Abdominal Epilepsy in Children and Adults

Medically Reviewed by Christopher Melinosky, MD on January 15, 2023
Written by Matthew Hoffman, MD
4 min read

Abdominal epilepsy is an exceptionally rare syndrome of epilepsy that's more likely to occur in children. With abdominal epilepsy, seizure activity causes abdominal symptoms. For example, it may cause pain and nausea. Anticonvulsant medications can improve the symptoms.

Abdominal epilepsy is so uncommon that some experts question whether it exists. Abdominal pain is common in people with epilepsy as well as without. So it could be that the abdominal pain is only coincidental, not caused by seizures.

Little is known about abdominal epilepsy because of it's rarity..

With abdominal epilepsy, it's thought that seizures occur that primarily affect the digestive system. Gastrointestinal symptoms are the result. Those symptoms include:

  • abdominal pain, usually sharp or cramping and lasting seconds to minutes
  • nausea and/or vomiting
  • fatigue, lethargy, or sleep following seizures
  • altered level of consciousness, such as confusion or unresponsiveness
  • convulsive seizures known as generalized tonic-clonic seizures

People with reported abdominal epilepsy have different patterns of symptoms. Further, symptoms may vary in the same person from one time to the next. For example, a person might have convulsive seizures and abdominal pain during one episode. Then the person may only have abdominal pain during another seizure.

No one knows what causes abdominal epilepsy. Because the condition is so rare, no high-quality studies exist. There have been too few reported cases to identify risk factors, genetic factors, or other potential causes.

Diagnosing abdominal epilepsy can involve a chicken-or-the-egg debate. Seizures in epilepsy are sometimes preceded by patterns of symptoms. These patterns of symptoms are called auras. Just before a seizure, some people with epilepsy might smell something that's not there. Others might see flashing lights.

Auras with abdominal symptoms are common in epilepsy. You can call it a gut feeling. Nausea, pain, flatulence, or hunger can herald a seizure. But are the abdominal symptoms ever evidence of seizures in their own right?

Some experts think the diagnosis of abdominal epilepsy should be made when abdominal symptoms are the main manifestation of seizure activity.

They propose these criteria for the diagnosis of abdominal epilepsy:

  • periodic abdominal symptoms that can't be explained after extensive medical testing, including blood tests, imaging scans, and endoscopy
  • symptoms that suggest a central nervous system problem (for example, confusion or lethargy)
  • an abnormal electroencephalogram (EEG)
  • sustained absence of abdominal symptoms while taking an epilepsy medication

Medical and neurologic testing might include:

  • computed tomography (CT) scans of the abdomen and brain
  • magnetic resonance imaging (MRI) scan of the brain
  • ultrasound of the abdomen
  • endoscopy of the gastrointestinal tract, either upper (through the mouth), lower (through the rectum), or both
  • blood tests
  • electroencephalogram (EEG)

Abdominal epilepsy is treated like other forms of epilepsy, with anticonvulsant drugs. Phenytoin (Dilantin) is often used. Since no controlled studies exist, though, other drugs might be equally effective.

In case of an emergency, drugs known as “rescue medications” may be needed. These drugs do not take the place of daily medications and should only be used to help stop a seizure quickly in dangerous situations. Depending on the circumstance, they can be administered:

  • Nasally - Sprayed up the nose
  • Orally - Swallowed in pill form 
  • Sublingually - Placed under the tongue to dissolve
  • Buccally - Placed between the cheek and the gum to dissolve
  • Rectally - Given via a gel through the anus 

The most commonly used medications are benzodiazepines because they get into the bloodstream quickly to start working on the brain to stop the seizure. They include:

In the known cases of abdominal epilepsy, treatment with epilepsy drugs has usually significantly reduced abdominal symptoms and emergencies are rare. That's not proof that the abdominal symptoms were caused by seizures, though. Epilepsy drugs act on nerves in general. They might simply soothe abdominal pain that way, or through a placebo effect.