Sgallo02

Abdominal Epilepsy

Abstract

Abdominal epilepsy is a sharp pain that can cause an epileptic episode. Because of its rarity, the condition only has 36 reported cases. It is a question condition due to when abdominal pain is experienced. Abdominal epilepsy needs to follow a certain criteria in order to be properly diagnosed. Abdominal epilepsy does not have a set mechanism or pathophysiology, but there have been multiple proposals on how neurotransmitters can affect the GI tract to cause abdominal pain and epileptic episodes to follow. Treatment for this condition is treated as general epilepsy. The prognosis follows as well because of its rarity.

Signs and Symptoms

The number one symptom found in abdominal epilepsy is abdominal pain; sharp or cramping pain that can last from a few seconds to a few minutes. AE symptoms include nausea, vomiting, and diarrhea. The symptoms may vary in AE, meaning the symptom of abdominal can happen after a seizure has occurred or can be the initial and/or sole cause of the seizure. After the seizure, the individual will experience fatigue, as well as confusion or unresponsiveness.

Cause

Abdominal Epilepsy does not have solid cause because how rare this condition is. There are only 36 reported causes of abdominal epilepsy in the previous 40 years. Because of the rarity of abdominal epilepsy, there is a criteria that has to be met by the individual in order to be properly diagnosed. It is a questionable condition because of how rare it is that doctors sometimes think that the abdominal pain that is experienced before or after the seizure is just coincidental.

Mechanism / Pathophysiology

Because of the variation in the symptoms of this condition and rarity of it as well, the mechanism is rather question including the condition itself.

In some research that has been done, there have been proposals on the mechanism of abdominal epilepsy. First proposal includes that abnormal brain activity can begin from the temporal lobe which then causes for the amygdala to transmit signals to the gastrointestinal tract through signals to the dorsal motor nucleus of the vagus nerve, where GI symptoms begin. Another proposal includes that the hypothalamus activates sympathetic pathways from the amygdala to the GI tract to cause symptoms.

Diagnosis

Even though the individual has to meet certain criteria to be properly diagnosed for abdominal epilepsy, there is still testing that is available. The testing includes CT scans of the brain and abdomen, MRI scan of the brain, ultrasound of the abdomen, EEG of the brain to measure the electrical activity, and blood tests.

For abdominal epilepsy, because of the lack of studies, the rarity of the condition, and the few reported cases, there is no family history that can show the condition is genetic. Previous medical history of the individual experiencing these symptoms will be analyzed to see is there is any recurrence and apply it to the specific criteria to be properly diagnosed.

The criteria that needs to be met in order to be properly diagnosed with abdominal epilepsy are as follows:

1. Repeated abdominal pain with no initial cause.
2. Central nervous symptoms that coincide with the abdominal pain symptoms. i.e.: abdominal pain before or after the seizure.
3. EEG of the brain showing abnormalities in brain activity
4. Individual showing positive response to specific treatment given.

Treatment

The main concern in diagnosing abdominal epilepsy is finding if the abdominal pain/symptoms are recurring with seizures. But when treating abdominal epilepsy, it is treated like other types of epilepsy. Treatment consists of anticonvulsant drugs, known as phenytoin. This drug has reduced abdominal symptoms in individuals who have this condition but it is still unclear if abdominal symptoms are the cause or result of epileptic episodes.

Some lifestyle changes for prevention of an epileptic episode is to take note of the triggers. Triggers are different in every patient. Some triggers can be noises or flashing lights, so it would be best to avoid that. Also heavy exercise can trigger epileptic episodes, so there should be some moderation in that as well.

Since treatment of abdominal epilepsy is treated like any other type of epilepsy and depending on the amount of epileptic episodes the patient has (or severity), there are surgical procedures to eliminate epilepsy completely or to reduce the severity/frequency of episodes. Some of these surgical procedures include resective surgery which is the removal of a small part of the brain, laster interstitial thermal therapy which is using laser to destroy a small portion of the brain and is less invasive, or deep brain stimulation, which is implantation of an electrode to time the electrical signals of a seizure.

Prognosis

Since treatment of abdominal epilepsy is treated like a general type of epilepsy, prognosis is as well. For prognosis, it all depends on age, health history, genetic makeup, the severity of their epilepsy, as well as the patients treatment plan which is also based on the severity of their epilepsy. Other factors also include brain infection, other nuerological disorders the patient may have, and vascular disorders.

Epidemiology

Because of rare abdominal epilepsy is, a lot of it is not known. There are only 36 reported causes of abdominal epilepsy in the previous 40 years.

Research

Again because of the lack of evidence for abdominal epilepsy, the amount of research for it is rather small. In this case of a 14 year old who had abdominal pain, research has been on a case basis. Even though there was diagnosis of epilepsy in this patient, it was concluded that the abdominal pain that she was experiencing before an epileptic episode, the abdominal pain was the key symptom in her partial seizures. Abdominal epilepsy follows more a criteria in order to be diagnosed whereas when it is treated and studied, the epilepsy aspect is the main focus.