By: Nicholas Parekh
What is abdominal epilepsy?
Abdominal epilepsy is a rare form of temporal lobe epilepsy that often manifests as episodes of abdominal pain, nausea, and vomiting followed by loss of consciousness or postictal sleepiness and mostly affects children. Due to the primary symptoms of abdominal pain and vomiting being relatively common in many different disorders, abdominal epilepsy is usually the last diagnosis one would consider because physicians tend to be biased toward finding a physical cause as opposed to a neurological cause with this set of symptoms. This is not helped by the fact that this disorder is very rare, and most of the existing knowledge on it comes from case studies of individual patients. Patients with this condition may end up being misdiagnosed with psychogenic abdominal pain, or pain that arises from psychiatric issues, when all the more common causes are ruled out, receive inappropriate treatment that does not resolve their symptoms, and be stigmatized in the process.
Symptoms of abdominal epilepsy
Episodes of abdominal epilepsy typically last for five to twenty minutes and occur randomly. This differs from an abdominal migraine where the pain can last for hours to days. Pain is usually centered around the belly button but can occur in other parts of the abdomen. Abdominal pain may be accompanied by symptoms more commonly associated with epilepsy such as a loss of consciousness or a generalized tonic-clonic seizure. The pain can also come with migraine symptoms like a throbbing headache, nausea, and vomiting. Patients may then enter a postictal state following the episode where they will feel lethargic and sleep more than usual. Some people may experience abdominal pain as an aura, a sort of warning before a larger seizure occurs.
Treatment for abdominal epilepsy
Proper treatment of patients with abdominal epilepsy may be hindered by the lack of awareness of the disorder even among experienced doctors. When physicians hear that a patient is experiencing abdominal pain, their differential diagnosis, a list of diseases that may be causing the patient’s symptoms, is typically biased toward the stomach, intestines, liver, and other abdominal organs, especially if they are not trained in neurology. Therefore, abdominal imaging and biological tests are usually performed first and rule out an abdominal cause. Doctors will then often refer the patient to a psychiatrist for evaluation of his or her psychogenic pain, or feelings of pain produced by a psychological disorder, which is a catch-all term for diseases of unknown etiology. This may cause patients to be afraid to seek further help for their disorder due to the stigma surrounding psychogenic disorders (e.g. being told they are “crazy” or “making it up”), and they will continue to receive ineffective treatments and suffer from future episodes of abdominal epilepsy. For example, many children who have abdominal epilepsy are diagnosed with conversion disorder, a type of psychogenic disorder that causes individuals to display but not have symptoms like loss of consciousness, seizures, and abdominal pains. Approximately 50% of preschool-age children are misdiagnosed as having conversion disorder when they have a disorder with a biological basis. The likelihood of misdiagnosis with conversion disorder is increased when there are no clearly identifiable triggers and/or the child is of low socioeconomic status.
Diagnosing abdominal epilepsy
When abdominal epilepsy is suspected, an electroencephalogram (EEG), a diagnostic tool that records the brain’s electrical activity is used to detect epileptiform, or epilepsy-like, brain activity. An abnormal EEG in the setting of gastrointestinal and/or neurological symptoms will indicate a diagnosis of abdominal epilepsy. Patients are then usually started on an antiepileptic drug such as Trileptal or Valproic. If they have fewer or no episodes of pain after starting the drug, then the patient is confirmed to have abdominal epilepsy. The disorder can be effectively managed once it is diagnosed; the difficulty comes with arriving at the diagnosis. When patients have abdominal pains, they usually go to a gastroenterologist first for good reason – most of the time abdominal pain has abdominal causes such as acid reflux, pancreatitis, and irritable bowel disorder. However, when an abdominal cause is ruled out, the patient may want to seek out a neurologist to identify a neurological cause such as abdominal epilepsy, if there is one.
Abdominal epilepsy is a rare form of temporal lobe epilepsy that often manifests as episodes of abdominal pain, nausea, and vomiting followed by loss of consciousness or postictal sleepiness and mostly affects children. Abdominal epilepsy is rare and is often misdiagnosed as psychogenic pain or conversion disorder. Once any abdominal conditions are ruled out, an EEG may be done to find any abnormal brain activity causing abdominal pain. Once a diagnosis is made, anticonvulsant medication is the primary source of treatment.
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