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

Abstract

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.

Keywords: Eating epilepsy; Reflex seizures; Symptomatic epilepsy.

Fig. 1

Ictal EEG recordings of patient 1 (13 years) after 10″ (a) and 30″ (b) from food intake; showing a brief seizure characterized by jaw hypotonia and gaze staring associated with diffuse low-amplitude fast activity followed by generalized spikes and sharp waves mainly evident on mid-temporal areas (c). Ictal EEG of patient 2 showing a brief discharge of high-voltage spikes and sharp waves mainly evident on mid-temporal areas (d)

Fig. 2

Radiological features. a-c) Brain MRI of Patient 1 performed at 13 years of age. a) Coronal, b) sagittal, and c) axial 3D T1-weighted reformatted images reveal bilateral polymicrogyria involving the insula and perisylvian regions, slightly more extended on the left side (arrows). d-h) X-ray and brain MRI of Patient 2 performed at 2 years of age. D) Long-spine plain film in the AP projection shows the severe dorsolumbar scoliosis. e) Sagittal T1-weighted and f) DRIVE (DRIVen Equilibrium) T2-weighted images demonstrate the hypoplasia of the adenohypophysis (arrows) associated with a minor dysmorphism of the brainstem characterized by a shorter midbrain (empty arrow). g) Coronal and h) axial T2-weighted images reveal thinning of the periventricular white matter with enlargement of the lateral ventricles (asterisks) and frontal subarachnoid spaces (thick arrows). Note the enlargement of the Meckel's caves (arrowheads)