10/08/72 The New York Times article "DOCTORS WARNED OF RARE
EPILEPSY" - Physicians Fear Condition May be Misdiagnosed -
by Lawrence K. Altman
Two California physicians have called their colleague's
attention to abdominal epilepsy, a rare condition in which
few children experience recurrent episodes of abdominal pain
without the seizures or convulsions that usually characterize
epilepsy.
The physicians - Dr. Richard R. Babb, a gastroenterologist,
and Dr. Paul B. Eckman, a neurologist, at the Palo Alto
Medical Clinic - described the condition in the current issue
of the Journal of the American Medical Association because
they said, "in our experience physicians know little about
this rare entity."
The doctors said they hoped the article would minimize the
prospects of misdiagnosis, in which a surgeon, for example,
might do an unnecessary operation or a physician might call
the patient neurotic when the true condition was not
recognized.
NOT JUST A BELLYACHE
The doctors emphasized that abdominal epilepsy could be
effectively treated with the same drug that is used to
prevent seizures from the more common form of epilepsy.
However, they pointed out that abdominal epilepsy was not the
usual bellyache that just about every child suffers on
occasion.
Although abdominal epilepsy is not common, pediatricians must
remember it along with scores of other rare and more common
disorders when they examine a child with abdominal pain. The
reason is that without adequate examination and without
considering the remote possibility, the physician can never
be certain that this is "the one patient in a hundred" whose
bellyache is due to such a rare condition.
So complex are the causes of abdominal pain that surgeons
like Dr. Zachary Cope have earned fame within the medical
profession for writing classic textbooks on the methods of
distinguishing among the wide variety of causes of acute
abdominal pain.
PAIN COMES ON FAST
Epilepsy has been known since ancient times. Doctors have
long known that about one epileptic patient in five often
experiences an aura - a brief period preceding a seizure -
characterized by abdominal symptoms like pain, nausea and
vomiting. But just since 1868 have doctors reported that
abdominal epilepsy can occur without a seizure. Only in
recent years have pediatric textbooks included brief
descriptions of the conditions.
Abdominal epilepsy is characterized by an abrupt onset of
pain in the mid or upper abdomen that usually lasts just a
few minutes. Then the pain disappears until days or weeks
later when another episode recurs.
Dr. Babb and Dr. Eckman pointed out in the journal article
that in each attack the child generally loses his appetite,
has nausea or vomiting and may become confused or
disoriented. But the child does not become unconscious.
"Classically, after the attack is over, the patient will
generally fall asleep, feeling well upon awaking," the Pala
Alto doctors wrote.
CONFIRMATION STRESSED
Others in the past, like Dr. Eustace F. Douglas and Dr.
Philip T. White of Milwaukee, have emphasized that the
diagnosis of abdominal epilepsy is not made just by examining
the patient. Also, they emphasized the need to confirm the
diagnosis by electroencephalograms, or brain wave tests.
Despite the absence of a seizure with abdominal epilepsy,
neurologists have found that the brain wave tracings have
abnormal patterns when the patient experiences an attack of
abdominal epilepsy. Favorable response to treatment with a
drug like Dilantin also is helpful in making the diagnosis
of abdominal epilepsy.
Rigid criteria are needed to make the diagnosis, the doctors
said, because otherwise many Americans would needlessly be
taking medication every day for a rare condition that they
did not truly have.
Edgar Cayce Readings © 1971, 1993, 1994, 1995 by the Edgar Cayce Foundation