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These attacks occcured at random intervals, sometimes every few days and sometimes once a month. Her symptoms during these episodes included cramps, episodic vomiting, headache and pain experienced as a pressure sensation in her abdomen that radiated to her lumbar area. Although the patient experienced two episodes of generalized seizures, her abdominal pain was typically not associated with convulsions or loss of consciousness, although was typically followed by somnolence, lethargy, and increased sleep.

The patient also reported absence episodes, independent of the abdominal pain. At the age of 10 years, the patient reportedly experienced an episode in which she felt dizzy and lost the ability to concentrate, experienced frequent odd sensations in her left ear persisting until the present and, occasionally, a pulling sensation on her teeth.

In spite of the unremarkable results yielded by an EEG investigation, the episodes of compromised consciousness continued. Her emotional response to these symptoms was a depressed mood throughout her adolescence and she was consequently referred for counseling.

During her mid-20s, the patient continued to experience sensations in her left ear, with these symptoms progressing to the point that she believed that she was suffering from some type of auditory condition. At the age of thirty seven, the patient suffered her first episode of the abdominal symptoms combined with a generalized seizure.

Specifically, she awakened with abdominal pain during the night and went to the toilet, where she collapsed and had a generalized seizure. This event included tongue biting and incontinence, with the entire episode lasting ten minutes. She was confused post-ictally, and the patient required several days to fully recover. She was prescribed carbamazepine and reportedly did not suffer any further generalized seizures for well over a decade.

At the age of fifty, the patient suffered another generalized seizure. As was the case in her initial seizure, she reportedly experienced abdominal pain immediately prior to the generalized seizure. Symptoms included loss of consciousness and involuntarily shaking of her limbs, although no incontinence or tongue biting.

Following this second seizure in 2018, the patient underwent an MRI of her brain. Results indicated the presence of a pituitary lesion which was further evaluated with dedicated pituitary imaging. Although an endocrinological referral was made, all endocrinologic assessments were within normal limits. At that point, the patient underwent exhaustive investigations including routine blood tests, electrocardiography, abdominal ultrasound and upper gastrointestinal endoscopy showing only a hiatal hernia.

Gastric biopsies were normal and no other abnormalities were found in any of the other general medical and neurological investigations. An EEG record was within normal limits. Adding pregabalin reduced the frequency and severity of abdominal pain and associated lethargic episodes.

The patient denies any subsequent seizure episodes, and reports abdominal pain control with which she is satisfied. According to the patient, the addition of the pregabalin was the factor that she saw as most salient to her recovery. The pathophysiology and etiology of abdominal epilepsy remain unknown. Research suggests that the insula and Sylvian fissure might play an important role, contributing to the etiology of the pathology. Most patients diagnosed with abdominal epilepsy have registered abnormalities in their EEGs, such as high voltage, slow waves and generalized spike and wave discharges.

Furthermore, the localization of the pain is important to note, as it is typically found in the periumbilical or upper abdominal areas. Abdominal epilepsy remains a rare condition and should only be considered if there are idiopathic paroxysmal abdominal pain and migraine-like symptoms in patients. To facilitate this complex clinical diagnosis, physicians should include an EEG with 24 hr monitoring. In this case, attribution of psychogenic (i. Historically, the Freudian psychoanalytic model regarded chronic pain and somatic disorders as thinly disguised psychological issues.

The medical field of antiquity traditionally regarded conditions such as migraine, asthma, arthritis, hypertension, diabetes, and tuberculosis as syndromes of exclusively psychogenic etiologies,5 such as repressed emotions or an anxious disposition. This model is contigent on the interconnectedness of biology, psychology, and socio-environmental factors-all of which influence disease pathology. However, within the biopsychosocial framework, disease is regarded as a biologically-based phenomenon that can both be influenced by psychology and can also cause psychological outcomes,18 while making no assertion regarding underlying psychological causes.

While many conditions have made the leap from the psychogenic to the biopsychosocial model, other rare conditions, such as abdominal epilepsy or a number of chronic pain conditions are still too often relegated to the status of psychological disorders. Although the biopsychosocial model can have its benefits, he notes that it is most likely evoked when faced with our most challenging patients. By failing to take the myriad physical symptoms seriously from the onset, the precious window of time during which interventions can abate disease progression quickly dwindles.

Finally, at the age of fifty-two, her symptoms have been largely alleviated with carbamazepine and, seemingly more critical, a therapeutic dosage of pregabalin. As illustrated by the case in question, a patient presenting with medically unexplained symptoms, even those which seem to be bidirectionally modulated by psychological factors, does not justify a psychological evaluation as the sole avenue for treatment.

This approach inherently places the blame on the patient for his or her symptoms. Watson HS, Cockbain AJ, Wong JCK, Stallard J, Anwar S. Long-term follow-up of patients diagnosed with nonspecific abdominal pain (NSAP): identification of pathology as a possible cause for NSAP. Zdraveska N, Kostovski A. Epilepsy presenting only with severe abdominal pain.