Abdominal aura | |
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Specialty | Neurology, Epileptology |
Symptoms | Abdominal pain, nausea, vomiting |
Causes | Epileptic seizures, migraine |
Differential diagnosis | Irritable bowel syndrome (IBS), infectious gastroenteritis, anxiety |
Treatment | Anticonvulsants |
Abdominal aura (from Latin abdomen, "belly," and aura, "wind, odor, or gleam of light"), [1] [2] also known as visceral aura and epigastric aura, is a type of somatosensory aura that typically manifests as abdominal discomfort in the form of nausea, malaise, hunger, or pain. Abdominal aura is typically associated with epilepsy, especially temporal lobe epilepsy, [3] [4] and it can also be used in the context of migraine. The term is used to distinguish it from other types of somatosensory aura, notably visual disturbances and paraesthesia. [1] The abdominal aura can be classified as a somatic hallucination. Pathophysiologically, the abdominal aura is associated with aberrant neuronal discharges in sensory cortical areas representing the abdominal viscera. [1]
A variety of sensations and associated symptoms can be attributed to abdominal aura:
The symptoms of abdominal aura generally coincide with or precede the associated migraine or seizure, and depending on the etiology, they may last seconds to hours. [6] [7]
In epilepsy, aura refers to a type of focal seizure, in which seizure activity is limited to a portion of the brain and the person remains conscious and may experience a wide variety of sensory effects. [8] This type of focal seizure can often, but does not always, precede or evolve into another type of seizure. [3]
Abdominal aura is a common type of epileptic aura, and it is very common in temporal lobe epilepsy compared to extratemporal focal epilepsies. [3] In one study, more than half of patients with temporal lobe epilepsy experienced abdominal aura, and most of those cases of abdominal aura evolved into a generalized motor seizure. [3]
In addition to the abdominal pain and nausea/vomiting, other symptoms of seizures can sometimes be seen in abdominal epilepsy and may be helpful in diagnosis, including a duration of seconds to minutes, confusion or unresponsiveness during episodes, lethargy or sleep after episodes, and progression from abdominal aura into another type of seizure. [5]
If the abdominal aura does not precede or evolve into another type of seizure, it can be very difficult to diagnose. The most conclusive way to diagnose abdominal epilepsy is by correlating the abdominal symptoms with epileptic activity on an electroencephalogram (EEG). [5]
The presence of episodic abdominal complains in a person with known epilepsy does not necessarily indicate that they are having epileptic abdominal aura, as abdominal discomfort and nausea are very common symptoms in people with and without epilepsy. [5]
Treatment of abdominal epilepsy generally consists of anticonvulsants to prevent the seizures. [5]
Migraine aura typically precedes the onset of headache, evolves slowly, and most commonly consists of visual, sensory, and/or speech and language changes. Migraine aura can also occur in isolation without the headache. [6] Nausea, vomiting, and abdominal discomfort are common symptoms of migraine, and while they are not classically considered aura symptoms for the purposes of diagnosing migraine with aura, [6] the abdominal symptoms may still precede and predict the onset of migraine headache.
Abdominal aura is also seen in some disorders that are closely related to migraine, including cyclical vomiting syndrome and abdominal migraine.
Cyclical vomiting syndrome is a condition associated with recurrent episodic attacks of vomiting with periods of normalcy in between. It most commonly presents in childhood, and its symptoms overlap strongly with the gastrointestinal symptoms of migraine. [6] While poorly understood, it is also believed to be related to migraine in its etiology. There are mitochondrial DNA changes that are common among patients with cyclical vomiting syndrome and patients with migraine, and a family history of migraine is common among people who are diagnosed with cyclical vomiting syndrome. [9]
Abdominal migraine is an episodic disorder associated with recurring episodes of severe abdominal pain in the absence of headache. [6] In addition to abdominal pain, symptoms often include anorexia, nausea, vomiting, and pallor. Episodes typically last 2-72 hours, and patients are completely symptom-free in between episodes. It most commonly presents during childhood, and most children who experience abdominal migraine will go on to develop migraine headaches later in life. [6]
Migraine is a genetically-influenced complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea and light and sound sensitivity. Other characterizing symptoms may include vomiting, cognitive dysfunction, allodynia, and dizziness. Exacerbation or worsening of headache symptoms during physical activity is another distinguishing feature.
