Medicine: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] 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]

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]

Usually, the procedure for its diagnosis starts by extracting information about the presence of typical symptoms (such as paroxysmal, abdominal pain, and other GI symptoms). Symptoms that are persistent throughout or persist for hours are less probable to be indications of abdominal epilepsy. Convulsions, impairment in consciousness and other neurological symptoms are ought to be considered along with the 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. ↑ "Abdominal epilepsy, an uncommon cause of recurrent abdominal pain: a brief report". Gut 56 (3): 439–441. March 2007. doi:10.1136/gut.2006.094250. PMID 17339252. 
  2. ↑ "Epilepsy with severe abdominal pain". Mayo Clin. Proc. 77 (12): 1358–1360. December 2002. doi:10.4065/77.12.1358. PMID 12479525. 
  3. ↑ 3.0 3.1 "Abdominal epilepsy". Best Pract Res Clin Gastroenterol 19 (2): 263–274. April 2005. 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. http://www.aafp.org/afp/20000101/letters.html. Retrieved 2009-01-12. 
  5. ↑ "The spectrum of abdominal epilepsy in adults". Am. J. Gastroenterol. 84 (10): 1294–1296. October 1989. 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. https://pubmed.ncbi.nlm.nih.gov/2801681/. 
  7. ↑ "Abdominal Epilepsy and Foreign Body in the Abdomen – Dilemma in Diagnosis of Abdominal Pain". Yonsei Med. J. 46 (6): 870–873. December 2005. doi:10.3349/ymj.2005.46.6.870. PMID 16385668. 
  8. ↑ "Abdominal epilepsy misdiagnosed as psychogenic pain". Postgrad Med J 64 (750): 281–282. April 1988. doi:10.1136/pgmj.64.750.281. PMID 3186570. 
  9. ↑ Murai, Tomohiko; Kinoshita, Masako (2019-06-10) (in en). Acute Diarrhea as a Manifestation of Abdominal Epilepsy. IntechOpen. ISBN 978-1-78923-866-2. https://www.intechopen.com/chapters/67604. 
  10. ↑ 10.0 10.1 10.2 10.3 "Abdominal Epilepsy in Children and Adults". WebMD. 18 March 2013. http://www.webmd.com/epilepsy/guide/abdominal-epilepsy-in-children-and-adults. 
  11. ↑ 11.0 11.1 11.2 Zinkin, Noah T.; Peppercorn, Mark A. (2005-04-01). "Abdominal epilepsy" (in en). 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. https://www.sciencedirect.com/science/article/pii/S152169180400143X. 
  12. ↑ Zinkin, Noah T.; Peppercorn, Mark A. (2005-04-01). "Abdominal epilepsy" (in en). 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. https://www.sciencedirect.com/science/article/pii/S152169180400143X. 
  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. https://pubmed.ncbi.nlm.nih.gov/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. 
  15. ↑ Navarro-Orozco, Daniel; Sánchez-Manso, Juan Carlos (2021), "Neuroanatomy, Middle Cerebral Artery", StatPearls (Treasure Island (FL): StatPearls Publishing), PMID 30252258, http://www.ncbi.nlm.nih.gov/books/NBK526002/, 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. 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?" (in en). 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" (in en). Archives of Neurology 40 (4): 251–252. doi:10.1001/archneur.1983.04050040081017. ISSN 0003-9942. PMID 6403002. http://archneur.jamanetwork.com/article.aspx?doi=10.1001/archneur.1983.04050040081017. 
  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. 
  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. ↑ "Abdominal epilepsy versus "abdominal migraine"". Ann. Intern. Med. 33 (1): 122–133. July 1950. doi:10.7326/0003-4819-33-1-122. PMID 15426097. 

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