LETTER TO THE EDITOR
Year : 2013  |  Volume : 8  |  Issue : 3  |  Page : 253

Abdominal epilepsy: Is it so common?

Piyush Ostwal
Department of Neurology, Padmashree Dr. D Y Patil Medical College, Hospital and Research Centre, Pimpri-Chinchwad, Pune, Maharashtra, India

Date of Web Publication

26-Dec-2013

Correspondence Address:
Piyush Ostwal
601, N4, Nakshatram, Premlok Park, Pimpri Chinchwad, Pune - 411 033, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1817-1745.123698

How to cite this article: Ostwal P. Abdominal epilepsy: Is it so common?. J Pediatr Neurosci 2013;8:253

How to cite this URL: Ostwal P. Abdominal epilepsy: Is it so common?. J Pediatr Neurosci [serial online] 2013 [cited 2023 Nov 30];8:253. Available from: https://www.pediatricneurosciences.com/text.asp?2013/8/3/253/123698

Dear Sir,

I read with interest "abdominal epilepsy (AE) in chronic recurrent abdominal pain" by Kshirsagar et al. published in JPN. ^[1] The most striking finding was the high proportion (74%) of patients who were found to have abnormal electroencephalogram (EEG) in the cohort of patients with abdominal pain. However, the methodology of the study and the way conclusions were arrived at raises a few questions.

This study suggests diagnosis of AE in 111 patients over the study period of 3 years, whereas AE is thought to be a rare condition with just 36 cases reported in medical literature over 34 years. ^[2] The expertise of the person who has reported EEG for the study has not been mentioned. The temporal/fronto-temporal/generalized/parieto-temporal type of EEG change is not a standard terminology and does not convey a definite meaning. In patients with clinically suspected epilepsy the yield of a single routine EEG is only about 60%. ^[3],[4] However in this study, where one would not suspect epilepsy strongly, the high yield of EEG is unexplained. In spite of a large number of abnormal EEGs, none of the patient had spike abnormality (apart from the one's with spike and wave pattern), which is again unusual in my experience of epileptiform abnormalities on EEG.

Apart from AE other cause of paroxysmal abdominal pain, which should be suspected in such children is abdominal migraine. The clinical feature, which may help to distinguish between the two is the duration of the attack, which lasts a few minutes in case of epilepsy and a few hours for migraine. Such description of attack of abdominal pain has not been mentioned in this study. The duration of headache may further help us in distinguishing epilepsy from migraine. The headache was recorded as an associated symptom in (20%) of patients in this study, but duration has not been mentioned.

An impressive 88% of patients in this study had symptomatic improvement with oxcarbazepine. Since the diagnosis in question is a paroxysmal event, therefore a sufficient duration of follow-up for each patient is needed or reduction in the number of episodes should be documented before patient can be declared improved. In this particular study, the criteria used to define improvement have not been mentioned. Furthermore, the duration for which patients were followed to declare improvement is not mentioned.

One of the aims of the study was to find out the incidence of AE among patients with chronic abdominal pain. Technically incidence cannot be determined from this study design. And even for calculating prevalence the total number of patients screened is needed, which has not been mentioned in spite of it being a prospective study. Furthermore, the mention of cases and controls mentioned in the aims is flawed. There were really no cases and controls in this study.

The impression that AE may be as common as found in this study needs further confirmation in a better designed study to eliminate the shortcomings of this study.

 

References

1.	Kshirsagar VY, Nagarsenkar S, Ahmed M, Colaco S, Wingkar KC. Abdominal epilepsy in chronic recurrent abdominal pain. J Pediatr Neurosci 2012;7:163-6.
2.	Zinkin NT, Peppercorn MA. Abdominal epilepsy. Best Pract Res Clin Gastroenterol 2005;19:263-74.   [PUBMED]
3.	Chowdhury RN, Hasan AH, Rahman KM, Mondol BA, Deb SR, Mohammad QD. Interictal EEG changes in patients with seizure disorder: Experience in Bangladesh. Springerplus 2013;2:27.   [PUBMED]
4.	Goodin DS, Aminoff MJ, Laxer KD. Detection of epileptiform activity by different noninvasive EEG methods in complex partial epilepsy. Ann Neurol 1990;27:330-4.

This article has been cited by 1 Focal epilepsy with abdomenal pain N. V. Selyanina, M. A. Danilova, Yu. V. Karakulova, A. G. Malov, L. N. Brezhneva, E. A. Shilyaeva Experimental and Clinical Gastroenterology. 2023; (6): 180 [Pubmed] | [DOI] 2 Author response Kshirsagar, V.Y., Nagarsenkar, S., Ahmed, M., Colaco, S., Wingkar, K.C. Journal of Pediatric Neurosciences. 2013; 8(3): 253-254 [Pubmed]