Simplified diagram of central autonomic network (CAN)

findings relatively specific for epileptic seizures, and (4) a sustained improvement

Hitherto, publications concerning abdominal epilepsy are quite limited in number. Accurate prevalence rate of abdominal epilepsy has not been evaluated. There are 36 cases reported in literature, in the review of abdominal epilepsy by Zinkin and Peppercorn [4]. We found other 15 cases of abdominal epilepsy in

*Abbreviations: LOC, loss of consciousness; GTCS, generalized tonic-clonic seizure; NA, not available; CBZ, carbamazepine; PHE, phenytoin; LTG, lamotorigine; OXC, oxcarbazepine; DIA, diazepam; VPA, sodium valporate;*

Though many authors cite this criterion in their case reports published hitherto, there are several points at issue in this definition as follows. The gastrointestinal symptoms as acute symptomatic seizures should be ruled out; i.e., unprovoked chronic recurrence or more than 60% probability to recur is needed to diagnose epilepsy [5]. It is difficult to certify the diagnosis by EEG findings (difficulty to record in ictal state, difficulty to record EEG activities via scalp electrodes in cases with epileptogenic foci on mesial temporal area or insular cortex especially in small areas, and low rate of detecting the epileptogenic discharge on patient with epilepsy in general). In case of refractory epilepsy, symptoms could not be improved by antiepileptic drug. Therefore new definition is expected to capture the real entity of

of symptoms by antiepileptic medication [4].

*DOI: http://dx.doi.org/10.5772/intechopen.86719*

*Acute Diarrhea as a Manifestation of Abdominal Epilepsy*

this disease.

**3. Epidemiology**

*CZP, clonazepam*

*Summary of case reports by literature.*

**Table 1.**

**89**

#### **Figure 1.**

*Simplified diagram of central autonomic network (CAN).*

In the widely accepted operational definition of epilepsy, it requires that an individual has at least two provoked seizures on separate days, generally 24 hours apart. There are various seizure types in accord with the cortical function of the epileptic foci and propagated areas in epilepsy. Abnormal abdominal sensation often heralds the onset of epileptic seizures. Among them, there is a rare syndrome called abdominal epilepsy in which episodic gastrointestinal complaints like abdominal pain, abdominal discomfort, nausea, vomit, and diarrhea are the primary or the sole manifestation of epileptic seizures. It is important for clinicians to know that abdominal epilepsy is one of the differential diagnoses of gastrointestinal signs, especially when they are acute onset and recurrent, and that it is treatable with antiepileptic medications.

Here we review abdominal epilepsy as one of the causes in acute diarrhea.

### **2. Definition**

Abdominal epilepsy is characterized by paroxysmal gastrointestinal signs and symptoms resulting from epileptic activity of the neurons in the brain. Epileptic seizures of several patients with abdominal epilepsy are accompanied with impairment of the CNS like loss of consciousness and headache. There is no authorized diagnosis criterion for abdominal epilepsy at present. Zinkin and Peppercorn propose the following criteria for diagnosis of abdominal epilepsy. That is to say, (1) paroxysmal gastrointestinal manifestations of undetermined origin after thorough evaluation including laboratory, radiographic, and endoscopy testing, (2) symptoms originated from the CNS, (3) an abnormal electroencephalogram (EEG)

#### *Acute Diarrhea as a Manifestation of Abdominal Epilepsy DOI: http://dx.doi.org/10.5772/intechopen.86719*

findings relatively specific for epileptic seizures, and (4) a sustained improvement of symptoms by antiepileptic medication [4].

Though many authors cite this criterion in their case reports published hitherto, there are several points at issue in this definition as follows. The gastrointestinal symptoms as acute symptomatic seizures should be ruled out; i.e., unprovoked chronic recurrence or more than 60% probability to recur is needed to diagnose epilepsy [5]. It is difficult to certify the diagnosis by EEG findings (difficulty to record in ictal state, difficulty to record EEG activities via scalp electrodes in cases with epileptogenic foci on mesial temporal area or insular cortex especially in small areas, and low rate of detecting the epileptogenic discharge on patient with epilepsy in general). In case of refractory epilepsy, symptoms could not be improved by antiepileptic drug. Therefore new definition is expected to capture the real entity of this disease.
