Eating Epilepsy in North India: Case Series and Its Management

Abstract

Eating epilepsy is a rare form of reflex epilepsy where seizures are triggered by eating. We describe a case series of 12 such patients presenting to our epilepsy clinic based in North India. Eating epilepsy was noted to have male predominance with focal seizures with impaired awareness. Most of these patients had either temporal or perisylvian localization. Clobazam taken half an hour before meal was found to be an effective add-on therapy in its management. (2019;9:152-156

Eating epilepsy. A narrative review

“…Eating epilepsy (EE) is a rare form of RE with a prevalence of 1:1000-2000 of all patients with epilepsy, although it ranges higher in Asia [3][4][5][6] . EE is more common in males and usually presents as focal seizures with impaired awareness which can occur before, during, and/or after eating 3,4,7 .…”

“…Ethnic origin and environmental factors such as chemical composition of food, culinary habits, feeding behavior, and emotional and psychological involvement may be important in EE etiology 7,17 . EE can present with other epileptic syndromes, structural pathologies (malformations, tumors), and/or brain injury (hypoxic brain damage, gliosis, encephalomalacia, and meningoencephalitis) 4,7,17 . Therefore, it has been proposed that EE may be a long-term manifestation of an initial precipitating event in the past 7,17 .…”

“…Clinical presentation of EE is diverse. Seizures usually present as focal onset with impaired awareness and less commonly with generalized onset, including atonic, myoclonic, or even autonomic types 3,4,7,17 . EE occurs more frequently in the context of temporal or frontal lobe epilepsies 4 and it usually is symptomatic or associated with imaging abnormalities in these locations (Tables 1 and 2).…”

“…Electroencephalographic (EEG) findings can be normal or present focal or diffuse epileptiform abnormalities 3 . Magnetic resonance imaging (MRI) can also be normal or present structural abnormalities specifically in temporolimbic or suprasylvian areas, particularly in the insular and opercular cortex 3,4,7,12 . A clinical neurotopographic correlation can be made with EEG finding and/or imaging findings.…”

“…Some patients respond and benefit from antiepileptic drugs. Although management of choice has not yet been established, intake of clobazam before meals may be effective as add-on therapy in the management of EE 3,4 . Kokes et al suggest that seizures that originate from the left temporal region may be more resistant to antiepileptic management 7 .…”