The other day, I encountered an uncommon medical diagnosis, abdominal epilepsy. Maybe I was absent when this was taught in med school or maybe it was mentioned but it just didn't register in my memory bank. Anyway, for those colleagues who haven't heard of this as well, here's what I found out about it, so that next time you are faced with a weird abdominal pain, you will think of abdominal epilepsy as a differential.
There are many medical causes of abdominal pain; abdominal epilepsy is one of the rare causes.
From a medical perspective, the term epilepsy refers not to a single disease, but to a group of symptoms with numerous causes. The common factor in all forms of epilepsy is an excessive electrical excitability of the brain. The increased excitation is called a seizure and may manifest as a partial or total loss of consciousness and muscle spasms or other involuntary movements. Many conditions can produce epilepsy. For example, a genetic predisposition is believed to be involved in some cases. In others instances, trauma to the head, brain tumors and stroke are known to be causative factors. Yet, in approximately one half of all cases of epilepsy the cause is unknown (Pedley, 1985). This predominant category of epilepsy is classified as idiopathic, which means "disease without recognizable cause." (Thomas, 1973) Abdominal epilepsy is one of them.
Abdominal epilepsy is an uncommon syndrome in which there are group of gastrointestinal disturbances, most commonly abdominal pain, caused by epileptiform seizure activity seen on EEG tracing. Abdominal epilepsy is where the external abdominal muscle twitches uncontrollable. Abdominal epilepsy is an uncommon cause for abdominal pain in children and adults. Although abdominal symptoms of abdominal epilepsy may be similar to those of the irritable bowel syndrome, it may be distinguished from it by the presence of altered consciousness during some of the attacks, a tendency toward tiredness after an attack, and by an abnormal EEG.
The pathophysiology of abdominal epilepsy remains unclear. It is not clear if the initial disturbance in abdominal epilepsy arises in the brain. There are direct sensory pathways from the bowel via the vagus nerve to the solitary nucleus of the medulla which is heavily connected to the amygdala. These can be activated during intestinal contractions. (Peppercorn & Herzog, 1989, p. 1296).
Common clinical features of abdominal epilepsy include abdominal pain, nausea, bloating, and diarrhea with nervous system manifestations such as headache, confusion, and syncope (Peppercorn & Herzog, 1989). "Although its abdominal symptoms may be similar to those of the irritable bowel syndrome, it may be distinguished from the latter condition by the presence of altered consciousness during some of the attacks, a tendency toward tiredness after an attack, and by an abnormal EEG"(Zarling, 1984, p.687). Mitchell, Green- wood and Messenheimer (1983) regard cyclic vomiting as a primary symptom of abdominal epilepsy manifesting as simple partial seizures (1983).
Abdominal epilepsy is usually treated with anticonvulsant medication. After exclusion of more common etiologies for the presenting complaints, workup should proceed with an electroencephalogram. When associated with anatomical abnormality abdominal epilepsy is difficult to control with medication alone. Where the diagnosis is seriously considered, neurological consultation should be considered. In such cases, appropriate neurosurgery can provide a cure or, at least, make this condition easier to treat with medication. Once all known intra-abdominal causes have been ruled out, many cases of abdominal pain are dubbed as functional. If the doctors are not aware of abdominal epilepsy, this diagnosis is easily missed, resulting in inappropriate treatment. Treatment of abdominal epilepsy typically begins with anticonvulsant medication, and resolution of symptoms with therapy helps to confirm the diagnosis.
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