The contribution of brain imaging to the study of panic disorder

Aims - The present review is aimed to evaluate the recent contribution of brain imaging techniques to the definition of neuroanatomofunctional models of panic disorder (PD). Methods - Structural and functional brain imaging studies of PD, conducted from January 1993 to October 2003 and selected through a comprehensive Medline search (key-words: panic disorder, emotions, brain imaging, EEG, Event-Related Potentials, MRI, fMRI, PET, SPECT, TC) were included in the review. The Medline search has been complemented by bibliographic cross-referencing. Results - The majority of the reviewed studies suggests that a dysfunction of a neural circuit encompassing prefrontal and temporo-limbic cortices is present in PD. A right hemisphere preferential involvement in PD has been shown by several studies. Conclusions - Reviewed neuroimaging studies suggest a dysfunction of frontal and temporo-limbic circuitries in PD. However, those studies cannot be considered conclusive because of several methodological limitations. Longitudinal and multi-modal studies involving larger patient samples, possibly integrated with population-based and genetic studies, would provide more insight into pathophysiological mechanisms of PD.