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 ABDOMINAL EPILEPSY


 
The association of abdominal symptoms with epilepsy has been recognized for many years.  For example, "gastric and intestinal disturbances" were viewed as primary etiological factors by medical doctors during the late 19th and early twentieth century (Musser & Kelly, 1912).  The invention and clinical application of the electroencephalo-gram (EEG) during the 1920's shifted the focus of medical attention from the abdomen to the brain where, for the most part, it has remained to this day.

Another example of the abdominal connection in epilepsy is the aura which is common in certain types of epilepsy.  For example, temporal lobe epileptic seizures frequently begin with an aura.  In neurological terms, an aura is actually a mild seizure which precedes the primary seizure.  It can be thought of as a warning that a seizure is about to happen.  Most often, auras manifest as an altered consciousness or peculiar sensation.  "The most common aura is of vague gastric distress, ascending up into the chest"   (Gordon, 1942, p. 610).

Modern medical science has rediscovered the abdominal connection in epilepsy.  Several papers published in the medical journals during the 1960s called attention to the abdominal connection in epilepsy.  Over the past forty years, numerous researchers and clinicians have reported on various aspects of abdominal epilepsy.

Common clinical features of abdominal epilepsy include abdominal pain, nausea, bloating,  and diarrhea with nervous system manifestations such as headache, confusion, and syncope (Peppercorn & Herzog, 1989).  "Although its abdominal symptoms may be similar to those of the irritable bowel syndrome, it may be distinguished from the latter condition by  the  presence  of  altered  consciousness during some of the attacks, a tendency  toward  tiredness  after  an  attack,  and  by  an  abnormal EEG" (Zarling, 1984, p.687).  Mitchell, Greenwood and Messenheimer (1983) regard cyclic vomiting as a primary symptom of abdominal epilepsy manifesting as simple partial seizures (1983).

Although abdominal epilepsy is diagnosed most often in children, the research of Peppercorn and Herzog (1989) suggests that abdominal epilepsy may be much more common in adults than is generally recognized:

"Abdominal epilepsy is well described among pediatric patients but is recognized only infrequently in adults.  Our experience over the past 15 years indicates that the disorder may not be as rare as is suggested by the paucity of literature on the subject.  Moreover, the variability of the clinical presentation indicates a spectrum to both the gastrointestinal (GI) and central nervous system (CNS) manifestations of abdominal epilepsy in adults."  (Peppercorn & Herzog, 1989, p. 1294)

One of the primary problems in understanding abdominal epilepsy is clearly defining the relationship of the abdominal symptoms to the seizure activity in the brain.  In other words, what is the pathophysiology of abdominal epilepsy.  Is the essential pathology in certain areas of the brain which happen to be connected to the abdominal organs?  Or, is the primary pathology in the abdomen which is conveyed through connecting nerve fibers to the brain resulting in epileptic seizures?  Peppercorn and Herzog noted both possibilities in their attempt to understand the cause of abdominal epilepsy:

"The pathophysiology of abdominal epilepsy remains unclear.  Temporal lobe seizure activity usually arises in or involves the amygdala.  It is not surprising, therefore, that patients who have seizures involving the temporal lobe have GI symptoms, since discharges arising in the amygdala can be transmitted to the gut via dense direct projections to the dorsal motor nucleus of the vagus.  In addition, sympathetic pathways from the amygdala to the GI tract can be activated via the hypothalamus.

On the other hand, it is not clear that the initial disturbance in abdominal epilepsy arises in the brain.  There are direct sensory pathways from the bowel via the vagus nerve to the solitary nucleus of the medulla which is heavily connected to the amygdala.  These can be activated during intestinal contractions."  (Peppercorn & Herzog, 1989, p. 1296).

In other words, the trigger for the seizures may be in the abdomen.   At this time, there is no definitive model of abdominal epilepsy which explains the association of brain seizures and abdominal symptoms.  However, there is a growing body of medical information which may lead to a better understanding of this complex relationship.
 
