Abdominal epilepsy: an uncommon of non-convulsive status epilepticus

To recognize abdominal epilepsy in adults.

Case report.

Case 1: A 21-year-old woman with DM type I presented with a 2-month history involving four episodes of severe abdominal pain and vomiting, each of which lasted four to five days. She had a recurrence every two weeks. The EEG revealed 'spike and wave ' and she was started an intravenous phenytoin that resolved the symptoms. Case 2: A 20-year-old woman with DM type I was admitted with a 2-month history of recurring severe left upper quadrant pain associated with occasional nausea but no vomiting. She experienced two more episodes of generalized tonic-clonic seizures and was treated with 300 mg phenytoin given orally The abdominal pains gradually subsided and she was symptom-free within two days. An EEG showed frequent sharp waves. She was treated with 10 mg intravenous diazepam and her symptoms and sharp waves disappeared within two minutes. Case 3: A 46-year-old man with DM type I was admitted with a four-month history of recurring severe epigastric pain and vomiting. His physical examination, laboratory tests, and extensive investigation for a primary GI disorder revealed nothing unusual. The EEG revealed spike and wave and he was treated with intravenous AED (phenytoin) loading after which the symptoms disappeared.

Physicians should consider abdominal epilepsy in diabetics with recurrent, intractable abdominal pain in whom extensive investigations for primary gastrointestinal (GI) disorders are unremarkable.