Open Access
CC BY-NC-ND 4.0 · International Journal of Epilepsy 2025; 11(S 02): S1-S56
DOI: 10.1055/s-0045-1813061
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The Enigma of Reflex Eating Epilepsy: A Cohort Study of Fifty Patients with Insights from Multimodal Evaluation

Autoren

  • E. James Noel

    1   NIMHANS, Bengaluru, Karnataka, India

  • Aparajita Chatterjee

    2   Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • Ajay Asranna

    2   Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • Shishir Nagesh Duble

    2   Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • Ravindranadh Chowdary Mundlamuri

    2   Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • Raghavendra Kenchaiah

    2   Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • N Mariyappa

    2   Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
    3   MEG Research Lab, India

  • K. G. Bhargava

    2   Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
    3   MEG Research Lab, India

  • Lakshminarayanapuram Gopal Viswanathan

    2   Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • Karthik Kulanthaivelu

    4   Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • T.A. Sangeeth

    2   Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • Chandana Nagaraj

    4   Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • Rose Dawn Bharath

    4   Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • Jitender Saini

    4   Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • Sandhya Mangalore

    5   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • Nishant Sadashiva

    5   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • A. Arivazhaghan

    5   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • Malla Bhaskara Rao

    5   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

  • Sanjib Sinha

    2   Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Objectives: This article aimed to evaluate the clinical, electroencephalographic, neuroimaging characteristics, and treatment outcomes of patients diagnosed with eating epilepsy (EE).

Methods: This retrospective study was conducted at a tertiary care epilepsy referral center in India. Patients diagnosed with EE between 2002 and 2025, with at least one EEG and MRI available for review, were consecutively included. Clinical data and multimodal evaluation findings, including video EEG, brain MRI, PET-MRI, and magnetoencephalography, were systematically collected using a structured proforma. Seizure outcomes and treatment strategies were subsequently analyzed.

Results: A total of 50 patients (35 males) were included in this cohort, with a mean age at onset of epilepsy being 11.91 ± 8.18 years. All patients had drug-refractory epilepsy.

Focal seizure with impaired awareness was the most common seizure type (90%). MRI imaging was abnormal in 25 (50%), and the most common finding was perisylvian gliosis. Patients with a history of perinatal insult (OR = 22.15) and intellectual disability (OR = 5.09) were more likely to have MRI abnormalities. Multimodal investigations most consistently implicated the perisylvian epileptic networks, as demonstrated by VEEG (52%), MRI (32%), PET-MRI (38.1%), and MEG (64.1%). Approximately one-fourth of the patients were seizure-free at their last follow-up.

Conclusion: Eating epilepsy is a disabling form of reflex epilepsy with heterogeneous clinical, electroencephalographic, and neuroimaging features, which are not necessarily substrate-specific. Findings from our study point to the presence of a wide epileptogenic network prominently involving perisylvian regions. Treatment outcomes in drug-refractory EE remain suboptimal and further studies are needed for better understanding and management of this complex entity.



Publikationsverlauf

Artikel online veröffentlicht:
24. Oktober 2025

© 2025. Indian Epilepsy Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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