CLINICAL BRIEFS : ABDOMINAL EPILEPSY -539

Cardiology Monographs, Grune and Strat- ton, New York, 1981. p 50.

3. Rodruguez CA, Suebling W , Hastreiter AR. Clinical forms of atrial flutter in infancy. Pediatrics 1968; 73 : 69.

4. Rowland TW, Keane JF. Mathew R, Chameides L, et al. Idiopathic atrial flut- ter in infancy, A review of 8 cases. Pediat- tics 1978; 61 : 52-56.

5. MoUer JH, Davachi F, Anderson RC. Atrial flutter in infancy. Pediatrics 1969; 15 : 643-651.

6. Richard H, Hell'ant WB. Bellet's Essen- tials of Cardiac Arrythmias, Saunders 1980, 2nd Edn., 85-94.

7. Barclay RPC, Barr DGDC. Cardioversion in a case of congenital atrial flutter. Arch Dis Child 1972; 47 : 833.

Abdominal Epilepsy Pradeep Agrawal, Naresh K. Dhar, M.S. Bhatia and S.C. Malik

Department of Psychiatry, Lady Hardinge Medical College and Associated Hospitals, New Delhi

Abdominal epilepsy is now considered as definite clinical entity. It is said that Trousseau was first to describe abdominal epilepsy in 1868. Few people considered periumblical pain to be a form of masked epilepsy?~ Klinman et al 3 described 12 chil- dren with abnormal EEG to be suffering from abdominal epilepsy. Moore 4 wrote a series of articles on abdominal epilepsy de- scribing its clinical features and EEG find- ings. Livingstone 5 described 14 patients who had an associated state of exhaustion and sleep. Authors suggested the value of triad of features including recurrent ab- dominal pain; electroencephalo-graphie abnormalities and favourable response to anticonvulsant treatment. Millichap et al 5 described 33 children with cyclical vomiting and abdominal discomfort, considered by them to be a form of autonomic epilepsy. They stressed need for abnormal finding in EEG, or some sign of involvement of brain function and diagnosis should be positive

rather than after exclusion of other dis- eases. Emphasis on the role of abnormal EEG'f '~dings was also suggested by many authors. ~ In one study of 459 children and another with 550 children 9 it was concluded that there was a specific syndrome of par- oxysmal pain, headache, behavioural and autonomic disturbances which could be considered as convulsive disorder. This was based on abnormal EEG findings in form of spikes.

CASE REPORT

M.C. a 6 year old male child came to Kalawati Saran Child Hospital with com- plaints of : Brief episodes of paroxysmal pain in umblical region with lassitude fol- lowed by sleep for the past 2 years.

The abdominal pain developed suddenly when patient was 4 year old. It was very severe, colicky in nature and used to last for about half an hour. It was localized to umblical region and a few times it would

540 THE INDIAN JOURNAL OF PEDIATRICS Vol. 56, No. 4

radiate to epigastric region. There was no relationship of pain with meals but the episode of pain was preceded by lack of ap- petite on the same day. The initial fre- quency of such episode was once a month but for the past 3 months the frequency in- creased to every fortnight. Episodes of pain could occur at any time during the day. Some times pain occurred while the child was asleep at night.

There was no history of vomiting, diar- rhea, constipation, fever, jaundice or pass- hag of worm. There was no history of any antecedant illness involving central nervous system. No other form of epilepsy was ap- parent. Family history was also negative. Patient was investigated thoroughly for the abdominal pain and his routine blood ex- aminations were with in normal limits. Liver function test, plain X-ray abdomen and chest PA view were found to be nor- mal. He was adviced Barium meal upper G.I.T. and follow through, and ultra sound examination of liver, which came out to be

Fig. EEG record showing changes of epilepsy (see text).

normal. The pediatricians were unable to find out the cause of pain abdomen and at this stage the patient was referred to Psy- chiatry OPD after every possible organic cause for pain abdomen was ruled out by them with a provisional diagnosis as 'Func- tional'.

