Abdominal epilepsy

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Abdominal epilepsy
Other namesAutonomic epilepsy

Abdominal epilepsy is a rare condition most frequently found in children, consisting of gastrointestinal disturbances caused by epileptiform seizure activity.[1][2][3][4][5] It has been described as a type of temporal lobe epilepsy.[6] Responsiveness to anticonvulsants can aid in the diagnosis.[7] Distinguishing features of abdominal epilepsy include (1) Abnormal laboratory, radiographic, and endoscopic findings revealing paroxysmal GI manifestations of unknown origin (2) CNS symptoms (3) Abnormal EEG.[8] Most published medical literature dealing with abdominal epilepsy is in the form of individual case reports. A 2005 review article found a total of 36 cases described in the medical literature.[3]

Symptoms and signs[]

Abdominal epilepsy is marked by is GI symptoms such as abdominal pain followed by uncontrollable vomiting, usually preceded by lethargy. Lethargy and confusion is the most common neurological symptoms associated with abdominal epilepsy. Other symptoms include generalized tonic-clonic seizures followed by sleep, and unresponsiveness.[9][10]

Cause[]

It is unknown as to what causes abdominal epilepsy. While a causal relationship between seizure activity and the GI symptoms has not been proven, the GI symptoms cannot be explained by other pathophysiological mechanisms, and are seen to improve upon anticonvulsant treatment. Because the condition is so rare, no high-quality studies exist. There have been too few reported cases to identify risk factors, genetic factors, or other potential causes.[9]

Diagnosis[]

Criteria for diagnosis of abdominal epilepsy includes frequent periodic abdominal symptoms, an abnormal electroencephalogram (EEG) and significant improvement of gastrointestinal symptoms after taking anti-seizure medication. Medical testing for diagnosis can be completed using MRI scans of the brain, CT scans and ultrasounds of the abdomen, endoscopy of the gastrointestinal tract, and blood tests.[9]

Treatment[]

Like other forms of epilepsy, abdominal epilepsy is treated with anticonvulsant drugs, such as phenytoin. Since no controlled studies exist, however, other drugs may be equally effective.[9]

Pathophysiology[]

The pathophysiology behind abdominal epilepsy remains speculative. Several studies indicate that insula and sylvian fissures also known as lateral sulcus could be related with inducing the abdominal epilepsy. Their location is found to coincide with the locations of the abdomen on the Sensory homunculus.[11] Any pathophysiological changes in the M2 portion of cerebral artery which flows through lateral sulcus is associated with the epilepsies of the temporal and parietal regions.[12] Cerebral tumors have been assessed to be a plausible cause of abdominal epilepsy.[13] Right parietal and occipital encephalomalacia, biparietal atrophy and bilateral perisylvian polymicrogyria has been possibly associated with ictal abdominal pain associated with abdominal epilepsy.[14]

History[]

French physician and scientist Armand Trousseau is commonly credited as being the first to describe the condition in 1868 in a boy with paroxysmal GI symptoms culminating in grand mal epileptic seizure.[15] The first account of abdominal epilepsy supported by EEG tracings came in 1944 in an article by M.T. Moore, followed by subsequent case reports from the same group.[16][17]

Footnotes[]

