We describe a patient who experienced recurrent episodes of abdominal pain as a prominent feature of his seizure disorder. Treatment with carbamazepine could not prevent these painful sensations, but a selective amygdalohippocampectomy completely controlled the episodic pain and the seizures associated with loss or alteration of consciousness. During the presurgical evaluation, the episodes of abdominal pain correlated with amygdalar seizure discharges.
Abdominal pain is a common complaint in primary care, but a specific etiology cannot always be identified. Psychological and emotional factors can play an important role in selected patients with abdominal discomfort.1,2 In some patients, however, an explanation beyond psychosomatic and local causes must be considered. Sometimes the episodic nature of abdominal pain suggests the diagnosis of epilepsy. Therefore, a number of articles have addressed the phenomenon of so-called abdominal epilepsy.3-5 However, some patients with episodic abdominal pain have no additional features of a typical seizure such as loss or alteration of consciousness; therefore, this rare type of seizure could be misdiagnosed.
We describe a patient who for decades presented with this rare combination of pain and epilepsy a symptom and a disorder that primary care physicians believed were unrelated. A thorough evaluation that included invasive electroencephalographic (EEG) recording revealed that the patient’s abdominal pain was related to a partial seizure disorder.