EDGAR CAYCE'S PERSPECTIVE ON ABDOMINAL EPILEPSY
 
Edgar Cayce's explanation of abdominal epilepsy is that nervous system incoordination in the abdomen ("abdominal brain") is transferred to the brain via the medulla oblongata.  The medulla oblongata is a major nerve center at the base of the brain where the spinal cord enters the brain.

As discussed in other sections, Cayce identified "adhesions" in the lacteal ducts of the abdomen as the source of the nervous system incoordination which was transferred from the abdominal brain to the brain in the head via the medulla oblongata.  Physiologically, lacteal ducts are part of the lymphatic system.  They absorb fats and proteins  from the small intestine.  Cayce stated that various etiological factors (e.g., high fever, abdominal injury, reflexes from other portions of the nervous system) could produce "adhesions" in the area of the lacteal ducts.  An adhesion is a:

"... union of two surfaces that are normally separate; also, any fibrous band that connects them.  Surgery within the abdomen sometimes results in adhesions from scar tissue.  As an organ heals, fibrous scar tissue forms around the incision. This scar tissue may cling to the surface of adjoining organs, causing them to kink.  Adhesions are usually painless and cause no difficulties, although occasionally they produce obstruction or malfunction by distorting the organ."    (Miller & Keane, 1972, p. 16)

Abdominal adhesions were a major etiological factor in Cayce's model of epilepsy.  He noted that adhesions to the lacteal duct area could be produced by a variety of sources including high fever, abdominal injury, and nerve reflexes from injured spinal centers.
 
Here are a couple of examples of Cayce's description of the pathophysiology of abdominal epilepsy.  The first case involved an eighteen year old male. Cayce stated that there had been a spinal injury producing nerve reflexes to the abdomen which:

"... caused a slowing of the circulation through the areas of the lacteal ducts, thus producing a cold area there, that has produced a partial adherence of tissue.
     With the activity of the lymph through the area, we find that periodically, when there is the lack of proper eliminations through the alimentary canal, there occurs a reflex to the coordination between sympathetic [abdominal brain]  and cerebrospinal [central nervous] system area; that takes the governing of the impulse, as it were, to the brain reactions; or a form of spasmodic reaction that might be called epileptic in its nature."  (1980-1)
 
Note the reference to adhesion ("adherence of tissue") and a slowing of circulation through this area.  Cayce believed that  restricted circulation produced coldness in the area of the lacteal ducts (on the right side of the abdomen). According to Cayce, "From EVERY condition that is of true [idiopathic] epileptic nature there will be found a cold spot or area between the lacteal duct and the caecum."  (Cayce, 567-4)
 
Also note the reference to periodicity associated with "activity of the lymph through the area" and "proper eliminations through the alimentary canal."  In other words, cycles of seizure activity were linked to activity of the gastrointestinal tract (i.e., digestion and eliminations).  Hence seizure activity may be associated with digestive problems with certain types of foods (e.g., carbohydrates and fats) and/or with improper eliminations (diarrhea or constipation).
 
Another important point is the importance of  "coordination" between the nervous system in the abdomen and the nerves of the brain.  Consistent with the growing body of medical information on the "abdominal brain" and enteric nervous system, Cayce referred to the abdominal brain as the "solar plexus brain," (2259-1 & 1800-15),  the "secondary brain" (294-212), and the "central brain in the solar plexus" (4613-1).  He noted that the brain in the abdomen with its nervous system (the "sympathetic" system) and the brain in the head with its nervous system (the "cerebrospinal system") must coordinate to maintain physical and mental health.  When these two systems are out of harmony with each other, various forms of illness usually result.  Epileptic seizures might be regarded as the most severe form of incoordination between these two brains and nervous systems of the body.  Actually, the extent of nervous system incoordination might be described as almost a complete dissociation.
 
