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

Abstract

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].

Epileptic belly dancing: a video‐polygraphic recording

“…Focal aware motor seizures with abdominal clonic jerking consist of episodic, short‐lasting, rhythmic movements of the abdominal wall, which are often misdiagnosed at first, owing to their rarity and heterogeneous aetiology [1‐4]. As in our case, electroclinical findings indicate that seizures originate in the parietal region [2].…”

Abdominal Epilepsy, A Diagnosis to Consider in Children with Recurrent Vomiting: A Case Report

“…Currently, use of abdominal epilepsy term is still controversial among neurologists. Tatum (2020) recommended changing the term of abdominal epilepsy to focal aware motor seizures with abdominal clonic jerking because this term may explain this disease better [6].…”

Unilateral abdominal clonic jerking as an epileptic phenomenon

“…Seizures presenting as unilateral abdominal wall clonic jerking have been reported infrequently in the literature. There are 20 cases published in the English literature, the majority of which were an expression of epilepsia partialis continua [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] (See Table 1 ).…”

“…Seizures involving abdominal symptoms can be difficult to diagnose, and a recent article published highlighted these diagnostic challenges [15] . Patients with subjective non-motor abdominal complaints have been diagnosed with “abdominal epilepsy” based solely on EEG abnormalities or response to anti-seizure medication, which has the potential of misdiagnosis.…”

“…Of the 20 prior cases of seizures with abdominal wall clonic jerking in the English literature, only 11 of 15 with ictal EEG results published had ictal rhythms and 5 of 10 with interictal EEG results published had spikes or sharp waves. Notably, high-density EEG has been used to help detection of epileptiform abnormalities in these patients and these authors recommend video-EEG with ictal recording for diagnosis [15] .…”