Eating epilepsy

Reflex Epilepsy

Reflex seizures (RS) are epileptic events that are objectively and consistently elicited in response to a specific afferent stimulus or by an activity of the patient. The specific stimulus can be a variety of heterogenous intrinsic or extrinsic factors, ranging from the simple to the complex, such as flashing lights or reading a book. These seizures can take a variety of forms, comprising either general or focal onset, with or without secondary generalization. Reflex epilepsies (RE) are classified as a specific syndrome in which all epileptic seizures are precipitated by sensory stimuli. The few designated RE include idiopathic photosensitive occipital lobe epilepsy, other visual sensitive epilepsies, primary reading epilepsy, and startle epilepsy. RS that occurs within other focal or generalized epilepsy syndromes that are associated with distinct spontaneous seizures are classified by the overarching seizure type. Most patients experience spontaneous seizures along with their provoked events. RS originate from stimulation of functional anatomic networks normally functioning for physiological activities, that overlap or coincide with regions of cortical hyperexcitability. Generalized RS typically occur within the setting of IGEs and should be considered as focal seizures with quick secondary generalization via cortico-cortical or cortico-reticular pathways. In aggregate, activation of a critical neuronal mass, supported and sustained by cortico-subcortical and thalamocortical pathways eventually result in a seizure. Treatment includes antiseizure medication, commonly valproate or levetiracetam, along with lifestyle modifications, and when amenable, surgical intervention. High clinical suspicion and careful history taking must be employed in all epilepsy patients to identify reflex triggers.

Symptomatic eating epilepsy: two novel pediatric patients and review of literature

Eating epilepsy (EE) is a form of reflex epilepsy in which seizures are triggered by eating. It is a rare condition but a high prevalence has been reported in Sri Lanka. In EE, the ictal semiology includes focal seizures with or without secondary generalization or generalized seizures. Some cases are idiopathic while focal structural changes on imaging, if present, are often confined to the temporal lobe or perisylvian region. On the other hand, some cases support the hypothesis of a genetic aetiology. The prognosis of EE is extremely variable due to the different nature of the underlying disorder. We describe two patients with symptomatic eating epilepsy, a 13-year-old boy with a bilateral perisylvian polymicrogyria and a 2-year-old boy with a genetic cause. The presence of structural lesions or the dysfunction of specific cortical regions in the context of a germline genetic alteration might lead to a hyperexcitation fostering the epileptogenesis. We review the available literature to clarify the aetiopathogenesis and the mechanisms underlying EE to improve the diagnosis and the management of these rare conditions.

Neonatal Eating Epilepsy: Pathophysiological and Pharmacologic Aspects

We report a case of neonatal Eating Epilepsy. The baby was admitted to the Neonatal Intensive Care Unit of Chieti after delivery, with respiratory distress syndrome. In the first day of life the baby had an episode of arterial desaturation and cyanosis with EEG alterations. After laboratory and instrumental investigations we found a correlation between EEG abnormalities and GER. So we administered a combination of anticonvulsive and antacid therapy and, considering the total improvement of EEG, we diagnosed a neonatal form of “eating epilepsy”.

Eating epilepsy or feeding epilepsy in an infant

A five month old infant is reported with Eating Epilepsy (feeding epilepsy/feeding related epilepsy). This is an uncommon type of reflex epilepsy in children, and should be considered if the history and investigations for gastro esophageal reflux and apparent life threatening event are negative. A clear stepwise history helps in diagnosis.

Eating Epilepsy in Oman: A case series and report on the efficacy of temporal lobectomy

Eating epilepsy (EE), where seizures are triggered by eating, is rare and has not been reported in the Gulf region. In EE, the ictal semiology includes partial or generalised seizures. Focal brain changes on imaging, if present, are often confined to the temporal lobe or perisylvian region. Therapeutic options, especially in those patients who are refractory to pharmacotherapy, have not been well-established. We report a series of five patients with EE from Oman, a country located in the eastern part of the Arabian Gulf region, and highlight the usefulness of temporal lobectomy in one patient who had medically-intractable EE. Surgical intervention could be considered as a potential therapeutic option in carefully selected patients with medically-intractable seizures.

