Abdominal Epilepsy

Causes, Symptoms and Treatments of Abdominal Epilepsy

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. Abdominal epilepsy is generally characterized by

• Paroxysmal gastrointestinal complaints
• Symptoms of a central nervous system disturbance
• An abnormal electroencephalogram with findings specific for a seizure disorder

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. Common symptoms of abdominal epilepsy include abdominal pain, nausea, bloating, and diarrhea with nervous system manifestations such as headache, lethargy, confusion, and syncope. Some of the studies regard cyclic vomiting as a primary symptom of abdominal epilepsy manifesting as simple partial seizures.

There are many medical causes of abdominal pain; abdominal epilepsy is one of the rare causes. Another example of the abdominal connection in epilepsy is the aura, which is common in certain types of epilepsy. For example, temporal lobe epileptic seizures frequently begin with an aura. An aura is actually a mild seizure, which precedes the primary seizure. It can be thought of as a warning that a seizure is about to happen. Abdominal epilepsy is a form of temporal lobe epilepsy presenting with abdominal aura. Temporal lobe epilepsy is often idiopathic, however it may be associated with dysembryoplastic neuroepithelial tumors and other benign tumors, mesial temporal lobe sclerosis, arterio-venous malformations, gliomas, neuronal migration defects or gliotic damage as a result of encephalitis.

Abdominal epilepsy is well described among pediatric patients. One of the primary problems in understanding abdominal epilepsy is clearly defining the relationship of the abdominal symptoms to the seizure activity in the brain. That is the difference between pathophysiology and temporal lobe seizure activity. The pathophysiology of abdominal epilepsy remains unclear. Temporal lobe seizure activity usually arises in or involves the amygdala. Therefore the patients who have the temporal lobe seizures have gastrointestinal symptoms, since discharges arising in the amygdala can be transmitted to the gut via dense direct projections to the dorsal motor nucleus of the vagus. In addition, sympathetic pathways from the amygdala to the gastrointestinal tract can be activated via the hypothalamus.

It is not clear whether 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. In other words, the trigger for the seizures may be in the abdomen. At this time, there is no definitive model of abdominal epilepsy, which explains the association of brain seizures and abdominal symptoms.

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.