Friday, August 16, 2013

Abdominal pain and seizures

Motivation: A man walks in to the hospital with seizures also complains of periodic stomach pain.  I wonder could it also be a seizure?  After all, migraines in children are clearly linked to episodes of abdominal pain.  Could epileptic discharges create a similar phenomenon?

Turns out that this issue has been thought of by many - in fact, Trousseau had also thought about the issue in 1868.  Reviewed here is a compilation of the common clinical presentation.

Paper: Zinkin, NT, Peppercorn, MA. "Abdominal epilepsy" Best Practice & Research Clinical Gastroenterology (2005); 19(2): 263-274.

Methods: Review of 36 reported cases in english literature.  Patients were required to have paroxysmal EEG abnormalities with correlated clinical spells.

Results:
Clinical Characteristics: In meta-analysis of 36 published cases, most frequent feature was a sharp pain (86%) commonly in peri-umbilical and upper abdominal pain.  Nausea and vomiting was an infrequent feature in 28% followed by diarrhea (5%) and bloating (3%).  Besides abdominal pain, some disturbance in consciousness was observed in 64% ranging from generalized seizures to dizziness.  Duration of seizures was at most a few minutes.  EEG did not have a consistent localization for inter-ictal epileptiform activity.

Discussion: I think that abdominal epilepsy is worth considering as a diagnosis in someone with bouts of brief abdominal pain with some change in consciousness/"funny" feeling.  There are many people - often hard to treat people - with unexplained abdominal pain.  Some get unsatisfactory diagnosis of irritable bowel syndrome or somatoform disorders.  If there is no other explanation, an EEG may be in order.

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