Pharmacoresistant Abdominal Seizures in Symptomatic Localization-Related Epilepsy

Area of Science:

• Neurology
• Pediatrics
• Gastroenterology

Background:

• Abdominal epilepsy is an infrequent cause of recurrent abdominal pain, often overlooked in both pediatric and adult populations.
• It presents with or without additional symptoms, complicating diagnosis and management.

Observation:

• A 7-year-old boy with a history of ventriculoperitoneal shunting for obstructive hydrocephalus and left hemiparesis presented with chronic abdominal pain.
• Extensive evaluations at multiple centers preceded referral.
• Video electroencephalogram (EEG) revealed interictal and ictal abnormalities, corroborated by MRI and PET findings localized to the right hemisphere.

Findings:

• The patient exhibited drug-refractory abdominal seizures despite treatment with four antiepileptic drugs.
• A partial response was noted, with significant reduction in seizure frequency and severity.

Implications:

• This case underscores the potential drug resistance associated with abdominal seizures in patients with symptomatic focal epilepsy.
• Highlights the importance of considering abdominal epilepsy in the differential diagnosis of recurrent abdominal pain, especially in patients with a history of neurological conditions.
• Suggests a need for further research into optimal treatment strategies for refractory abdominal epilepsy.