Unaware and unrestrained: binge-eating behavior in epileptic absence seizures

Background: Binge-eating disorder (BED) frequently co-occurs with dissociative symptoms and psychiatric comorbidities, yet potential neurological underpinnings remain underexplored. Case presentation: We report an 18-year-old female with BED presenting with frequent binge episodes accompanied by memory lapses and altered consciousness. Initially attributed to dissociation, comprehensive evaluation revealed previously undiagnosed absence epilepsy, confirmed by EEG and neuroimaging. Neuropsychological assessment demonstrated significant impairments in working memory, processing speed, and divided attention. Treatment with lamotrigine (200 mg/day) resulted in complete remission of binges occurring during absence seizures and substantial cognitive improvements across multiple domains. Conclusions: This case highlights the critical importance of neurological evaluation in eating disorder patients presenting with altered consciousness or memory lapses. The temporal relationship between seizures and binge episodes, coupled with treatment response, suggests potential neurobiological mechanisms linking epileptic activity to disinhibited eating behaviors. Clinicians should maintain heightened awareness of possible epilepsy-eating disorder comorbidity and consider integrated treatment approaches addressing both neurological and psychiatric components.