Here is another description of the basic nervous system incoordination by Edgar Cayce given for an adult suffering from epilepsy:

"As indicated, the lesions - or adhesions and lesions - in the lacteal ducts are the basic cause for the disturbance in the nervous system.... When there is an expression or activity from the sympathetic nervous system ... we find there is movement or impulse to and from the brain centers themselves.  Then with a lesion or adhesion the impulse is cut off - or deflected.... Then this ... connection with the solar plexus nerve centers [abdominal brain], making for an incoordination with the cerebrospinal nerve system, produces at the base of the brain - or through the medulla oblongata - an incoordinant reaction [seizure] ...
Q.  Do you find any condition existing in the brain, or is it reflex?
A.  As we find, and as indicated, the accumulations that have been there [in the cerebral brain] are rather reflex - and are produced by the condition in the lacteal duct area."   (1025-2)
 
Note that the reflex from the abdomen produced "accumulations" in the cerebral brain .  Perhaps a modern brain scan or electro-encephalogram would have detected a focal lesion in the brain as the source of the seizure.  Yet, Cayce insisted that the source of the condition was in the abdomen.  Also note that the reflex from the abdomen was mediated through the medulla oblongata, an important nerve center at the upper portion of the spinal cord where it enters the skull.  This is significant because Cayce sometimes recommended that a piece of ice be placed at this area during the aura or at the beginning of the seizure.  This simple technique has proven effective in several contemporary cases where Cayce's therapeutic model has been utilized.  Incidentally, this technique for preventing seizures  was also used by osteopathic physicians during the early decades of this century.
 
Following is an exemplary excerpt from the Cayce readings on epilepsy which summarizes his approach:

"As has been indicated  and should be noted by the masseur or osteopath  the lesions that cause attacks are in the lacteal duct and those areas about the assimilating system and the upper portion of jejunum and caecum.
     There are NO brain lesions, but there is that which at times hinders the
coordination between the impulses of the body and the normal physical
reactions or that break between the cerebrospinal and the sympathetic or vegetative [enteric] nerve system, that coordinates from the lacteal duct through the adrenals and their reaction to the pineal; causing the spasmodic reaction in the medulla oblongata, or that balance at the base of the brain.
     Have sufficient periods of the Castor Oil Packs.  To be sure, they are disagreeable, but they will break up lesions as no other administrations will.  The best time to take these is the evening, to be sure.  These should be given in series; applied for an hour each evening for two or three evenings BEFORE each osteopathic adjustment is to be made, see?  At least every OTHER series, follow same with at least a tablespoonful of Olive Oil taken internally....
     Keep these up until this coldness AND the lesion in the right side is removed,  which is just a hand's breadth below the point of the rib, or over that area of the ducts.
     To be sure, there may be many questions as to the exact area of the ducts, even according to some anatomists for they have changed their ideas of people, and yet people haven't changed a very great deal!
     There are, to be sure, lacteal ducts.  There are the strings or ducts all through the upper portion of the alimentary canal, or jejunum; but the larger patch or area is that lying just below the lower end of the duodenum, and where same EMPTIES into the jejunum, see? ...
     The adhesions in these ducts here were produced by an excess temperature, which the body suffered at some period when there was too SUDDEN dropping of the temperature (which they may check and find to be correct), and NOT sufficient water, or manipulations, or activity, through the alimentary canal.
     This has gradually caused the disturbances to the general breaking of coordination in the nerve systems, and brings about  for this body  the SOURCE of the attacks.
     These CAN be  these will be eliminated, if these applications here suggested will be followed."   (2153-4)
 
Cayce's primary treatment recommendations for epilepsy were directed at eliminating the nervous system incoordination in the abdomen.  Castor oil packs, massage and diet were some of the therapies commonly suggested by Cayce to heal the abdominal brain and prevent seizures in the cranial brain.
 
REFERENCES
 
Gordon, B.  (Ed.).  (1942).  Hughes practice of medicine (16th ed.).  Philadelphia: The Blakiston Company.

Mitchell, W. G., Greenwood, R.S. & Messenheimer, J. A.  (1983).  Abdominal  epilepsy: Cyclic vomiting  as  the  major  symptom of simple partial seizures. Archives of  Neurology, 40(4) 251 - 252.

Peppercorn, M. A. & Herzog, A. G.  (1989).  The spectrum of abdominal epilepsy in adults. American Journal of Gastroenterology, 84(10), 1294 - 1296.

