Recurrent abdominal pain: when an epileptic seizure should be suspected?

Abstract

-Recurrent episodes of abdominal pain are common in childhood. Among the diagnostic possibilities are migraine and abdominal epilepsy (AE). AE is an infrequent syndrome with paroxystic episodes of abdominal pain, awareness disturbance, EEG abnormalities and positive results with the introduction of antiepileptic drugs. We present one 6 year-old girl who had short episodes of abdominal pain since the age of 4. The pain was followed by cry, fear and occasionally secondary generalization. MRI showed tumor in the left temporal region. As a differential diagnosis, we report a 10 year-old boy who had long episodes of abdominal pain accompanied by blurring of vision, vertigo, gait ataxia, dysarthria, acroparesthesias and vomiting. He received the diagnosis of basilar migraine. In our opinion, AE is part of a large group (partial epilepsies) and does not require a special classification. Pediatric neurologists must be aware of these two entities that may cause abdominal pain. RESUMO -Episódios recorrentes de dor abdominal são freqüentes na infância e entre as causas neurológicas há migrânea e epilepsia abdominal (EA). EA é uma síndrome que consiste de episódios paroxísticos de dor abdominal associada à alteração de consciência, anormalidades eletrencefalográficas e boa resposta à terapia anticonvulsivante. Apresentamos uma menina de 6 anos que tinha desde os 4 anos episódios de curta duração de dor abdominal, seguidos por choro, medo e ocasional generalização secundária. A RM mostrou a presença de um tumor em região temporal esquerda. Como diagnóstico diferencial, apresentamos um menino de 10 anos que há 12 meses referia episódios de dor abdominal de longa duração acompanhados por turvação visual, vertigem, marcha atáxica, disartria, acroparestesia e vômito, recebendo posteriormente o diagnóstico de migrânia basilar. Em nossa opinião, EA faz parte de um grande grupo (epilepsias parciais) e não requer uma classificação especial. O neuropediatra deve estar alerta para essas duas entidades que podem cursar com dor abdominal. PALAVRAS-CHAVE: crises parciais, tumor do lobo temporal, migrânea basilar, dor abdominal e epilepsia sintomática.

A Rare Cause of Abdominal Pain: Abdominal Epilepsy

“…Abdominal epilepsy (AE) is a very rare cause of this clinical entity, and it may sometimes be overlooked in the differential diagnosis. AE is characterized by episodic paroxysmal abdominal and periumbilical pain, various abdominal complaints, specific abnormalities on electroencephalography (EEG), and good response to antiepileptic drugs (1). Gastrointestinal signs and symptoms may be the only indication of convulsions.…”

Abdominal epilepsy as an unusual cause ofabdominal pain: A case report

“…The pathophysiology of disease remains unknown. Insula andsylvian fissure may have an important role in explainingof ictal abdominal pain 1 . Supplementary motor area and somatosensorial area may be related with location for abdominal epilepsy.…”

“…Abdominal pain, in etiology sometimes difficult to be defined, is a frequent complaint in childhood.Abdominal epilepsy, also known as autonomic epilepsy, is an extremely rare cause of abdominal pain 1 . It is characterised by; unexplained, paroxysmal-episodic abdominal and periumbilical pain resulting from a central nervous system disturbance 1,2,3 , an abnormal electro-encephalogram (EEG) with the spesific findings for epileptic disorders 4 , and favorable response toanti-epileptic drugs 3 .…”

“…It is characterised by; unexplained, paroxysmal-episodic abdominal and periumbilical pain resulting from a central nervous system disturbance 1,2,3 , an abnormal electro-encephalogram (EEG) with the spesific findings for epileptic disorders 4 , and favorable response toanti-epileptic drugs 3 . In this article, we present a 5 year old girl with diagnosis of idiopathic abdominal epilepsy.…”

Reply letter to the editor: the continuing story of George Gershwin and his brain tumor—would the outcome have been different today?

“…According to the reports of some authors, all gliomas of WHO grade II perform a malignant transformation over time [2,18]. The case of George Gershwin may be an example because his case report shows an indication of the existence of a low-grade glioma [5,9,11,12,16,17]. Today, Gershwin probably would have a benefit from the chance of an earlier diagnosis and extirpation, advanced comprehensive operation techniques, as well as radiological and chemotherapeutical treatment regimes, perhaps before a lowgrade glioma can change into a malignant form.…”