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.
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.
