The association of abdominal symptoms with epilepsy has been recognized for many years. For example, "gastric and intestinal disturbances" were viewed as primary etiological factors by medical doctors during the late 19th and early twentieth century (Musser & Kelly, 1912). The invention and clinical application of the electroencephalo-gram (EEG) during the 1920's shifted the focus of medical attention from the abdomen to the brain where, for the most part, it has remained to this day.
Another example of the abdominal connection in epilepsy is the aura which is common in certain types of epilepsy. For example, temporal lobe epileptic seizures frequently begin with an aura. In neurological terms, an aura is actually a mild seizure which precedes the primary seizure. It can be thought of as a warning that a seizure is about to happen. Most often, auras manifest as an altered consciousness or peculiar sensation. "The most common aura is of vague gastric distress, ascending up into the chest" (Gordon, 1942, p. 610).
Modern medical science has rediscovered the abdominal connection in epilepsy. Several papers published in the medical journals during the 1960s called attention to the abdominal connection in epilepsy. Over the past forty years, numerous researchers and clinicians have reported on various aspects of abdominal epilepsy.
Common clinical features of abdominal epilepsy include abdominal pain, nausea, bloating, and diarrhea with nervous system manifestations such as headache, confusion, and syncope (Peppercorn & Herzog, 1989). "Although its abdominal symptoms may be similar to those of the irritable bowel syndrome, it may be distinguished from the latter condition by the presence of altered consciousness during some of the attacks, a tendency toward tiredness after an attack, and by an abnormal EEG" (Zarling, 1984, p.687). Mitchell,
Although abdominal epilepsy is diagnosed most often in children, the research of Peppercorn and Herzog (1989) suggests that abdominal epilepsy may be much more common in adults than is generally recognized:
"Abdominal epilepsy is well described among pediatric patients but is recognized only infrequently in adults. Our experience over the past 15 years indicates that the disorder may not be as rare as is suggested by the paucity of literature on the subject. Moreover, the variability of the clinical presentation indicates a spectrum to both the gastrointestinal (GI) and central nervous system (CNS) manifestations of abdominal epilepsy in adults." (Peppercorn & Herzog, 1989, p. 1294)
One of the primary problems in understanding abdominal epilepsy is clearly defining the relationship of the abdominal symptoms to the seizure activity in the brain. In other words, what is the pathophysiology of abdominal epilepsy. Is the essential pathology in certain areas of the brain which happen to be connected to the abdominal organs? Or, is the primary pathology in the abdomen which is conveyed through connecting nerve fibers to the brain resulting in epileptic seizures? Peppercorn and Herzog noted both possibilities in their attempt to understand the cause of abdominal epilepsy:
"The pathophysiology of abdominal epilepsy remains unclear. Temporal lobe seizure activity usually arises in or involves the amygdala. It is not surprising, therefore, that patients who have seizures involving the temporal lobe have GI symptoms, since discharges arising in the amygdala can be transmitted to the gut via dense direct projections to the dorsal motor nucleus of the vagus. In addition, sympathetic pathways from the amygdala to the GI tract can be activated via the hypothalamus.
On the other hand, it is not clear that the initial disturbance in abdominal epilepsy arises in the brain. There are direct sensory pathways from the bowel via the vagus nerve to the solitary nucleus of the medulla which is heavily connected to the amygdala. These can be activated during intestinal contractions." (Peppercorn & Herzog, 1989, p. 1296).
In other words, the trigger for the seizures may be in the abdomen. At this time, there is no definitive model of abdominal epilepsy which explains the association of brain seizures and abdominal symptoms. However, there is a growing body of medical information which may lead to a better understanding of this complex relationship.
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