Автономна епілепсія з гастроінтестинальною аурою та нічними генералізованими нападами: клінічний випадок

Despite the fact that abdominal pain is a common symptom of various pathological conditions, it can also be suggestive of a diagnosis of epilepsy. Autonomic epilepsy may present with paroxysmal gastrointestinal symptoms mimicking abdominal pathology or functional disorders, making diagnosis challenging. In 36 cases reported in the last 34 years, the most common gastrointestinal symptoms included abdominal pain, nausea, vomiting, etc. Although many mechanisms have been outlined, the cause of autonomic epilepsy with gastrointestinal symptoms still remains unclear current hypotheses suggest that the Sylvian fissure and the insular cortex may serve as sources of epileptic activity. Recognition of autonomic epilepsy in such casesis important, as timely identification and antiseizure treatment lead to significant clinical improvement.Case presentation. A female patient presented with recurrent nocturnal episodes beginning with abrupt awakening due to painful urges to defecate, followed by loss of consciousness, generalized tonic–clonic seizures and postictal confusion. Initially rare, the episodes increased to 4—5 events per year, exclusively during sleep,with normal neurological status between seizures. Brain MRI revealed bilateral cortical atrophy of the frontal and temporal lobes, asymmetry of the lateral ventricles, and periventricular leukoaraiosis. Overnight video­EEG revealed interictal sharp waves during sleep without recorded ictal events. Levetiracetam therapy (500 → 750 mg/day) led to complete seizure control. Discussion. In this case, the combination of nocturnal onset, with gastrointestinal manifestations, and subsequent generalized tonic—clonic activity suggests either a focal seizure manifesting as gastrointestinal pain with secondary generalization or a generalized seizure preceded by a gastrointestinal aura. Video­EEG monitoring confirmed the epileptogenic nature and contributed to understanding the pathophysiology of these symptoms. Levetiracetam proved effective in achieving seizure freedom. Conclusions. This case highlights a rare epileptic presentation with nocturnal seizures preceded by a painful gastrointestinal urge. Recognizing such visceral symptoms may aid earlier diagnosis and appropriate treatment.