Wednesday, March 17, 2010

Mmm... Food-Induced Seizures

In a tasty new paper, British neurologists Kate El Bouzidi et al report on the case of a woman who suffered epileptic seizures whenever she saw, smelled, or ate food:
A 44-year-old right-handed woman was walking in the Scottish highlands. Upon unwrapping her lunch, she had a focal seizure with witnessed onset on the right side of the face and secondary generalization... She was airlifted to hospital. Three weeks later, the smell of food triggered another seizure and she was admitted to the neurology unit...
Even hospital fare was able to provoke the attacks:
The next morning, the patient had a simple partial seizure after eating a spoonful of porridge. Thereafter, most meals triggered seizures, as did other food-related stimuli such as being offered a piece of cake, seeing her visitors pass around food at her bedside, and smelling the hospital dinner trolley.
Anti-convulsant drugs failed to control the seizures. An MRI scan revealed an abnormal mass and electrode recordings from the surface of the brain confirmed that the seizure activity was starting nearby. The mass was surgically removed - it turned out to have been a grade IV glioblastoma cancer - which put an end to the seizures, although sadly we're told that the surgery was "subtotal" i.e. they weren't able to remove the tumour entirely.

The authors note that eating-induced seizures have been reported hundreds of times, most commonly in India and Sri Lanka, curiously enough, but this is the first known case in which merely seeing or thinking about food was also a trigger. Why it happens is a mystery: presumably, neural activation in response to the taste or smell of food somehow spills over into the epileptic focus... but the details are sketchy.
In this case, seizures were specifically triggered by food-related stimuli in the context of hunger. The finding of a seizure focus in the left frontal operculum, adjacent to the tumor, is consistent with the hypothesis that activation of this region by appetite triggered seizure activity that then propagated to the surrounding cortex and was manifest clinically as a motor seizure.
ResearchBlogging.orgEl Bouzidi K, Duncan S, Whittle IR, & Butler CR (2010). Lesional reflex epilepsy associated with the thought of food. Neurology, 74 (7), 610-2 PMID: 20157165

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