  1. ^ Dutta SR, Hazarika I, Chakravarty BP (March 2007). "Abdominal epilepsy, an uncommon cause of recurrent abdominal pain: a brief report". Gut. 56 (3): 439–441. doi:10.1136/gut.2006.094250. PMC 1856820. PMID 17339252.
  2. ^ Eschle D, Siegel AM, Wieser HG (December 2002). "Epilepsy with severe abdominal pain". Mayo Clin. Proc. 77 (12): 1358–1360. doi:10.4065/77.12.1358. PMID 12479525.
  3. ^ a b Zinkin NT, Peppercorn MA (April 2005). "Abdominal epilepsy". Best Pract Res Clin Gastroenterol. 19 (2): 263–274. doi:10.1016/j.bpg.2004.10.001. PMID 15833692.
  4. ^ Levendorf M (January 2000). "Chronic abdominal pain and abdominal epilepsy". Am Fam Physician. 61 (1): 50. PMID 10643951.
  5. ^ Peppercorn MA, Herzog AG (October 1989). "The spectrum of abdominal epilepsy in adults". Am. J. Gastroenterol. 84 (10): 1294–1296. PMID 2801681.
  6. ^ Topno N, Gopasetty MS, Kudva A, B L (December 2005). "Abdominal Epilepsy and Foreign Body in the Abdomen – Dilemma in Diagnosis of Abdominal Pain". Yonsei Med. J. 46 (6): 870–873. doi:10.3349/ymj.2005.46.6.870. PMC 2810606. PMID 16385668.
  7. ^ Singhi PD, Kaur S (April 1988). "Abdominal epilepsy misdiagnosed as psychogenic pain". Postgrad Med J. 64 (750): 281–282. doi:10.1136/pgmj.64.750.281. PMC 2428499. PMID 3186570.
  8. ^ Murai, Tomohiko; Kinoshita, Masako (2019-06-10). Acute Diarrhea as a Manifestation of Abdominal Epilepsy. IntechOpen. ISBN 978-1-78923-866-2.
  9. ^ a b c d "Abdominal Epilepsy in Children and Adults". Epilepsy Health Center. WebMD. 18 March 2013. Retrieved 13 February 2014.
  10. ^ Zinkin, Noah T.; Peppercorn, Mark A. (2005-04-01). "Abdominal epilepsy". Best Practice & Research Clinical Gastroenterology. Unusual Causes of Abdominal Pain. 19 (2): 263–274. doi:10.1016/j.bpg.2004.10.001. ISSN 1521-6918.
  11. ^ García-Herrero, D.; Fernández-Torre, J. L.; Barrasa, J.; Calleja, J.; Pascual, J. (December 1998). "Abdominal epilepsy in an adolescent with bilateral perisylvian polymicrogyria". Epilepsia. 39 (12): 1370–1374. doi:10.1111/j.1528-1157.1998.tb01340.x. ISSN 0013-9580. PMID 9860077.
  12. ^ Navarro-Orozco, Daniel; Sánchez-Manso, Juan Carlos (2021), "Neuroanatomy, Middle Cerebral Artery", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30252258, retrieved 2021-12-13
  13. ^ Franzon, Renata C.; Lopes, Camila F.; Schmutzler, Kátia M. R.; Morais, Maria Isabel R.; Guerreiro, Marilisa M. (September 2002). "Recurrent abdominal pain: when an epileptic seizure should be suspected?". Arquivos de Neuro-Psiquiatria. 60: 628–630. doi:10.1590/S0004-282X2002000400021. ISSN 0004-282X.
  14. ^ Mitchell, Wendy G. (1983-04-01). "Abdominal Epilepsy: Cyclic Vomiting as the Major Symptom of Simple Partial Seizures". Archives of Neurology. 40 (4): 251. doi:10.1001/archneur.1983.04050040081017. ISSN 0003-9942.
  15. ^ Agrawal, Pradeep; Dhar, Naresh K.; Bhatia, M. S.; Malik, S. C. (1989). "Abdominal epilepsy". The Indian Journal of Pediatrics. 56 (4): 539–541. doi:10.1007/BF02722438. PMID 2633998. S2CID 45216244.
  16. ^ M.T. Moore (1944). "Paroxysmal abdominal pain: a form of focal symptomatic epilepsy". JAMA. 124 (9): 1233–40. doi:10.1001/jama.1944.02850090017005. PMID 21006167.
  17. ^ Moore MT (July 1950). "Abdominal epilepsy versus "abdominal migraine"". Ann. Intern. Med. 33 (1): 122–133. doi:10.7326/0003-4819-33-1-122. PMID 15426097.

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