Eating Epilepsy, a Rare and Under-Recognized Reflex Epilepsy (P6.367)

Objective: To report a patient with eating reflex epilepsy. Background: Eating epilepsy is a rare subtype of reflex epilepsy. The published literature on this syndrome includes only case reports and small case series. Here we report a case of eating epilepsy and review the current literature. Methods: Case report and review of literature Results: A 65 year-old woman presented with a 7-year history of seizures often provoked by or associated with eating. Spells were described as beginning with an aura of dizziness and impaired speech, followed by lip smacking and stiffening or jerking of extremities, without loss of awareness. She denied incontinence or oral trauma. She was admitted for inpatient video EEG (vEEG) monitoring. Three seizures of left frontotemporal onset were recorded, two during eating and one within 5 minutes after eating. Behavior consisted of moaning, grimacing, throat-clearing, continued chewing, flexing and extending fingers, without loss of awareness. Brain MRI was normal. PET scan showed bitemporal hypometabolism, greater on the left. Conclusions: Eating epilepsy is a rare form of reflex epilepsy. Twenty-six publications with 67 patients were reported since 1979. Male to female ratio is about 1:1. Age of seizure onset ranged from 2 weeks to 51 years. The most common seizure semiology is focal seizures with impaired consciousness, but focal seizures without impaired consciousness, generalized tonic-clonic seizures, tonic spasms, and status epilepticus have been reported. Scalp EEG typically shows temporal lobe onset (50[percnt] left, 33[percnt] right, 17[percnt] bilateral). Brain MRI usually showed structural abnormalities including sclerosis, atrophy, hypoplasia or mass lesions. PET scans from 2 patients showed multifocal hypometabolism. Ictal SPECT from 3 patients reported frontal (1), anterior temporal (1), and parietal-insular (1) hyper-perfusion. Treatment has included anti-seizure drugs, surgery, and vagus nerve stimulation. Connections between temporal lobe and olfactory/gustatory centers may account for this rare reflex epilepsy. Disclosure: Dr. Chen has nothing to disclose. Dr. Sahaya has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Hinkle has nothing to disclose. Dr. Greenfield has received royalty payments from Lippincott Williams and Wilkins.