Abdominal epilepsy in chronic recurrent abdominal pain

Abstract

Background:Abdominal epilepsy (AE) is an uncommon cause for chronic recurrent abdominal pain in children and adults. It is characterized by paroxysmal episode of abdominal pain, diverse abdominal complaints, definite electroencephalogram (EEG) abnormalities and favorable response to the introduction of anti-epileptic drugs (AED). We studied 150 children with chronic recurrent abdominal pain and after exclusion of more common etiologies for the presenting complaints; workup proceeded with an EEG. We found 111 (74%) children with an abnormal EEG and 39 (26%) children with normal EEG. All children were subjected to AED (Oxcarbazepine) and 139 (92%) children responded to AED out of which 111 (74%) children had an abnormal EEG and 27 (18%) had a normal EEG. On further follow-up the patients were symptom free, which helped us to confirm the clinical diagnosis.Context:Recurrent chronic abdominal pain is a common problem encountered by pediatricians. Variety of investigations are done to come to a diagnosis but a cause is rarely found. In such children diagnosis of AE should be considered and an EEG will confirm the diagnosis and treated with AED.Aims:To find the incidence of AE in children presenting with chronic recurrent abdominal pain and to correlate EEG findings and their clinical response to empirical AEDs in both cases and control.Settings and Design:Krishna Institute of Medical Sciences University, Karad, Maharashtra, India. Prospective analytical study.Materials and Methods:A total of 150 children with chronic recurrent abdominal pain were studied by investigations to rule out common causes of abdominal pain and an EEG. All children were then started with AED oxycarbamezepine and their response to the treatment was noted.Results:111 (74%) of the total 150 children showed a positive EEG change suggestive of epileptogenic activity and of which 75 (67.56%) were females and 36 (32.43%) were male, majority of children were in the age of group of 9-12 years. Temporal wave discharges were 39 (35.13%) of the total abnormal EEG's. All the children were started on AEDs and those with abnormal EEG showed 100% response to treatment while 27 (18%) children with normal EEG also responded to treatment. Twelve (8%) children did not have any improvement in symptoms.Conclusions:A diagnosis of AE must be considered in children with chronic recurrent abdominal pain, especially in those with suggestive history, and an EEG can save a child from lot of unnecessary investigations and suffering.

A Rare Cause of Abdominal Pain: Abdominal Epilepsy

“…Peppercorn and Herzog (9) used phenobarbital, phenytoin, valproic acid, and carbamazepine in their patients. Anticonvulsant drugs are recommended for all patients (for a maximum of 2 years) until their complaints have disappeared or EEG has returned to normal (5). EEG alone is not decisive in these patients, and it is important to correlate the findings with the clinical status (10).…”

Abdominal epilepsy mimicking conversion disorder: a case report

“…Several drugs, either singly or in combination, have been used in management. Kshirsagar et al [12] and Dutta et al [7] found that oxcarbazepine significantly reduced the symptoms in patients. Yunus et al [13] reported that valproic acid treatment in the abdominal epilepsy like this case rapidly improved their patient's abdominal symptoms.…”

Abdominal Epilepsy: A Rare Cause of Unexplained Abdominal Pain

“…Recurrent abdominal pain may also be seen in visceral hyperalgesia, peptic ulcer disease and abdominal migraine [14,15]. The most common differential diagnosis for AE is abdominal migraine as they have many overlapping features.…”

“…(1) Patients may have normal EEG patters in the inter-ictal periods and diagnosis must not be purely based on an EEG [15].…”