A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches.
Micropsia is a condition affecting human visual perception in which objects are perceived to be smaller than they actually are. Micropsia can be caused by optical factors, by distortion of images in the eye, by changes in the brain, and from psychological factors. Dissociative phenomena are linked with micropsia, which may be the result of brain-lateralization disturbance.
Macropsia is a neurological condition affecting human visual perception, in which objects within an affected section of the visual field appear larger than normal, causing the person to feel smaller than they actually are. Macropsia, along with its opposite condition, micropsia, can be categorized under dysmetropsia. Macropsia is related to other conditions dealing with visual perception, such as aniseikonia and Alice in Wonderland Syndrome. Macropsia has a wide range of causes, from prescription and illicit drugs, to migraines and (rarely) complex partial epilepsy, and to different retinal conditions, such as epiretinal membrane. Physiologically, retinal macropsia results from the compression of cones in the eye. It is the compression of receptor distribution that results in greater stimulation and thus a larger perceived image of an object.
A headache is often present in patients with epilepsy. If the headache occurs in the vicinity of a seizure, it is defined as peri-ictal headache, which can occur either before (pre-ictal) or after (post-ictal) the seizure, to which the term ictal refers. An ictal headache itself may or may not be an epileptic manifestation. In the first case, it is defined as ictal epileptic headache or simply epileptic headache. It is a type of pain seizure that can remain isolated or be followed by other manifestations of the seizure. On the other hand, a ictal non-epileptic headache is a headache that occurs during a seizure but it is not due to an epileptic mechanism. When the headache does not occur in the vicinity of a seizure, it is defined as inter-ictal headache. In the case it's a disorder separate from epilepsy, it's a comorbidity.
Cyclic vomiting syndrome (CVS) is a chronic functional condition of unknown pathogenesis. CVS is characterized as recurring episodes lasting a single day to multiple weeks. Each episode is divided into four phases: inter-episodic, prodrome, vomiting, and recovery. Inter-episodic phase, is characterized as no discernible symptoms, normal everyday activities can occur, and this phase typically lasts one week to one month. The prodrome phase is known as the pre-emetic phase, characterized by the initial feeling of an approaching episode, still able to keep down oral medication. Emetic or vomiting phase is characterized as intense persistent nausea, and repeated vomiting typically lasting hours to days. Recovery phase is typically the phase where vomiting ceases, nausea diminishes or is absent, and appetite returns. "Cyclic vomiting syndrome (CVS) is a rare abnormality of the neuroendocrine system that affects 2% of children." This disorder is thought to be closely related to migraines and family history of migraines.
An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is actually a minor seizure.
Acephalgic migraine is a neurological syndrome. It is a relatively uncommon variant of migraine in which the patient may experience some migraine symptoms such as aura, nausea, photophobia, and hemiparesis, but does not experience headache. It is generally classified as an event fulfilling the conditions of migraine with aura with no headache. It is sometimes distinguished from visual-only migraine aura without headache, also called ocular migraine.
Focal seizures are seizures that affect initially only one hemisphere of the brain. The brain is divided into two hemispheres, each consisting of four lobes – the frontal, temporal, parietal and occipital lobes. A focal seizure is generated in and affects just one part of the brain – a whole hemisphere or part of a lobe. Symptoms will vary according to where the seizure occurs. When seizures occur in the frontal lobe, the patient may experience a wave-like sensation in the head. When seizures occur in the temporal lobe, a feeling of déjà vu may be experienced. When seizures are localized to the parietal lobe, a numbness or tingling may occur. With seizures occurring in the occipital lobe, visual disturbances or hallucinations have been reported.
In the field of neurology, seizure types are categories of seizures defined by seizure behavior, symptoms, and diagnostic tests. The International League Against Epilepsy (ILAE) 2017 classification of seizures is the internationally recognized standard for identifying seizure types. The ILAE 2017 classification of seizures is a revision of the prior ILAE 1981 classification of seizures. Distinguishing between seizure types is important since different types of seizures may have different causes, outcomes, and treatments.
