Focal epilepsy with ictal abdominal pain: a case report

Cerminara, Caterina; Malhany, Nadia El; Roberto, Denis; Curatolo, Paolo

doi:10.1186/1824-7288-39-76

Cited by 10 publications

(11 citation statements)

References 12 publications

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“…Previously, the diagnosis of AE was based upon an abnormal EEG (Devore et al, 1955), including epileptiform discharges (Papatheophilou et al, 1972;Garcia-Herrero et al, 1998) and "dysrhythmias" (Bental et al, 1967), with only a few reports on ictal EEG (Matsuo, 1984;Cerminara et al, 2013;Aljaafari et al, 2018). Previously, studies on patients diagnosed with AE focused on temporal epileptiform abnormalities (Moore, 1962;Zinkin and Peppercorn, 2005).…”

Section: Video-eeg Monitoringmentioning

confidence: 99%

True abdominal epilepsy is clonic jerking of the abdominal musculature^*

Tatum¹,

Schuele²,

Templer³

et al. 2020

Epileptic Disorders

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Aims. Abdominal epilepsy (AE) has long been reported as a rare phenomenon in children with various episodic gastrointestinal sensory and painful symptoms suspected to be due to epileptic seizures. Originally, AE was diagnosed when abdominal sensory or painful symptoms were associated with pain, temporal lobe origin, an epileptiform or paroxysmal EEG pattern, and a clinical response to antiseizure medication. AE has also been associated with non-epileptic etiologies such as migraine. Reports of abdominal epilepsy based on an abnormal EEG or clinical response to antiseizure medication without diagnosis confirmation by video-EEG are at best speculative, and at worst, misdiagnoses. Methods. We describe three adult patients with focal aware motor seizures manifesting as recurrent, isolated prolonged painless rhythmic clonic jerking of the abdominal musculature including epilepsia partialis continua. Results. All patients had a contralateral structural lesion on high-resolution brain MRI in the abdominal region of the motor homunculus. Standard EEG was unrevealing and only after extra EEG electrodes and video-EEG monitoring was the ictal origin confirmed. Conclusions. Historically, AE has been described as a disorder involving subjective sensory symptoms including vague abdominal pain, instead of epileptic motor signs of abdominal clonic jerking. We recommend replacing the use of vague terms such as AE with International League Against Epilepsy terminology along with diagnostic confirmation validated by video-EEG monitoring. [Published with video sequence].

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Section: Video-eeg Monitoringmentioning

confidence: 99%

True abdominal epilepsy is clonic jerking of the abdominal musculature^*

Tatum¹,

Schuele²,

Templer³

et al. 2020

Epileptic Disorders

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“…3 There are no recommendations on the choice of the anticonvulsant. 2 Of the 18 pediatric cases, carbamazepine was used in 3 cases, oxcarbazepine in 2 cases, valproate in 2 cases, phenytoin in 1 case, phenobarbitone in 3 cases, both phenytoin as well as phenobarbitone in 2 cases, and surgical management done in 2 cases. Thirteen children became absolutely seizure free, while 2 children showed reduced frequency of seizures.…”

Section: Discussionmentioning

confidence: 99%

“…1 Although all other forms of epilepsy may occur in infants, abdominal epilepsy (AE) has not been described younger than 1 year of age. 2 The authors speculate that the reason for this is that two out of the four diagnostic criteria of AE require that the patient himself will be able to "speak out" that he is having abdominal pain and fatigue, dizziness, headache, etc. 3 However, this is impossible for the young infants, in whom inconsolable cry is the only language of any type of discomfort.…”

Section: Introductionmentioning

confidence: 99%

Excessive Cry in a 5-Month-Old Infant Possibly due to Abdominal Epilepsy

et al. 2017

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Excessive and unexplained cry is a common problem with infants. Most of the causes are benign or easily treatable, with exception of a few. However, we encountered a 5-month-old, otherwise healthy male infant, who used to cry inconsolably every day on the afternoon for about 3 hours and then used to fall asleep. This had been going on for the last 6 weeks. After waking up, infant seemed perfectly normal. History, physical examination, and routine investigations failed to diagnose the cause. An electroencephalogram showed epileptic abnormalities. The “crying episodes” disappeared after starting phenobarbitone. Although two of the four criteria for diagnosis of abdominal epilepsy (AE) are impossible to be met in an infant of this age (because he cannot speak out his ailments whether he is having abdominal pain, headache, dizziness, etc.); still we believe that this was a case of AE. Various case reports have stated that “sustained response to anticonvulsants has been accepted as one of the criteria for the diagnosis of AE.” We suggest AE to be kept in mind even when dealing with an infant of unresolved excessive crying.

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“…The syndrome has been well documented in children . However, there are very few reported cases among adults .…”

Section: Discussionmentioning

confidence: 99%

“…A more recent study showed that epileptic pain including abdominal pain is a rare symptom of seizures in both children and adults . Despite the scarcity of described cases among adults, there are several case reports of abdominal epilepsy in children . One study involving 150 children with chronic recurrent abdominal pain found that 74% of them had abdominal epilepsy .…”

Section: Discussionmentioning

confidence: 99%