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Vomiting as an ictal manifestation of epileptic seizures and syndromes
1Division of Neurology and Clinical Neurophysiology, King Khalid University Hospital, Riyadh, Saudi Arabia.
Insights
Ictal vomiting in children with epilepsy is often linked to benign childhood epilepsies (BCE) with occipital spikes. Recognizing this can prevent unnecessary medical tests and reduce patient anxiety.
Area of Science:
- Neurology
- Pediatric Epilepsy
Background:
- Vomiting during epileptic seizures (ictal vomiting) is an uncommon manifestation.
- Limited data exists on the specific patient populations and epilepsy syndromes associated with ictal vomiting.
Purpose of the Study:
- To investigate the clinical characteristics and epilepsy syndromes associated with ictal vomiting in pediatric patients.
- To determine the significance of ictal vomiting as a potential indicator for specific epilepsy types.
Main Methods:
- Retrospective analysis of 900 epilepsy patients.
- Detailed clinical evaluation of 24 patients experiencing ictal vomiting.
- Correlation analysis with epilepsy syndromes, including benign childhood epilepsies (BCE) with occipital and centro-temporal spikes.
Main Results:
- Ictal vomiting occurred in 24 pediatric patients, predominantly with partial, nocturnal seizures and impaired consciousness.
- A significant association was found between ictal vomiting and benign childhood epilepsies (BCE) with occipital spikes (p < 0.001).
- No significant association was observed with centro-temporal spikes (p < 0.2).
Conclusions:
- Ictal vomiting in children is a significant clinical sign associated with specific epilepsy syndromes, particularly BCE with occipital spikes.
- Identifying this association can aid in diagnosis, potentially reducing the need for extensive investigations.
- This finding has implications for understanding seizure semiology and epilepsy classification in children.
Abstract:
Twenty-four out of 900 adult and children patients with epilepsy, were found to have vomiting during an ictus. All the 24 patients were children before puberty with a similar clinical pattern consisting of partial seizures which were mainly nocturnal. Ictal vomiting was always concurrent with other epileptic manifestations, more often deviation of the eyes and impairment of consciousness. The initial part of the ictus was short or prolonged for hours with frequent "marching" to hemi-convulsions and generalised seizures. Seventeen of the 24 children suffered from benign childhood epilepsies (BCE) with complete remission in long follow-up. A significantly higher association was found between ictal vomiting and the syndrome of BCE with occipital spikes (p less than 0.001) but not with centro-temporal spikes (p less than 0.2). The recognition of this association may have important theoretical implications. On clinical grounds, it may prevent unnecessary investigations and undue concern.