Blog #148: EPILEPSY AND SEVERE ABDOMINAL PAIN

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.