Abdominal epilepsy is a rare condition consisting of gastrointestinal disturbances caused by epileptiform seizure activity. It is most frequently found in children, though a few cases of it have been reported in adults. It has been described as a type of temporal lobe epilepsy. Responsiveness to anticonvulsants can aid in the diagnosis. 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. 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.
Panayiotopoulos syndrome is a common idiopathic childhood-related seizure disorder that occurs exclusively in otherwise normal children and manifests mainly with autonomic epileptic seizures and autonomic status epilepticus. An expert consensus has defined Panayiotopoulos syndrome as "a benign age-related focal seizure disorder occurring in early and mid-childhood. It is characterized by seizures, often prolonged, with predominantly autonomic symptoms, and by an EEG [electroencephalogram] that shows shifting and/or multiple foci, often with occipital predominance."
The classification of all headaches, including migraines, is organized by the International Headache Society, and published in the International Classification of Headache Disorders (ICHD). The current version, the ICHD-3 beta, was published in 2013.
Migralepsy is a rare condition in which a migraine is followed, within an hour period, by an epileptic seizure. Because of the similarities in signs, symptoms, and treatments of both conditions, such as the neurological basis, the psychological issues, and the autonomic distress that is created from them, they individually increase the likelihood of causing the other. However, also because of the sameness, they are often misdiagnosed for each other, as migralepsy rarely occurs.
Vertiginous epilepsy is infrequently the first symptom of a seizure, characterized by a feeling of vertigo. When it occurs, there is a sensation of rotation or movement that lasts for a few seconds before full seizure activity. While the specific causes of this disease are speculative there are several methods for diagnosis, the most important being the patient's recall of episodes. Most times, those diagnosed with vertiginous seizures are left to self-manage their symptoms or are able to use anti-epileptic medication to dampen the severity of their symptoms.
Forced Normalization (FN) is a psychiatric phenomenon in which a long term episodic epilepsy or migraine disorder is treated, and, although the electroencephalogram (EEG) appears to have stabilized, acute behavioral, mood, and psychological disturbances begin to manifest. If, or when, treatment for the disorder is halted, the disturbances go away, but the episodic spikes on the EEG reappear. H. Landolt coined the term 'Forced Normalization' in 1953 in response to a change he witnessed in epileptic EEGs, which monitor electrical activity in the brain. These changes were followed by abrupt behavioral changes in the patient. Landolt concluded that forced normalization is "the phenomenon characterized by the fact that, with the occurrence of psychotic states, the electroencephalography becomes more normal or entirely normal, as compared with previous and subsequent EEG findings." Forced normalization, as described by Landolt, was therefore an electrophysiological phenomenon with the electroencephalograph at its helm.
Idiopathic childhood occipital epilepsy of Gastaut (ICOE-G) is a pure but rare form of idiopathic occipital epilepsy that affects otherwise normal children and adolescents. It is classified amongst benign idiopathic childhood focal epilepsies such as rolandic epilepsy and Panayiotopoulos syndrome.
Abdominal migraine(AM) is a functional disorder that usually manifests in childhood and adolescence, without a clear pathologic mechanism or biochemical irregularity. Children frequently experience sporadic episodes of excruciating central abdominal pain accompanied by migrainous symptoms like nausea, vomiting, severe headaches, and general pallor. Abdominal migraine can be diagnosed based on clinical criteria and the exclusion of other disorders.
An epilepsy syndrome is defined as "a characteristic cluster of clinical and Electroencephalography (EEG) features, often supported by specific etiological findings ."
Occipital epilepsy is a neurological disorder that arises from excessive neural activity in the occipital lobe of the brain that may or may not be symptomatic. Occipital lobe epilepsy is fairly rare, and may sometimes be misdiagnosed as migraine when symptomatic. Epileptic seizures are the result of synchronized neural activity that is excessive, and may stem from a failure of inhibitory neurons to regulate properly.