Author response.

Dear Sir,

We appreciate the interest you have shown in our article on abdominal epilepsy (AE) and are grateful for the opportunity to clarify the queries raised by you.[12]

When we had planned the study, we were well aware about the low prevalence of the condition. We were surprised by the number of positive electroencephalograms (EEGs) we found during the study and the positive response these patients gave to antiepileptic drugs.

The patients we chose had a chronic duration of episodic abdominal pain. These patients were either referred to us by private pediatricians or were being treated by us for a long period. The patients were subjected to a battery of investigations and also treated with various medications, but the cause could not be identified and the symptoms persisted. Such patients were subjected to EEG, the EEGs were reported by a well trained physiologist who has been trained in reading EEG from Ruby Hall clinic, Pune and the findings were reconfirmed by the neurologist.

Patients who had symptoms suggestive of abdominal migraine were treated accordingly; thus abdominal migraine was ruled out before we subjected the patients to EEG. As shown in Table 7 of our article, there are few studies that had a high incidence of AE based on EEG. Here studies such as Livingstone et al. and Kellyway et al. show a positive EEG in 78.5% and 86% patients, respectively.[34]

The criteria, to consider a patient symptom free, was reduction in the number of abdominal pain episodes. The patients were followed up for a period of 2 years. There was complete regression of the symptoms in 88% of patients and this was reconfirmed after 2 years with a repeat EEG. We agree that 74% of the patients with a positive EEG could not be considered, as the true incidence, as we did not screen other children with abdominal pain.

We agree to the shortcomings of the study. The main aim of the study was to highlight whether the incidence of AE is really so high, and by not subjecting these children to EEG are we missing the submerged part of the iceberg of cases. And also to create awareness among pediatricians about the importance of EEG in chronic abdominal pain.