Belly pain is a common
complaint primary care doctors deal with. A specific cause often can’t be
determined. Psychological and emotional causes are considered when your doctor
cannot identify a cause. But, don’t exclude a physical cause that can’t be
detected. As I have often told my patients, “Medicine is the practice of an
art. Doctors really have too few answers and doctors can cause lots of
problems.” So, follow-ups and gathering more information often reveals the
correct diagnosis.
Episodic belly pains can
suggest epilepsy known as ABDOMINAL EPILEPSY. This phenomenon is rare. In a
large series of patients with epilepsy only 2.8% (24 of 858) experienced pain
of any sort (headache, facial and body pains on one side) but only 3 of these
24 patients had belly pain: severe and sharp “like a knife”. 1 I
personally considered this possibility, especially in children. Some people
with this condition have no other features of epilepsy, i.e., no altered
consciousness or movements such as lip-smacking seen in complex partial
seizures, exaggerated swallowing, shaking nor incontinence during the episode.
A case described by physicians at the Mayo Clinic contained both elements of
episodes of pain and epilepsy. Many physicians and patients can be confused by
this combination of symptoms. 2
A person had no known
risk factors for epilepsy except for a fall at age 4. He lost consciousness
associated with the fall. That same year he experienced his first seizure: he
initially complained of belly pain, ran out of the house and had a convulsion.
EEG then showed no diagnostic etiology for the seizure, and he was given no
antiepileptic medications (AEM). At age 20 he had another convulsion and
carbamazepine was prescribed. When non-compliant the patient discontinued his
AEM and more convulsions occurred. Additionally, the patient complained of
recurrent episodes of central abdominal pain since childhood up to 10 times some
days; he could go a month without these pains. The pain would last seconds to
hours. Multiple examinations with
endoscopes peering into his intestinal tract were unrevealing. A diagnosis of
irritable bowel syndrome was proposed. At times the pain was so severe he
contemplated suicide.
Because of no altered
consciousness nor convulsions his carbamazepine dosage was reduced at age 32.
He then had a complex partial seizure preceded by belly pain which lasted
throughout the seizure. He then consulted with a neurologist who recognized the
recurrent episodes of belly pain as possible epileptic phenomenon. He was
hospitalized and studied with EEG and video monitoring. Several complex partial
seizures were recorded. Before each seizure onset he reported mid-belly pain.
EEGs showed an epileptic focus in the left frontotemporal region. MRI showed
scarring in the inner side of the temporal lobe, i.e., mesial temporal
sclerosis, a common abnormality found in complex partial seizures. Specialized
EEGs identified the abnormal focus. It was surgically removed and he has
remained free of seizures and episodic belly pains for 5 years, 3 without AEMs.
2
Other researchers found
these belly pain seizures associated with parietal lobe and frontal lobe
origins.
In my past blogs,
surgical removal of brain epileptic foci is beneficial, often curative, and
safe (see my blogs #143
and blog #114
at website LanceFogan.com)
1. Young
GB,Blume WT. Painful epileptic seizures. Brain. 1983; 106 (pt
3):537-554.
2. Eschle
D., Siegel A. and Wieser H-G. Epilepsy with severe abdominal pain. Mayo
Clin
3. Proc.
2002; 77:1358-1360.
Lance Fogan, M.D. is Clinical Professor
of Neurology at the David Geffen School of Medicine at UCLA. His emotionally hard-hitting family
medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his
first novel. Aside from acclamation on internet bookstore sites, U.S. Report of
Books, and the Hollywood Book Review, DINGS has been advertised in a recent
Publishers Weekly, New York Times Book Review and the Los Angeles Times
Calendar section. DINGS teaches epilepsy and is now available in eBook,
audiobook, and soft and hard cover editions.
