Case report

Biopsychosocial approaches to a patient with vomiting of 10 years' duration – a case of temporal lobe epilepsy

Hiromi Mutsuura¹ , Mikihiko Fukunaga¹ , Kenji Kanbara¹ , Takami Yagyu² , Kazumi Yamamoto¹ , Kana Kitamura¹ , Ikumi Ban¹ and Yoshihide Nakai¹

¹  Department of Psychosomatic Medicine, Kansai Medical University, Moriguchi-shi, Osaka, Japan

²  Neyagawa Sanatorium, Neyagawa-shi, Osaka, Japan

author email corresponding author email

BioPsychoSocial Medicine 2009, 3:2doi:10.1186/1751-0759-3-2

Published:	23 January 2009

Abstract

Background

Vomiting is commonly encountered in clinical medicine. When organic gastrointestinal, metabolic, and brain diseases are ruled out, many cases are considered to be functional. We experienced an adult patient with epilepsy whose main symptom was vomiting. Biopsychosocial approaches were needed to control the symptoms.

Case presentation

A 26-year-old female with a 10-year history of persistent vomiting was found to have temporal lobe epilepsy (TLE). Throughout this time, during which the vomiting had become part of a vicious cycle, her epilepsy was poorly controlled by medication. Biopsychosocial approaches were employed successfully and the patient subsequently undertook training to become a home-helper, started a job, and was able to leave her parents' house and live independently. All of her symptoms resolved after she became self-sufficient.

Discussion

Vomiting without impaired consciousness is seldom considered to be a manifestation of epilepsy. Difficulty in recording an electroencephalogram (EEG) because of the presence of persistent vomiting delayed the diagnosis. The improvement of symptoms was thought to have been due to the patient's emotional stabilization and physical improvement, which may have stabilized the limbic system.

Conclusion

When an illness persists for many years and conditioning and a vicious cycle occur secondarily, systematic biopsychosocial approaches are needed in addition to general treatment. Also, secondary symptoms make the diagnosis more difficult when efforts at treatment are ineffective.