Zarling,  E. J.  Abdominal epilepsy: an unusual cause of recurrent abdominal pain.  (1984).  American Journal of Gastroenterology, 79(9), 687 - 688.

ARTICLES ON ABDOMINAL EPILEPSY

The following articles are representative of the  abdominal epilepsy literature.  They are included as a resource for readers interested in further pursuing the topic.

Agrawal, P., Dhar, N. K., Bhatia, M. S. & Malik,  S. C.  (1989).  Abdominal epilepsy.  Indian Journal of  Pediatriacs, 56(4), 539 - 541.

Babb, R. R. & Eckman, P. B.  (1972).  Abdominal epilepsy.  Journal of the American Medical Association, 222(1), 6566.

Berdichevskii, M. (1965).  Mesodiencephalic epilepsy after abdominal injury.  Vopr Psikhiatr  Nevropatol, 11, 374 - 376.

Bondarenko, E. S., Shiretorova, D. Ch. & Miron, V. A.  (1986).  Abdominal  syndrome  in  the  structure of cerebral paroxysms in children and adolescents.  Soviet Medicine, (2), 39 - 44.

Douglas,  E. F. & White, P. T.  (1971).  Abdominal epilepsy: A reappraisal.  Journal of Pediatrics, 78(1), 5967.

Hotta, T. & Fujimoto, Y.  (1973).  A study on abdominal epilepsy.  Yonago Acta Medica,  17(3),   231 - 239.

Juillard, E.  (1967).  Abdominal pains and epilepsy.  Praxis, 56(3),  8384.

Loar,  C. R.  (1979).  Abdominal epilepsy.  Journal of the American Medical Association,  241(13), 1327.

Matsuo,  F.  (1984).  Partial epileptic seizures beginning in the truncal muscles.  Acta Neurologica Scandinavia, 69(5), 264 - 269.

Mitchell, W. G., Greenwood, R.S. & Messenheimer, J. A.  (1983).  Abdominal  epilepsy: Cyclic vomiting  as  the  major  symptom of simple partial seizures. Archives of  Neurology, 40(4) 251 - 252.

Moore, M. T.  (1972).  Abdominal epilepsy.  Journal of the American Medical Association, 222(11), 1426.

Moore,  M. T.  (1979).  Abdominal epilepsy [letter].   Journal of the American Medical  Association, 241(13), 1327.

O'Donohoe,  N. V.  (1971).  Abdominal epilepsy.  Developmental Medicine of Child Neurology,  13(6), 798 - 800.

Peppercorn, M. A., Herzog, A. G., Dichter, M. A. & Mayman, C. I.  (1978).  Abdominal epilepsy: A cause of abdominal pain in adults.  Journal of the American Medical Association, 40(22), 2450 - 2451.

Peppercorn, M. A. & Herzog, A. G.  (1989).  The spectrum of abdominal epilepsy in adults.  American Journal of Gastroenterology, 84(10), 1294 - 1296.

Reimann, H. A.  (1973).   Abdominal epilepsy and migraine.  Journal of the American Medical  Association, 224(1), 128.

Singhi, P. D. & Kaur, S.  (1988).  Abdominal epilepsy misdiagnosed as psychogenic pain. Postgraduate Medical Journal, 64(750), 281 - 282.

Solana de Lope, J., Alarcon, F. O., Aguilar, M.  J., Beltran, C. J.,    Barinagarrementeria, F. &  Perez, M. J.  (1994).  Abdominal epilepsy in the adult. Review of Gastroenterology, 59(4), 297 - 300.

Takei, T. & Nakajima, K. (1967).  Autonomic  abdominal epilepsy  clinicoencephalographic  evaluation of 24 cases.  Nippon Shonika Gakkai Zasshi, 71(5), 543 - 551.

Yingkun,  F.  (1980).  Abdominal epilepsy.  Chinese Medical Journal, 93(3), 135 - 148.

Zarling,  E. J.  Abdominal epilepsy: an unusual cause of recurrent abdominal pain.  (1984).  American Journal of Gastroenterology, 79(9), 687 - 688.

 

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