A detailed review of history and inter- view of the patient was done in the depart- ment of psychiatry and then a tentative di- agnosis of 'abdominal epilepsy', was made. To confirm our clinical impression patient was subjected to an EEG (Fig.) which re- vealed generalized slowing and abnormal spikes in right posterior leads which were consistent with our diagnosis of abdominal epilepsy. The child was put on carbamaz- epine 200 mg twice daily. He was asked to report to psychiatry OPD after 20 days. Patient reported improvement and there was no fresh episode of pain abdo- men. Child is regularly attending our OPD with no fresh episodes of pain.

DISCUSSION

Many cases of pain abdomen after rul- ing out known intra abdominal causes, are dubbed as functional without entertaining the possibility of abdominal epilepsy. This case beautifully illustrates how timely in- vestigation can help in formulating a proper diagnosis and treatment.

Our findings correlate well with the es- tablished cases reported by various authors of abdominal epilepsy. The diagnosis was established after the abnormal EEG find- ings were found in association with ab- dominal pain and there was improvement with antiepileptic treatment. In literature most cases presented with paroxysmal epi- sodic abdominal pain lasting for few min- utes but here in this case all other features were present except the duration which

CLINICAL BRIEFS : PRIMARY EWING'S TUMOR OF THE SKULL AT BIRTH 541

was appro',dmately half an hour. Eustace et al 1~ have reviewed the l i terature on ab- dominal epilepsy and suggested that there is a definite entity called 'Abdominal Epi- lepsy' and has described clinical features which correlate well with our case.

REFERENCES

1. Wallis HRE. Marked epilepsy. Lancet 1951; 1 : 70-72.

2. Still GF. Common Disorders and Diseases of Childhood. London : Frowde 1912 : 642-645.

3. Klingman WO, Langford WS. Paroxysmal attacks of abdominal pain, epileptic equivalent in children. Trans Am Neurol Assoc 1941; 67 : 228-230.

4. Moore MT. Abdominal epilepsy versus abdominal migraine. Ann lnt Med 1950;

33 : 122-125. 5. Livingstone S. Abdominal pain as a mani-

festation of epilepsy (abdominal epilepsy) in children. Pediatrics 1951; 38 : 687-688.

6. Millichap MD, Lombroso CT. Cyclic vomiting as a form of epilepsy in children. Pediatrics 1955; 15 : 705.

7. De Vore RN, Cole EL. Visceral pain as- sociated with abnormal EEG findings in parents and siblings. Report of one case of epilepsy. Pediatrics 1955; 47 : 231-232.

8. O'Brien JL, Godlensohn ES. Paroxysmal abdominal pain as a manifestation of epi- lepsy. Neurology 1957; 7 : 54%553.

9. Kellaway P, Crawley JW. A paroxysmal pain and autonomic disturbances of cere- bral origin. A specific electroclinical syndrome. Epilepsia 1960; 1 : 466-469.

10. Eustance F, Douglas MD. Abdominal epi lepsy- reappraisal. Pediatrics 1971; 78 : 59-62.

Primary Ewing's Tumor of the Skull at Birth

M.R.C. Naidu

Department of Neurosurgery, The Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad

Primary Ewing's tumor of the skull is rare. Congenital cases of Ewing's tumor are extremely unusual. There have been very few isolated case reports of primary Ewing's tumor of the skull in the world lit- erature. 13 Review of the li terature did not reveal any report where a child was born with primary Ewing's tumor of the skull. Hence, we report this case.

CASE REPORT

A girl was born with a swelling of 2 x 2 cm in size in the frontonasal area. This

gradually increased to the present size. There .was no history of fever or seizures. There was no history of any discharge from the swelling. The child was otherwise thriv- ing well.

Examination revealed well built and moderately well nourished baby. There was no evidence of anemia or lymphadenopa- thy. There was an 8 x 7 cm swelling at the fronto nasal region, extending towards the right side and covering the right eye almost complete ly (Fig. 1). The swelling was pedunculated and was attached to the skull