Case Report ‘‘Gourmand syndrome” in a child with pharmacoresistant epilepsy M. Kurian a, * , T. Schmitt-Mechelke b , C. Korff c , J. Delavelle d , T. Landis a , M. Seeck a a Department of Neurology, University Hospital of Geneva, Geneva, Switzerland b Children’s Hospital, District Hospital of Luzern, Lucerne, Switzerland c Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland d Department of Radiology, University Hospital of Geneva, Geneva, Switzerland article info Article history: Received 14 March 2008 Accepted 8 April 2008 Available online 23 May 2008 Keywords: Gourmand syndrome Epilepsy Eating disorder Magnetic resonance imaging Right hemisphere Lesion Obesity abstract We report the case of a 10-year-old boy with pharmacoresistant epilepsy, symptomatic of a right tempo- roparietal hemorrhagic lesion, who displayed an eating passion as described for the gourmand syndrome (GS) in adults and discuss the role of epilepsy in GS. This patient presented with a significant change in his eating habits (abnormal preoccupation with the preparation and eating of fine-quality food) concor- dant with the onset of his seizure disorder, without any previous history of eating disorders or psychiatric illness. This observation corroborates the important role of the right cerebral hemisphere in disturbed eating habits, including the relatively benign GS, and, possibly rarely, in less benign eating disorders such as anorexia and obesity. Ó 2008 Elsevier Inc. All rights reserved. 1. Introduction Eating disorders rarely develop from brain lesions in hypotha- lamic, brainstem, and hemispheric sites [1]. If the lesion resides in the cerebral cortex, the right hemisphere is often incriminated. Gourmand syndrome (GS) has been described as a benign eating disorder associated with lesions most often involving the right frontal and temporal structures. It involves a preoccupation with food and a preference for fine eating, and was first reported in 1997 in adult patients subsequent to cerebral lesions [2]. GS re- lated to a seizure disorder, however, has not yet been reported in young children. We report the case of a child with pharmacoresis- tant epilepsy, symptomatic of a right temporoparietal hemorrhagic lesion, who displayed an eating passion as described for the GS in adults. The role of epilepsy in GS is also discussed. 2. Case The patient, a right-handed 10-year-old boy, was born at 34 weeks of gestation after an uneventful pregnancy. He suffered from streptococcus B sepsis and hemorrhage in the right temporal lobe during his neonatal period. However, his development was normal with no particular events until the age of 8, when he started having seizures. The seizure semiology is stereotyped, with loss of contact and, rarely, oral automatisms or dystonic posturing of the left hand. He has never had any generalized tonic–clonic seizures or febrile convulsions. Seizure frequency varies from once a week to seven times per day, with little improvement despite treatment with different drugs. Pharmacoresistance was established against five different antiepileptic drugs (AEDs). The parents noticed a change in his eating habits within the same year of seizure onset. His appetite increased, but his prefer- ence for fine food was more striking. He would cook for himself and for the family, especially on weekends, and often became pre- occupied with development of new recipes. For example, he was very proud of his ‘‘Reispfanne” (rice preparation), a new recipe he created by himself that certainly tasted delicious according to his parents. They reported that he had preferences for certain sand- wiches, noodles, fish, and lamb dishes and certain fruits (sour fruits, grapefruit, oranges, etc.), but did not like fried foods or chips. Although it was popular among his peers to go to fast food restau- rants, he would insist that he did not like the quality of food there and preferred to cook for himself. Although his father runs the bak- ery in his home town, he was not exposed to any specialized or re- fined cooking within the family. In his family as well in the other families living in this part of Switzerland, traditional gender role assignment implied that cooking was done by women (as it was in the patient’s family). He has a brother (5 years) and a sister (6 years) in good health without any particular interest in eating or 1525-5050/$ - see front matter Ó 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2008.04.004 * Corresponding author. Presurgical Epilepsy Evaluation Unit, Department of Neurology, University Hospital of Geneva, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. Fax: +41 22 372 84 75. E-mail address: mary.kurian@hcuge.ch (M. Kurian). Epilepsy & Behavior 13 (2008) 413–415 Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh