abdominal epilepsy

Abdominal epilepsy is marked by GI symptoms such as abdominal pain followed by uncontrollable vomiting, usually preceded by lethargy. Lethargy and confusion are the most common neurological symptoms associated with abdominal epilepsy. Other symptoms include generalized tonic-clonic seizures followed by sleep, and unresponsiveness.{{cite web| url=http://www.webmd.com/epilepsy/guide/abdominal-epilepsy-in-children-and-adults | title = Abdominal Epilepsy in Children and Adults | website = Epilepsy Health Center | publisher = WebMD | date = 18 March 2013 | access-date = 13 February 2014}}{{Cite journal|last1=Zinkin|first1=Noah T.|last2=Peppercorn|first2=Mark A.|date=2005-04-01|title=Abdominal epilepsy|url=https://www.sciencedirect.com/science/article/pii/S152169180400143X|journal=Best Practice & Research Clinical Gastroenterology|series=Unusual Causes of Abdominal Pain|language=en|volume=19|issue=2|pages=263–274|doi=10.1016/j.bpg.2004.10.001|pmid=15833692|issn=1521-6918|url-access=subscription}} Abdominal aura characterized by abdominal sensations precedes the abdominal seizure. This is associated with pain, nausea, hunger, gassiness, especially in temporal lobe epilepsy.{{Cite journal |last1=Zinkin |first1=Noah T. |last2=Peppercorn |first2=Mark A. |date=2005-04-01 |title=Abdominal epilepsy |url=https://www.sciencedirect.com/science/article/pii/S152169180400143X |journal=Best Practice & Research Clinical Gastroenterology |series=Unusual Causes of Abdominal Pain |language=en |volume=19 |issue=2 |pages=263–274 |doi=10.1016/j.bpg.2004.10.001 |pmid=15833692 |issn=1521-6918|url-access=subscription }}

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.

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.

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.

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 cannot distinguish between the kinds of epilepsy. Moreover, an EEG report could be normal if an event is not accompanied by neurological symptoms. If it is doubtable, a neurologist should be consulted.

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. 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.{{Cite journal|last1=Zinkin|first1=Noah T.|last2=Peppercorn|first2=Mark A.|date=April 2005|title=Abdominal epilepsy|url=https://pubmed.ncbi.nlm.nih.gov/15833692/|journal=Best Practice & Research. Clinical Gastroenterology|volume=19|issue=2|pages=263–274|doi=10.1016/j.bpg.2004.10.001|issn=1521-6918|pmid=15833692}}

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.{{Cite journal|last1=García-Herrero|first1=D.|last2=Fernández-Torre|first2=J. L.|last3=Barrasa|first3=J.|last4=Calleja|first4=J.|last5=Pascual|first5=J.|date=December 1998|title=Abdominal epilepsy in an adolescent with bilateral perisylvian polymicrogyria|journal=Epilepsia|volume=39|issue=12|pages=1370–1374|doi=10.1111/j.1528-1157.1998.tb01340.x|issn=0013-9580|pmid=9860077|s2cid=38961285|doi-access=free}} 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.{{Citation|last1=Navarro-Orozco|first1=Daniel|title=Neuroanatomy, Middle Cerebral Artery|date=2021|url=http://www.ncbi.nlm.nih.gov/books/NBK526002/|work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=30252258|access-date=2021-12-13|last2=Sánchez-Manso|first2=Juan Carlos}} 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.{{Cite journal|last1=Mpondo|first1=Bonaventura C. T.|last2=Mwasada|first2=Godfrey|last3=Nyundo|first3=Azan A.|date=2016-10-13|title=Abdominal epilepsy, an uncommon cause of chronic and recurrent abdominal pain: a case report|journal=Clinical Case Reports|volume=4|issue=12|pages=1117–1119|doi=10.1002/ccr3.711|issn=2050-0904|pmc=5134139|pmid=27980744}}

Cerebral tumors have been assessed to be a plausible cause of abdominal epilepsy.{{Cite journal|last1=Franzon|first1=Renata C.|last2=Lopes|first2=Camila F.|last3=Schmutzler|first3=Kátia M. R.|last4=Morais|first4=Maria Isabel R.|last5=Guerreiro|first5=Marilisa M.|date=September 2002|title=Recurrent abdominal pain: when an epileptic seizure should be suspected?|journal=Arquivos de Neuro-Psiquiatria|language=en|volume=60|issue=3A|pages=628–630|doi=10.1590/S0004-282X2002000400021|pmid=12244404|issn=0004-282X|doi-access=free}} Right parietal and occipital encephalomalacia, biparietal atrophy, and bilateral perisylvian polymicrogyria has been possibly associated with ictal abdominal pain associated with abdominal epilepsy.{{Cite journal|last=Mitchell|first=Wendy G.|date=1983-04-01|title=Abdominal Epilepsy: Cyclic Vomiting as the Major Symptom of Simple Partial Seizures|url=http://archneur.jamanetwork.com/article.aspx?doi=10.1001/archneur.1983.04050040081017|journal=Archives of Neurology|language=en|volume=40|issue=4|pages=251–252|doi=10.1001/archneur.1983.04050040081017|pmid=6403002|issn=0003-9942|url-access=subscription}}

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.{{cite journal|title=Abdominal epilepsy| journal=The Indian Journal of Pediatrics| volume=56| issue=4| pages=539–541| year=1989| doi=10.1007/BF02722438| last1=Agrawal| first1=Pradeep| last2=Dhar| first2=Naresh K.| last3=Bhatia| first3=M. S.| last4=Malik| first4=S. C.| pmid=2633998| s2cid=45216244}} 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.{{cite journal|author=M.T. Moore|title=Paroxysmal abdominal pain: a form of focal symptomatic epilepsy|journal=JAMA|year=1944|volume=124|issue=9|pages=1233–40|doi=10.1001/jama.1944.02850090017005|pmid=21006167}}{{cite journal |vauthors =Moore MT |title=Abdominal epilepsy versus "abdominal migraine" |journal=Ann. Intern. Med. |volume=33 |issue=1 |pages=122–133 |date=July 1950 |pmid=15426097 |doi= 10.7326/0003-4819-33-1-122}}

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{{Seizures and epilepsy}}

Category:Epilepsy types

Category:Gastrointestinal tract disorders

Category:Rare diseases

Category:Seizure types