True abdominal epilepsy is clonic jerking of the abdominal musculature

Teaching Video NeuroImage: Status Epilepticus Manifesting as Belly Dancing Secondary to Subdural Hematoma

A 74-year-old man developed involuntary rhythmic contractions of his left abdomen, after drainage of a chronic right frontoparietal subdural hematoma (Figure). These movements had electroencephalographic correlation with periodic lateralized discharges over the right posterior quadrant (Video 1, Figure) and were classified as clonic abdominal seizures. Clonic abdominal seizures are a rare clinical finding in patients with seizure disorders. The symptomatogenic zone most commonly localizes to the contralateral paracentral frontoparietal region.1 Possible etiologies include primary brain tumors, brain metastasis, CNS infections, cortical dysplasia, stroke, and postsurgical complications.1,2 Clonic abdominal seizures are infrequent, but should be suspected in patients with rhythmic and regular contractions of the hemiabdominal wall in the context of a contralateral cerebral structural lesion.

Unilateral abdominal clonic jerking as an epileptic phenomenon

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We report three cases of focal aware seizures presenting as unilateral abdominal clonic motor movements.

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One of these cases is the first seizure manifesting as unilateral abdominal clonic motor movements with simultaneous intracranial electrode recording in the literature, and demonstrates the utility of intracranial EEG in the diagnosis.

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The symptomatic zone of seizures presenting as unilateral abdominal clonic motor movements is felt to be in an anatomically restricted area of the abdominal region of the motor homunculus.

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A careful clinical history is important in the assessment of this seizure type, and the diagnosis is ideally established with video-EEG.

Unilateral abdominal wall clonic seizures are a rare manifestation of epilepsy. We report three cases of focal aware seizures manifesting as unilateral abdominal clonic motor movements. Standard EEG for patients with focal motor abdominal seizures is often unrevealing, which can make the diagnosis difficult. We report the first case of intracranial EEG in the diagnosis of a patients with this type of semiology during a focal seizure. In the absence of an electroclinical seizure verified by video-EEG monitoring, caution should be made with the diagnosis. A careful history should be obtained to help differentiate between unilateral abdominal clonic jerking and other abdominal complaints.