Abstracts

Rationale:
Neurogenic causes are rarely considered in the differential diagnosis of patients with episodic abdominal complaints (Stevens, Med Ann Dist Columbia, 1949; 18(11):565-8). Abdominal epilepsy (AE) has long been reported as a rare phenomenon typically present in children who complain of various episodic gastrointestinal sensory and painful symptoms that have been suspected to be due to seizures that represent an epileptic mimic (Hoefer et al., J Am Med Assoc , 1951; 147(1):1-6;  Moore, J Am Med Assoc, 1945; 1291233-40). Originally, AE was diagnosed when abdominal sensory symptoms were associated with pain, suspected to be due to seizures of temporal lobe origin, with an epileptiform or paroxysmal EEG pattern, and who demonstrated a clinical response to antiseizure medication (Dutta et al., Gut , 2007; 56(3):439-41;  Mondal et al., World J Pediatr, 2014; 10(1):80-2). However, AE has also been ultimately found to be associated with non-epileptic etiologies such as migraine or syringomyelia (Riemann, JAMA, 1973; 224(1):128; Drexler et al., J Pediatr Gastroenterol Nutr, 1989; 9(4) 524-7). Without arriving at a diagnosis confirmed by video-EEG, the diagnosis of AE is at best speculative, and at worst, gross misdiagnosis that has been demonstrated in individual cases.
Method:
We describe three adult patients with focal aware motor seizures that manifest as recurrent, isolated prolonged painless rhythmic clonic motor jerking of the abdominal musculature, including patients manifesting abdominal jerking associated with epilepsia partialis continua. All patients had a contralateral structural lesion on high-resolution brain MRI with lesions that were located in the abdominal region of the motor homunculus.
Results:
Semiology was isolated to the abdominal muscular and standard interictal EEG was unrevealing in these cases. Epilepsy was only confirmed by video-EEG and identified epileptiform activity after applying dense array  EEG electrodes in one case. Seizures were symptomatic prolonged focal aware motor seizures and epilepsy partialis continua manifest as isolated abdominal clonic jerking without impaired awareness. MRI demonstrated a parietal lesion in each case.
Conclusion:
For decades, AE has been described as a subjective sensory disorder involving vague abdominal pain, though we now describe abdominal epilepsy with objective motor signs that involved paroxysmal isolated abdominal clonic jerking confirmed by video-EEG monitoring. We recommend replacing vague diagnostic terms like AE attributed to unsubstantiated abdominal symptoms, with current International League Against Epilepsy terminology of focal aware (motor) seizures affecting the abdominal musculature with the diagnosis confirmed only after video-electroencephalography monitoring is able to establish a true diagnosis of AE.
Funding:
:None