"Eating" epilepsy revisited- an electro-clinico-radiological study

Area of Science:

• Neurology
• Epileptology
• Neuroimaging

Background:

• Eating epilepsy (EE) is a rare reflex epilepsy.
• Understanding its underlying mechanisms and clinical presentation is crucial for management.

Purpose of the Study:

• To evaluate the clinical, video electroencephalographic (EEG), and MRI characteristics of patients with eating epilepsy.
• To explore potential epileptogenic networks in EE.

Main Methods:

• Retrospective analysis of 47 patients diagnosed with EE undergoing pre-surgical work-up (2003-2012).
• Data collection included electro-clinico-radiological findings and seizure outcomes.
• Comparison between exclusive EE and EE with unprovoked seizures, and MRI-negative vs. MRI-positive cases.

Main Results:

• 47 patients met EE criteria; 48.9% had exclusive EE.
• Lesional epilepsy with posterior cortex (PC) predominance was observed in 34%.
• PC interictal epileptiform discharges were more frequent in MRI-negative patients (p=0.003).
• Developmental delay and PC ictal onset were more prevalent in patients with co-existent unprovoked seizures (p=0.013, p=0.029).
• Seizure outcomes did not differ significantly based on MRI findings.
• Two patients undergoing anterior temporal lobectomy had persistent eating seizures.

Conclusions:

• EE is a complex epilepsy with potential cryptogenic and symptomatic etiologies.
• A multilobar network involving the PC and linked to limbic-opercular pathways is a plausible epileptogenic mechanism.
• Diligent and cautious surgical selection is recommended for EE patients.