Abdominal epilepsy

Last updated
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] Though a few cases of it have been reported in adults too. [6] It has been described as a type of temporal lobe epilepsy. [7] Responsiveness to anticonvulsants can aid in the diagnosis. [8] 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. [9] 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]

Contents

Symptoms and signs

Abdominal epilepsy is marked by 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. [10] [11] Abdominal aura characterized by abdominal sensations precedes the abdominal seizure. This is associated with pain, nausea, hunger, gassiness especially in temporal lobe epilepsy. [12]

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. [10]

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. [10]

Typically, the diagnostic process begins with gathering information regarding the presence of common symptoms like paroxysmal abdominal pain and other gastrointestinal issues. Symptoms that persist continuously or for prolonged periods are less likely to indicate abdominal epilepsy. It's important to consider convulsions, alterations in consciousness, and other neurological symptoms alongside gastrointestinal symptoms when diagnosing abdominal epilepsy. Though every episode of it may not be accompanied by a neurological symptom. This often makes these neurological symptoms unnoticeable for the patient. [11]

This is followed by the necessary evaluation that comprises neurological and physical examination, laboratory test, abdominal imaging using CT and ultrasound, endoscopy. Next if the above are normal but the history still suggests for this syndrome an EEG must be performed. EEG findings alone too cannot distinguish between the kinds of epilepsy. Moreover, often an EEG report could be normal if an event is not accompanied by neurological symptoms. If it is doubtable a neurologist should be consulted. [11]

Treatment

Like other forms of epilepsy, abdominal epilepsy is treated with anticonvulsant drugs, such as phenytoin. Based on the clinical response additional medication may be used for complementing it or it could be used instead of phenytoin. Since no controlled studies exist, however, other drugs may be equally effective. [10] Anticonvulsants target non-epileptic causes of abdominal pain via sedative mechanisms. It may also act just as a placebo. The prognosis is generally good and most patients are benefitted from medicines alone. [13]

Pathophysiology

The pathophysiology behind abdominal epilepsy remains speculative. Several studies indicate that insula and sylvian fissures also known as lateral sulcus could be related to inducing abdominal epilepsy. Their location is found to coincide with the locations of the abdomen on the Sensory homunculus. [14] Any pathophysiological changes in the M2 portion of cerebral artery which flows through lateral sulcus are associated with the epilepsies of the temporal and parietal regions. [15] The abdominal symptoms are believed to be associated with the transmission of impulses from the temporal lobe to the dorsal motor nucleus of the vagus nerve via the dense direct projections. The hypothalamus is also believed to induce sympathetic pathways from the amygdala in the medial temporal lobe to the GI tract to trigger such symptoms. [16]

Cerebral tumors have been assessed to be a plausible cause of abdominal epilepsy. [17] Right parietal and occipital encephalomalacia, biparietal atrophy, and bilateral perisylvian polymicrogyria has been possibly associated with ictal abdominal pain associated with abdominal epilepsy. [18]

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. [19] 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. [20] [21]

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. 1 2 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. Archived from the original on 2011-06-06. Retrieved 2009-01-12.
  5. ↑ Peppercorn MA, Herzog AG (October 1989). "The spectrum of abdominal epilepsy in adults". Am. J. Gastroenterol. 84 (10): 1294–1296. PMID   2801681.
  6. ↑ Peppercorn, M. A.; Herzog, A. G. (October 1989). "The spectrum of abdominal epilepsy in adults". The American Journal of Gastroenterology. 84 (10): 1294–1296. ISSN   0002-9270. PMID   2801681.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ Murai, Tomohiko; Kinoshita, Masako (2019-06-10). Acute Diarrhea as a Manifestation of Abdominal Epilepsy. IntechOpen. ISBN   978-1-78923-866-2.
  10. 1 2 3 4 "Abdominal Epilepsy in Children and Adults". Epilepsy Health Center. WebMD. 18 March 2013. Retrieved 13 February 2014.
  11. 1 2 3 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. PMID   15833692.
  12. ↑ 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. PMID   15833692.
  13. ↑ Zinkin, Noah T.; Peppercorn, Mark A. (April 2005). "Abdominal epilepsy". Best Practice & Research. Clinical Gastroenterology. 19 (2): 263–274. doi:10.1016/j.bpg.2004.10.001. ISSN   1521-6918. PMID   15833692.
  14. ↑ 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. S2CID   38961285.
  15. ↑ Navarro-Orozco, Daniel; Sánchez-Manso, Juan Carlos (2021), "Neuroanatomy, Middle Cerebral Artery", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30252258 , retrieved 2021-12-13
  16. ↑ Mpondo, Bonaventura C. T.; Mwasada, Godfrey; Nyundo, Azan A. (2016-10-13). "Abdominal epilepsy, an uncommon cause of chronic and recurrent abdominal pain: a case report". Clinical Case Reports. 4 (12): 1117–1119. doi:10.1002/ccr3.711. ISSN   2050-0904. PMC   5134139 . PMID   27980744.
  17. ↑ 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 (3A): 628–630. doi: 10.1590/S0004-282X2002000400021 . ISSN   0004-282X. PMID   12244404.
  18. ↑ Mitchell, Wendy G. (1983-04-01). "Abdominal Epilepsy: Cyclic Vomiting as the Major Symptom of Simple Partial Seizures". Archives of Neurology. 40 (4): 251–252. doi:10.1001/archneur.1983.04050040081017. ISSN   0003-9942. PMID   6403002.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.

