Clinical Insights Into Eating-Induced Reflex Epilepsy: A Case Report of an Eight-Year-Old Girl

TL;DR

An eight-year-old girl with seizures triggered by eating was diagnosed with reflex eating epilepsy after ruling out other conditions and found to improve with sodium valproate.

Contribution

This case report provides clinical insights into reflex eating epilepsy through a process of elimination and treatment response.

Findings

Seizures occurred primarily during mealtimes and were characterized by fixed gaze, jaw hypotonia, and impaired awareness.

Normal diagnostic tests led to the diagnosis of reflex eating epilepsy after ruling out other conditions.

Treatment with sodium valproate significantly reduced seizure frequency during meals.

Abstract

Eating epilepsy is a rare condition in children where seizures are triggered by the act of eating. An eight-year-old girl presented with seizures occurring primarily during mealtimes, characterized by a fixed gaze, jaw hypotonia, and impaired awareness. These seizures began at age seven, were initially uninvestigated, and progressively worsened over the year, reaching up to 20-30 episodes per meal. Diagnostic tests, including blood work, upper gastrointestinal endoscopy, psychiatric evaluation, and magnetic resonance imaging (MRI), were normal. The EEG showed generalized epileptiform activity, suggesting a seizure disorder, but the exact cause was unclear. After ruling out more common conditions with similar symptoms, such as gastroesophageal reflux disease, Sandifer syndrome, and psychogenic non-epileptic seizures, the diagnosis of reflex eating epilepsy was made in the end through a process of elimination, combining clinical features with EEG findings and through reviewing the literature. Treatment with oral sodium valproate monotherapy led to significant symptomatic improvement, reducing the frequency of seizures during meals.

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