Epilepsy and the gut: Perpetrator or victim?

Table 1 Differences between epilepsy with abdominal pain and abdominal migraine

Parameter	Epilepsy with abdominal pain	Abdominal migraine
Age	Mainly pediatric age (4-9 yr), scarce in adults	It starts in childhood (3-10 yr with a peak at 7), though it may occur in adults
Sex	More in males during childhood, more in females in adulthood	More in females
Prevalence	Very rare	More common affect 2% to 4% of children
Etiology	Focal partial temporal lobe epilepsy due to idiopathic or secondary causes	Food allergy, Mitochondrial DNA mutation (cytopathy), Corticotropin-releasing factors abnormalities, Endogenous prostaglandin release
Family history		Strong family history of migraine
Duration of episodes	Usually 10-30 min, 4–5 times/month	Usually, more than an hour (3-4 h), at least twice/6 mo
Aura	May present	May present
Headache if present	Short duration	Long duration
Consciousness	May be altered	Not affected
Postictal tiredness or confusion	May present	absent
EEG	Abnormal epileptogenic electrical activity of focal temporal epilepsy	Usually, normal
Postictal serum Prolactin	Usually, high	Usually normal, it may be high, especially in females
Prevention	Prevention and treatment of the cause in secondary cases and sleep hygiene in idiopathic cases	Good sleep hygiene, hydration, stress reduction, and avoiding dietary triggers
Prophylaxis therapy	Antiseizure medications	Amyltryptine, propranolol, cryoheptadine, pizotifen

EEG: Electroencephalogram.

Table 2 Common gastrointestinal side effects of antiseizure medications[122-129]

Antiseizure medications	Common gastrointestinal side effects
Carbamazepine	Dry mouth, mouth sores, glossitis, loss of appetite, dysphagia, nausea, vomiting, hurt burn, gastritis, stomach/abdominal pain, constipation, diarrhea, abnormal liver functions, cholestatic and/or hepatocellular jaundice, hepatitis; hepatic failure (very rare), and pancreatitis (rare), eosinophilic colitis
Ethosuximide	Anorexia, nausea, vomiting, gastric pain, diarrhea, gastric and intestinal atony with decreased peristaltic activity
Phenobarbital	Diarrhea, sore throat, swelling of the tongue/throat, nausea, vomiting, constipation, dysphagia, and heartburn. As it is a cytochrome P450 hepatic enzyme inducer, it can cause abnormal hepatic function, hepatitis, liver damage, cholestasis, toxic hepatitis, and jaundice
Phenytoin	Changes in taste sensation, gingival overgrowth, sore throat, mouth ulcers, diarrhea, nausea, vomiting, constipation, dysphagia, heartburn, idiosyncratic hepatotoxicity (< 1% of the patients), reduced gastrointestinal absorption of calcium, reduced hepatic synthesis of 25-hydroxycholecalciferol, cause a relative vitamin K deficiency
Valproate	Diarrhea, nausea, vomiting, constipation, dysphagia, gastritis with heartburn, several distinctive forms of acute and chronic liver injury, and vitamin D deficiency
Gabapentin	Vomiting, constipation, gastritis, pancreatitis
Topiramate	Taste perversion, anorexia, nausea, abdominal pain, indigestion, diarrhea, constipation
Lamotrigine	Dry mouth, nausea, vomiting, gastritis, diarrhea, or constipation