Related Research Articles

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 real painful seizure, that can remain isolated or be followed by other manifestations of the seizure. On the other hand, the 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 this case it is a disorder autonomous from epilepsy, that is a comorbidity.

Landau–Kleffner syndrome (LKS)—also called is a rare disease with acquired aphasia, acquired epileptic aphasia or aphasia with convulsive disorder—is a rare childhood neurological syndrome.

<span class="mw-page-title-main">Aura (symptom)</span> Symptom of epilepsy and migraine

An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is actually a minor seizure.

<span class="mw-page-title-main">Temporal lobe epilepsy</span> Chronic focal seizure disorder

In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. Temporal lobe epilepsy is the most common type of focal onset epilepsy among adults. Seizure symptoms and behavior distinguish seizures arising from the medial temporal lobe from seizures arising from the lateral (neocortical) temporal lobe. Memory and psychiatric comorbidities may occur. Diagnosis relies on electroencephalographic (EEG) and neuroimaging studies. Anticonvulsant medications, epilepsy surgery and dietary treatments may improve seizure control.

Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures arising in the frontal lobes of the brain, that often occur during sleep. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form in that both forms are characterized by partial (focal) seizures.

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.

Epilepsy surgery involves a neurosurgical procedure where an area of the brain involved in seizures is either resected, ablated, disconnected or stimulated. The goal is to eliminate seizures or significantly reduce seizure burden. Approximately 60% of all people with epilepsy have focal epilepsy syndromes. In 15% to 20% of these patients, the condition is not adequately controlled with anticonvulsive drugs. Such patients are potential candidates for surgical epilepsy treatment.

<span class="mw-page-title-main">Rolandic epilepsy</span> Most common epilepsy syndrome in childhood, usually subsiding with age

Benign Rolandic epilepsy or self-limited epilepsy with centrotemporal spikes is the most common epilepsy syndrome in childhood. Most children will outgrow the syndrome, hence the label benign. The seizures, sometimes referred to as sylvian seizures, start around the central sulcus of the brain.

Transient epileptic amnesia (TEA) is a rare but probably underdiagnosed neurological condition which manifests as relatively brief and generally recurring episodes of amnesia caused by underlying temporal lobe epilepsy. Though descriptions of the condition are based on fewer than 100 cases published in the medical literature, and the largest single study to date included 50 people with TEA, TEA offers considerable theoretical significance as competing theories of human memory attempt to reconcile its implications.

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."

Generally, seizures are observed in patients who do not have epilepsy. There are many causes of seizures. Organ failure, medication and medication withdrawal, cancer, imbalance of electrolytes, hypertensive encephalopathy, may be some of its potential causes. The factors that lead to a seizure are often complex and it may not be possible to determine what causes a particular seizure, what causes it to happen at a particular time, or how often seizures occur.

Abdominal aura, 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, 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. 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.

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.

<span class="mw-page-title-main">Epilepsy in children</span>

Epilepsy is a neurological condition of recurrent episodes of unprovoked epileptic seizures. A seizure is an abnormal neuronal brain activity that can cause intellectual, emotional, and social consequences. Epilepsy affects children and adults of all ages and races, and is one of the most common neurological disorders of the nervous system. Epilepsy is more common among children than adults, affecting about 6 out of 1000 US children that are between the age of 0 to 5 years old. The epileptic seizures can be of different types depending on the part of the brain that was affected, seizures are classified in 2 main types partial seizure or generalized seizure.

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 ."

A neonatal seizure is a seizure in a baby younger than age 4-weeks that is identifiable by an electrical recording of the brain. It is an occurrence of abnormal, paroxysmal, and persistent ictal rhythm with an amplitude of 2 microvolts in the electroencephalogram,. These may be manifested in form of stiffening or jerking of limbs or trunk. Sometimes random eye movements, cycling movements of legs, tonic eyeball movements, and lip-smacking movements may be observed. Alteration in heart rate, blood pressure, respiration, salivation, pupillary dilation, and other associated paroxysmal changes in the autonomic nervous system of infants may be caused due to these seizures. Often these changes are observed along with the observance of other clinical symptoms. A neonatal seizure may or may not be epileptic. Some of them may be provoked. Most neonatal seizures are due to secondary causes. With hypoxic ischemic encephalopathy being the most common cause in full term infants and intraventricular hemorrhage as the most common cause in preterm infants.

<span class="mw-page-title-main">Occipital epilepsy</span> Medical condition

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.

Musicogenic epilepsy is a form of reflex epilepsy with seizures elicited by special stimuli.

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.