Vagus nerve stimulation might have a unique effect in reflex eating seizures

We studied the effects of vagus nerve stimulation (VNS) on eating seizures, which theoretically would be triggered by neural activity and signaling from organs innervated by the vagus nerve. Three adult patients with daily nonreflex and reflex eating seizures were studied; one patient also had hot-water seizures. One patient had bilateral polymicrogyria and two had normal magnetic resonance imaging (MRI) findings. All patients were submitted to VNS implantation and had at least 2 years of postimplantation follow-up. Final stimulation parameters were 2.0-2.5 mA, 500 micros, and 30 Hz. Eating seizures decreased 70-95% and nonreflex seizures decreased 0-40% after VNS. There was no improvement in hot-water seizures. VNS seems to be an especially useful treatment modality in patients with reflex eating seizures not amenable to resective surgery.

Reflex epilepsies; clinical and demographic characteristics in a tropical country

BACKGROUND

This study is aimed at defining the clinical spectrum and demographic aspects of reflex epilepsy in a tropical country in Asia.

METHODS

We studied 526 consecutive patients with epilepsy. Details of seizure provoking factors were obtained from direct interviews and medical records.

RESULTS

Of the 526 patients, 47(8.9%) were found to be having reflex epilepsy. There were 25(53.2%) males and 22(46.8%) females. Family history of epilepsy and reflex epilepsy were found in 8(17%) and 3(6.4%) respectively. Provoking factors were, eating (34%), higher cerebral functions (17%), bathing (10.6%), photosensitivity (8.5%), startle induced (4.3%), and mixed (more than one of the above: 25.5%). Seizures were provoked by above factors, exclusively in 10 (21.3%), mostly (more than 50% occasions) in 10 (21.3%), and sometimes (less than 50% occasions) in 27 (57.4%) patients. The type of seizure was complex partial evolving to generalized in 23 (48.9%), complex partial in 10 (21.3%), and generalized in 14 (29.8%).

CONCLUSION

Our study highlights geographical differences in the spectrum of reflex epilepsy.

Eating seizures and emotional facial paresis: evidence suggesting the amygdala is a common anatomophysiological substratum

The medial basotemporal lobes (hippocampus, amygdala, parahippocampal gyrus) are considered to be parts of the system responsible for nonvolitional facial movements. In patients with temporal lobe epilepsy, lower facial weakness during emotional expression has been found to occur almost exclusively contralateral to the temporal lobe with the epileptogenic focus. Repetitive and chronic stimulation of the amygdala during eating has also been postulated as a probable mechanism for eating seizures. The authors present the illustrative aspects of both facial asymmetry and eating seizures in a case of mesial temporal lobe epilepsy (MTLE). This report provides evidence that the amygdala may be the common anatomical basis for three different aspects of this patient: emotional facial paresis, eating seizures, and sleep paroxysmal microarousals.

Tooth-brushing epilepsy: a report of a case with structural and functional imaging and electrophysiology demonstrating a right frontal focus

Patients with reflex epilepsies may provide insights into cerebral pathophysiology. We report a patient with an unusual form of reflex epilepsy in whom seizures are induced by tooth brushing. Magnetic resonance imaging (MRI) demonstrated a right posterior frontal low-grade tumor predominantly involving the precentral gyrus. Video-telemetry demonstrated right-sided epileptiform activity during a typical induced complex partial seizure. An ictal single photon emission computed tomography (SPECT) scan showed an area of hyperfusion that corresponded to the MRI lesion on coregistration with a surface-matching technique. A subsequent coregistered interictal SPECT scan demonstrated hypoperfusion in the same region. Ours is the first report to demonstrate a structural focus in this unusual form of reflex epilepsy. Possible mechanisms to explain the induction of the seizures are discussed.

Hyperventilation-induced seizures in mentally impaired children

Two children with profound development delay and medically intractable seizures were found to have hyperventilation-induced seizures. Following detection of this precipitating factor the parents, teachers and caretakers were taught to modify the childrens' breathing when they began to hyperventilate. In both patients this technique resulted in a dramatic decrease in seizure frequency.

Bulimia in a patient with temporal lobe epilepsy

Images

Eating seizures associated with focal cortical dysplasia

A 15-year-old boy in whom seizures were precipitated by drinking is described. Ictal EEG showed biparietal slow-wave discharges of greater amplitude over the right parietal lobe. Cerebral MRI disclosed right parieto-occipital cortical dysplasia. The mechanism which may be responsible for the seizures is briefly discussed.