the relation was limited to the prefrontal cortex. Investigating the temporal dynamics of neural activation in an ecologically valid situation may point to the potentially different roles of the amygdala and the insula as well as the prefrontal cortex prior to and during a panic attack.