Transcutaneous auricular vagus nerve stimulation in adult abdominal epilepsy associated with ketosis-prone diabetes: A case report.

Authors

Wei Zhang, Jingwei Ren, Guohai Li, Rundong Tang, Weiping Tian, Tongzhou Liang, Guohui Zhang, Junquan Liang

Published in

Medicine. Volume 105. Issue 26. Pages e49481. Jun 26, 2026.

Abstract

Abdominal epilepsy (AE) is a rare form of focal epilepsy that may present with recurrent paroxysmal gastrointestinal symptoms and can be difficult to distinguish from metabolic or gastrointestinal disorders. Ketosis-prone diabetes (KPD) may further complicate diagnosis because diabetic ketoacidosis, hypoglycemia, and glycemic instability can produce overlapping abdominal and neurobehavioral manifestations.
A 35-year-old Chinese man with poorly controlled type 2 diabetes mellitus and recurrent ketosis presented with severe abdominal pain and vomiting during an episode of diabetic ketoacidosis. He had a 2-year history of recurrent stereotyped periumbilical abdominal pain.
After unrevealing gastrointestinal, vascular, toxic, and metabolic evaluation, ictal electroencephalography (EEG) showed left temporal rhythmic sharp-slow-wave complexes with ipsilateral spread. The patient was diagnosed with ketosis-prone diabetes and EEG-supported AE, later considered drug-resistant.
Management included metabolic stabilization, oxcarbazepine-lamotrigine antiseizure therapy, and subsequent adjunctive transcutaneous auricular vagus nerve stimulation (taVNS) for persistent stereotyped abdominal episodes.
During follow-up after adjunctive taVNS, the patient reported fewer episodes of abdominal pain. Diabetic ketoacidosis did not recur, and no device-related adverse events were observed. Because improvement occurred alongside continued antiseizure therapy and metabolic stabilization, causality cannot be inferred from this single-case observation.
In diabetic patients with recurrent unexplained abdominal pain, AE should be considered when episodes are stereotyped, abrupt, or accompanied by orofacial automatisms, altered awareness, autonomic instability, or a mismatch between symptom severity and abdominal findings. Early EEG may help reduce diagnostic delay, whereas adjunctive taVNS should be viewed as exploratory.

PMID:
42363487
Bibliographic data and abstract were imported from PubMed on 27 Jun 2026.

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