The patient, Mr. Liu, aged 26, developed abdominal pain and discomfort after a cold, accompanied by nausea and vomiting. Symptoms last about a few minutes to half an hour, with recurrence at intervals. Mr. Liu came to the hospital for a related abdominal pain examination, but no obvious abnormalities were found. After the use of antispasmodic and acid-suppressing drugs, the nausea was slightly relieved, but the abdominal pain persisted. It is worth noting that Mr. Liu suddenly developed unconsciousness and convulsions during his visit to the emergency department, which lasted for nearly 5 minutes and then stopped. The emergency physician sedated him** and admitted him to the neurology ward for further treatment in view of the "high likelihood of epilepsy" diagnosis.
After being admitted to the hospital, Mr. Lau had convulsions again with foaming at the mouth, which lasted for two minutes and then stopped. However, his consciousness did not return. About five minutes later, Mr. Liu, who was not yet awake, had another seizure, which lasted for a minute and then stopped again. The doctor quickly performed ** and resuscitation for him according to the guidelines for the diagnosis and treatment of status epilepticus. About half an hour later, Mr. Liu woke up feeling weak and aching all over his body and had no memory of what had happened.
The doctor then performed some relevant head MRI and EEG examinations on Mr. Liu, and the results reconfirmed that Mr. Liu's abdominal pain was not a digestive problem, but the root cause was epilepsy. After taking anti-epileptic drugs**, Mr. Liu's abdominal pain and convulsions no longer appeared.
Is all abdominal pain caused by epilepsy?
After Moore first reported it in 1944, there are many names for this disease in the literature, such as visceral epilepsy, diencephalic epilepsy, thalamic and hypothalamic epilepsy, autonomic epilepsy, etc., clinically with reversible episodic abdominal pain as the main clinical manifestation, which can be accompanied by nausea, vomiting, pale complexion and other symptoms, the pain is mostly located in the periumbilical area, and the pain duration is a few minutes to a few hours. The onset and termination are sudden, more common in children, rarer, and often not diagnosed in time.
Why do you need an EEG for this type of epilepsy?
Abdominal pain epilepsy is diagnosed in conjunction with the history and clinical presentation, and EEG changes can assist in the diagnosis (70-80% of patients have epileptiform discharges in the temporal lobes on the EEG, which is evident during episodes of abdominal pain, but may also occur during intermittent episodes). However, there are also some patients whose EEG cannot find abnormalities, or can not be found by only one EEG examination, and multiple reexaminations are required, and long-range **EEG will have a better chance of recording abnormal discharges.
What is epilepsy?
Epilepsy is one of the common chronic diseases of the central nervous system, and epidemiological surveys show that its prevalence in the population is about 04%~1.0%, which can occur at any age, is the most common type of epilepsy. Among them, focal epilepsy accounts for about 61 of the most epilepsy in China7%。In Mr. Liu's case, temporal lobe epilepsy in focal epilepsy is considered.
What is temporal lobe epilepsy?
Temporal lobe seizures originate in the hippocampus, amygdala, parahippocampal gyrus, and lateral neocortical region of the medial temporal lobe, and are the most common focal epilepsy in clinical practice, and are more common in adolescents.
What are the symptoms of temporal lobe epilepsy?
The vast majority of cases of temporal lobe epilepsy are medial temporal lobe epilepsy, and the following symptoms are common in the early stages of seizures
Gastrointestinal symptoms such as discomfort in the upper abdomen or a feeling of rising gas, vomiting, etc.
Paleness, flushing, cyanosis, changes in heart rate or rhythm.
Autonomic symptoms such as urinary urgency, erect hairs, or pupil changes.
Emotional symptoms such as fear, anxiety, depression, etc.
Symptoms of cognitive impairment, such as a sense of déjà vu or strangeness, rapid recall of past experiences, or forgetfulness, may also occur.
Seizures are often accompanied by symptoms of unconsciousness, accompanied by automatism such as lip smacking or swallowing and involuntary groping movements of the upper limbs, and seizures can last for 1-2 minutes, with no relevant memories after the seizure.
Temporal lobe epilepsy and lateral temporal lobe epilepsy, also known as neocortical epilepsy, impaired consciousness occurs later than temporal lobe memory epilepsy, and sensory seizures such as hearing, vision, and vertigo are prone to occur in the early stage of the seizure, and the rate of automatism is lower, and the duration of seizures is relatively short, but it is more likely to be secondary to bilateral tonic-clonic seizures.
How should epilepsy be diagnosed?
At least 2 unprovoked seizures more than 24 hours apart;
or a single episode with a high risk of recurrence (greater than 60% probability in the next 10 years**, e.g., previous brain injury, significant abnormalities on EEG, neuroimaging abnormalities, nocturnal seizures);
or have been diagnosed with epilepsy;
Epilepsy can be diagnosed if one of the three is satisfied.
Focal epilepsy** should be classified as much as possible, and its ** can be classified into 6 categories: structural abnormalities, infection, immunity, metabolism, genetics, and other unknown causes. The "Guidelines for the Standardized Diagnosis and Treatment of Focal Epilepsy in China" released in June 2023 clearly pointed out that for patients with focal epilepsy or suspected focal epilepsy, relevant auxiliary examinations are needed to classify them, which is the key.
How is focal epilepsy**?
If the monotherapy is not well controlled, a combination of anti-seizure drugs with different mechanisms of action should be selected, taking into account factors such as the patient's age, gender, concomitant medications, comorbidities, and patient preferences.
If seizures cannot be effectively controlled after an adequate amount of treatment, a full course of treatment, and a reasonable selection of 2 or more anti-seizure drugs**, drug-resistant epilepsy may progress. If the presence of focal epilepsy is clear, it should be aggressively targeted, and if necessary, a multidisciplinary assessment of whether to perform surgery should be performed.