Incidence of Faulty Surgical Intervention in Children with Chronic Recurrent Abdominal Pain Proved as Abdominal Epilepsy

Abstract

ABSTRACT

Background: Abdominal pain is a common complaint of children. Chronic recurrent abdominal pain is a vague problem for pediatricians. Among the various causes of pain, abdominal epilepsy is not so uncommon cause and hence, is frequently ignored. 

Objective: To find out the incidence of abdominal epilepsy among children suffering from chronic recurrent abdominal pain, with the help of clinical symptoms and electroencephalography, incidence of faulty surgical intervention among those patients with abdominal epilepsy and to study their responses to empirical anti-epileptic drugs

Methods: This is a follow-up study involved children suffering from chronic recurrent abdominal pain. A detailed history was obtained for each child. Clinical examination was performed. All children were investigated for stool and urine examinations. Complete blood count was performed. Abdomen and pelvis ultrasonography was performed. EEG was done for every child to correlate the findings of EEG with clinical diagnosis of abdominal epilepsy. Each EEG was reported by experts, and they were followed up for two years to evaluate their responses to anti-epileptic régime medication.

Results: Thirty four (19.8%) children out of 172 children complaining from recurrent episodes of severe abdominal pain were having abdominal epilepsy. Twelve (35.3%) children out of the 34 children with abdominal epilepsy were exposed to faulty surgical intervention (appendectomy), eight of them (66.6%) having abnormal EEG changes while the other four patients have normal EEG records. Out of the 34 children with abdominal epilepsy aged 9-14 years old, 19 (55.9%) were girls and 15 (44.1%) were boys giving female to male ratio of 1:1.3. There were 22(64.7%) children having abnormal EEG (13 girls and 9 boys) and 12(35.3%) children have normal EEG.  All the children had history of abdominal pain and nausea, 30 (88.2%) had vomiting while 4(11.8%) children had loose bowel motion.  All the children presented with CNS manifestations. All of them responded to treatment with antiepileptic drug

Conclusion: abdominal epilepsy is a well recognized and not so uncommon entity; all doctors especially surgeons should keep in mind. Abdominal epilepsy is diagnosed clinically by suggestive history and the EEG is just helpful to make the differential diagnosis in narrow spectrum. Abdominal epilepsy is associated with gastrointestinal and neurological manifestations.