Rationale:
Eating disorders have been variously associated with epilepsy, typically of the temporal lobe and usually of the non-dominant hemisphere. However, the precise relationship to seizure frequency, seizure location, and effect of antiepileptic drugs are unclear from prior reports. 1-3 We describe a case with progressive nausea and anorexia associated with a progressive increase in seizure frequency, independent of antiepileptic drug changes, that stopped abruptly after dominant hemisphere hippocampal laser ablation.
Method:
Detailed in Results
Results:
A 56-year-old woman focal seizures, most without altered awareness, since 23 year-old. In 2000 she had video/EEG monitoring indicating left temporal seizuresand left mesial temporal sclerosis was detected on MRI. With changes in AED, seizures were controlled and she was had multiple years of seizure freedom. In 2016 seizures began to increase, although without alteration of awareness, 3-4 times per year. By 2018 seizure with loss of awareness increased to 8 times per month. In May 2018 weight was 165 lbs (BMI 27.5). The patient had received topiramate along with other antiepileptic drugs over time, but topiramate was discontinued in June 2018. Over one year there was a progressive increase in seizure frequency. The patient reported loss of appetite, consistent nausea and weight loss of 55 lbs (BMI 18.3) in July 2019, despite supplementation with Boost. Full GI workup including EGI was negative; the gastroenterologist believed nausea and appetite loss were seizure-related. Paraneoplastic workup was negative. Depression and anxiety office screening tests over a 6-year period were negative; neuropsychological testing did not reveal psychiatric illness and criteria for anorexia nervosa were not present. She underwent repeat pre-surgical evaluation where an episode of non-convulsive status lasting 15 minutes was associated with a clear left temporal ictal discharge. PET revealed hypometabolism in the left medial temporal region, MRI brain Left mesial temporal sclerosis, intracarotid amobarbital test revealed left hemisphere language dominance and adequate and equal memory scores bilaterally. Laser ablation of the left hippocampus was performed on 08/07/2019. By the next morning while an inpatient the patient reported resolution of nausea, and she began eating normally. At 10 month follow up, she reported only a single seizure without alteration of awareness, had no nausea, regained normal appetite, and had gained back 25 lbs. Her only post-surgical deficit was slightly increased complaints of verbal memory.
Conclusion:
This case shows an associated risk of developing Anorexia in patients with left temporal epilepsy coming from the hippocampus after ruling out secondary causes. To our knowledge, this is the first case report of left (dominant) temporal lobe epilepsy, well localized to the hippocampus who had a simultaneous increase in anorexia, nausea, and a 55-pound weight loss along with an increase in seizures over two years. Laser ablation surgery stopped seizures and resolved anorexia and nausea in less than 24 hours postoperatively,
Funding:
:None
FIGURES
Figure 1