Abdominal epilepsy

It describes a very rare variant of epilepsy

1. Abdominal epilepsy: A diagnosis often missed Dr Tarek A. Gouda Professor of Neurology, Zagazig university

2. Abdominal epilepsy (autonomic epilepsy), is a rare condition most frequently found in children, consisting of gastrointestinal disturbances caused by epileptiform seizure activity. However ,it can be seen in adolescent sand in adults. - It has been described as a type of temporal lobe epilepsy. Responsiveness to antiepileptics can aid in the diagnosis. Abdominal epilepsy

3. The most common symptom of abdominal epilepsy is abdominal pain followed by uncontrollable vomiting, usually preceded by lethargy. Symptoms may also include generalized tonic- clonic seizures . Abdominal epilepsy

4. - Criteria for diagnosis of abdominal epilepsy includes: 1- Frequent periodic abdominal symptoms. 2-An abnormal electroencephalogram (EEG) 3-Significant improvement of gastrointestinal symptoms after taking antiepleptic medication . Diagnosis

5. Investigations that support diagnosis of abdominal epilepsy includes: - MRI scans of the brain an computerized EEG, -CT scans and ultrasounds of the abdomen and endoscopy of the gastrointestinal tract. Diagnosis

6. - Abdominal epilepsy remains a rare condition and should only be considered if there are idiopathic paroxysmal abdominal pain and migraine-like symptoms in patients . -To facilitate this complex clinical diagnosis, physicians should include an EEG with 24 hr monitoring Diagnosis

7. -Early diagnosis of abdominal epilepsy can be achieved if it is noted that the attacks occur suddenly , are of brief duration , and resolve spontaneously . -Furthermore, the localization of the pain is important to note, as it is typically found in the periumbilical or upper abdominal areas . Diagnosis

8. A 18-year-old female patient presented with recurrent abdominal pain for the past 3 years. The pain was mainly paroxysmal , periumbilical , colicky, and had no relationship with meals . Each episode of pain used to last for 10 min, with spontaneous resolution of symptoms, and recurred 4–5 times per week. There was no history of associated vomiting, headache or convulsions . Case study

9. - Her laboratory studies were normal. - Ultrasonography of the abdomen was normal. - MRI brain was normal. -EEG record showed paroxysmal generalized spike and wave discharges. -The patient started treatment with Topiramate 50mg/day for one week which was increased to 100mg/day an the second week. She improved dramatically case study

10. EEG

11. The variability of clinical presentation in abdominal epilepsy indicates a spectrum of both gastrointestinal and CNS manifestations . The gastrointestinal manifestations include all or a combination of the following: recurrent abdominal pain, nausea and vomiting Clinical picture

12. CNS manifestations includes confusion , headache , dizziness . In some studies, the most common presenting symptoms were paroxysmal abdominal pain and vomiting. The CNS manifestations were subtle . Therefore, most patients may consult a gastroenterologist or a surgeon rather than a neurologist . Clinical picture

13. Although its abdominal symptoms may be similar to those of the irritable bowel syndrome. Abdominal epilepsy may be distinguished from the latter condition by : 1-presence of altered consciousness during the episodes . 2- tendency towards fatigue after the episode . 3- Abnormal EEG . Clinical picture

14. In patients with abdominal symptoms and headache , it is often difficult to differentiate abdominal migraine from abdominal epilepsy, because of the overlap of symptoms . Abdominal epilepsy versus Abdominal migraine

15. An EEG is a simple and non-invasive investigation , which may be helpful to differentiate between the two entities, as patients with abdominal epilepsy usually have specific EEG abnormalities, particularly of a temporal lobe seizure disorder. Abdominal epilepsy versus Abdominal migraine

16. - A sustained response to antiepileptics has been accepted as one of the criteria for the diagnosis of patients with abdominal epilepsy . - Carbamazepine or oxcarbazepine are considerd effective antiepileptics in this syndrome. However,There are no recommendations on the choice of antiepileptics to be used . Treatment

17. Abdominal epilepsy is an uncommon syndrome in which gastrointestinal complaints result from seizure activity. It is characterized by: (1 ) unexplained, paroxysmal gastrointestinal symptoms. ( 2) symptoms of a central nervous system dysfunction. ( 3) an abnormal EEG with findings specific for a seizure disorder . ( 4) improvement with antiepileptic drugs. Summary

18. It has been suggested that in patients with paroxysmal abdominal pain, nausea and vomiting with or without CNS manifestations , the possibility of abdominal epilepsy should be considered after exclusion of the more common etiologies for the presenting complaints . Conclusion

19. -Abdominal epilepsy in adults can be misdiagnosed as a physical or psychological disorder and be subjected to a number of expensive, time consuming investigations. -Creating awareness among physicians and surgeons about this clinical entity will improve patient care and management. Conclusion

20. Thank you