Abdominal epilepsy with peri-ictal MRI abnormality

Area of Science:

• Neurology
• Epileptology
• Neuroimaging

Background:

• Abdominal epilepsy is an under-recognized condition presenting with paroxysmal abdominal symptoms lacking a clear gastrointestinal etiology.
• Recurrent unexplained abdominal pain necessitates consideration of neurological origins.

Purpose of the Study:

• To present a case of abdominal epilepsy in an elderly patient.
• To illustrate the diagnostic utility of neuroimaging in identifying peri-ictal changes.
• To underscore the role of the insular cortex in the pathophysiology of abdominal epilepsy.

Main Methods:

• Case report of a 77-year-old woman with a lifelong history of nocturnal abdominal cramping, confusion, and speech difficulty.
• Magnetic Resonance (MR) imaging of the brain performed within 24 hours of an episode.
• Electroencephalography (EEG) to rule out other seizure types.
• Initiation of antiseizure medication for symptom management.

Main Results:

• MR imaging revealed cortical diffusion restriction and FLAIR signal abnormalities in the left frontal operculum and insular cortex.
• EEG findings were normal.
• Symptoms completely resolved following the administration of antiseizure medication.

Conclusions:

• This case expands the known clinical and radiological spectrum of abdominal epilepsy.
• The involvement of the insular cortex, a key center for autonomic and viscerosensory processing, is supported by imaging findings.
• Early consideration of neurological causes and appropriate treatment can lead to complete symptom resolution.